Frenulum breve is a congenital anatomical defect characterized by a shortening of the skin fold connecting the head of the penis with the foreskin. The presence of frenulum breve is accompanied by severe pain during erection and sexual intercourse, curvature of the penis in an erect state, premature ejaculation, the appearance of tears and ruptures of the frenulum during sexual intercourse. Diagnosis is based on anamnesis and examination of the external genitalia. Treatment is operative, includes plastic surgery or excision of the frenulum.
General information
Frenulum breve is an insufficient length and a small extensibility of the fold of skin passing from the foreskin to the head of the penis. Disease is a common anomaly in the development of male genitalia. In urology and andrology, frenulum breve occurs in 5% of men who have not been circumcised, and can cause them serious suffering at the physical and psycho-emotional level. Frenulum breve prevents the normal exposure of the glans penis during erection, so it usually first manifests itself during puberty and with the onset of active sexual life.
The frenulum of the foreskin is a thin vertical fold of skin on the posterior surface of the penis, formed by the inner sheet of the foreskin. It connects the foreskin with the head of the penis. In a normal state, the frenulum of the foreskin has a sufficient length, has good elasticity and is able to stretch significantly, providing free movement of the skin of the foreskin. During sexual arousal, the frenulum is easily lengthened, allowing the head of the penis to be exposed during erection, and then return the foreskin to its original position.
Causes
Frenulum breve is usually a congenital malformation of the penis and in many cases is combined with congenital phimosis. The reason for the formation of frenulum breve in adolescents may be the different growth rate of the structures of the skin and the cavernous bodies of the penis.
Sometimes shortening of the foreskin frenulum can occur due to chronic inflammatory diseases of the penis (balanitis, balanoposthitis), leading to a change in the structure of the tender tissue of the foreskin and frenulum. To provoke scarring and shortening of the frenulum can be chronic injuries of the foreskin, received during certain sports, wearing tight clothes and underwear. Diabetes mellitus, accompanied by a violation of the tissue regeneration process, can also contribute to scarring of the frenulum of the foreskin.
Symptoms
The severity of symptoms of frenulum breve depends on the degree of shortening of the skin fold. With a pronounced shortening of the frenulum during an erection, its strong tension is noted, accompanied by painful sensations. In an erect state, the head of the penis is poorly filled with blood, it is not fully exposed; the penis bends, bending towards the scrotum by 20 degrees or more, which makes it difficult or impossible to have sexual intercourse. Excessive tension of frenulum breve causes severe pain during sexual contact and leads to premature ejaculation. Due to active frictions, injuries of frenulum breve often occur – cracks, tears and tears; the latter are accompanied by severe bleeding.
Due to the obstacle to the complete displacement of the foreskin and the normal exposure of the glans penis, the presence of a short frenulum contributes to the prolonged stagnation of the smegma in the preputial sac and the development of the inflammatory process. Men with frenulum breve often have neurotic disorders, obsessive fear of sexual contact (erotophobia), psychogenic erectile dysfunction develops. When frenulum breve, coarse scar tissue forms at the site of injury; the frenulum is shortened even more and becomes even more susceptible to ruptures. Permanent injuries to frenulum breve increase the risk of secondary infection, including STIs.
Diagnosis and treatment
It is possible to identify a frenulum breve only starting from adolescence, therefore, young men in puberty need to consult a urologist or andrologist. The diagnosis of frenulum breve is not difficult and is based on the analysis of patient complaints and data from an objective examination of the penis. Timely diagnosis allows you to prevent complications of this pathology.
The only possible treatment option for frenulum breve is operative, aimed at increasing the length of the frenulum. For this purpose, plastic surgery of frenulum breve (frenulotomy) is performed, sometimes – removal of the frenulum (frenulectomy) by conventional surgery, as well as laser or radio wave scalpel. Contraindications to surgery are inflammatory diseases of the external genitalia, including STDs. Frenulotomy is a minimally invasive intervention performed on an outpatient basis, usually under local anesthesia. In the absence of previous ruptures of frenulum breve, a standard transverse-longitudinal frenulotomy is advisable, consisting in a transverse dissection of the frenulum and subsequent suturing of the wound edges in the longitudinal direction.
It is important to perform the operation in advance, without allowing an independent rupture of the frenulum. If its rupture has occurred, it is necessary to stop the bleeding, treat the wound with an antiseptic, apply a sterile bandage and immediately consult a doctor. In order to eliminate the rupture of frenulum breve, its suturing is performed, antibacterial ointments and local baths with herbal decoctions and antiseptics are prescribed. In the presence of previous ruptures and scarring of frenulum breve, a Z-shaped frenulotomy is performed, which allows due to the zigzag shape of the postoperative scar to avoid its excessive tension during sexual intercourse. When a short frenulum is combined with phimosis, partial or complete circumcision of the foreskin (circumcision) is also performed.
After frenulotomy, the length of the frenulum increases by 1-1.5 cm, its elasticity and sensitivity are preserved. Complete wound healing occurs within 2 weeks. During the postoperative period, the patient is able to work, but must refrain from sexual contact.
Prognosis
In the absence of correction of frenulum breve during sexual intercourse, there is a high risk of permanent frenulum ruptures with scar deformation and aggravation of clinical manifestations of pathology. Timely treatment of frenulum breve allows to avoid its traumatization in the future and restore the normal sexual life of the patient.