Frenulum Breve And Frenuloplasty – What Should You Know About It?

Frenulum is a small band of elastic tissue that serves as a connecting and retractile bond between foreskin and glans of penis. Under normal circumstances, this tissue is long enough to permit necessary retraction of foreskin (to allow frenulum to coil back under the glans shaft during penile erection). However, in a small percentage of men, frenulum is very short (also referred to as frenulum breve). It has been observed that men living with frenulum breve experiences foreskin problems such as gluing of foreskin to the glans of penis which often makes the penile movement difficult.

Sign and symptoms of Frenulum breve are specific for:

• Impaired flexibility or movements of penis
• Painful penile erections

It is reported that frenular problems are the second most common indication for which male patients opt for circumcision.

What Are Some Complications Associated With Frenulum Breve?

Due to small size of Frenulum, the risk of injury or tearing of tissue is pretty high. In some cases, persistent injury may lead to severe restriction of penile movements, erectile dysfunction or even dyspareunia due to scar tissue formation. According to a new study, dyspareunia is reported in 50% patients who have frenulum breve or scarring of frenulum for other reasons (1).

The diagnosis and identification of frenulum breve is challenging and the condition is often confused with psychosocial erectile dysfunction and phimosis.

How To Treat/ Manage Frenulum Breve?

This condition can be treated by a variety of surgical procedures; such as; creating a small knot around the frenulum by suturing a thread through the lower membrane. Other common management options are:

• Circumcision:

Circumcision is a minor surgical procedure that allows surgeons to remove excess skin from the tip of penis. Various research and clinical studies indicates that circumcision helps in reducing the risk of inflammatory and infectious diseases by improving overall physical and genital hygiene. However, a lot of men have their strong concerns against going under the knife, especially with their most precious tissue. It is imperative to mention that uncircumcised men often face a wide variety of problems; such as increased risk of developing sexually transmitted diseases and inflammation of glans due to poor genital hygiene.

• Frenuloplasty:

Besides circumcision, frenuloplasty is another option which can address in managing the disturbing symptoms without foreskin removal. As part of the procedure, a small transverse incision is made on the frenulum, which is then sutured back in the longitudinal direction to increase overall length (2). A number of other techniques and procedures can also be performed for frenuloplasty to achieve same great results, such as diathermy, CO2 laser and skin grafting. After frenuloplasty, the movement of penile skin is greatly increased and patients report remarkable reduction in pain during erections. Ideally, the patient can resume his normal sexual activities within a few weeks of undergoing frenuloplasty without any experiencing changes in the quality of sex life.

What To Expect After Frenuloplasty?

After Frenuloplasty, most patients experience moderate discomfort which can be reduced by local anesthetics. The patient is usually sent home after two hours of the surgery. For best results, it is recommended (3):

• To avoid driving for at least 24 hours after the surgery.
• The stiches either dissolves on their own or sheds off after a couple of weeks, post- procedure.
• There will be soreness for a week or two, which resolves spontaneously.
• Make sure to keep the wound clean with mild soapy water to minimize the risk of bacterial infection.
• The procedure is simple and is usually not associated with any complications during or after the surgery.

According to a new study reported in the BJU International (1), investigators suggested that the patient satisfaction rate after frenuloplasty is 100% in the short term (at 3-month follow-up visit) and 91% in the long-term (after 10 years of the procedure). Investigators also reported that the number of patients who require complete circumcision or repeat surgery after frenuloplasty is very low.

Speak to your doctor if you are experiencing pain/ discomfort during sexual intercourse or if you believe frenulum breve is responsible for your compromised quality of sex life. There are a number of treatment options with no adverse effects or post-procedure complications.

References

1. Dockray, J., Finlayson, A., & Muir, G. H. (2012). Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring. BJU international, 109(10), 1546-1550.

2. Arora, B. (2016). A Simple Technique of Frenuloplasty for penile frenulum breve. International Journal of Scientific Research, 5(2).

3. Rajan, P., McNEILL, S. A., & Turner, K. J. (2006). Is frenuloplasty worthwhile? A 12-year experience. Annals of the Royal College of Surgeons of England, 88(6), 583.