Reactions to phimosis in the United States

From what I gather from conversations, discussions in forums, etc

In France, there is a tradition, even today, to declare that boys must be able to retract their foreskin by age 6. Otherwise, physicians attempted to forcibly retract the foreskin, or advised the parents to do so. Nowadays, they prescribe a steroid cream and tell the child to do it. And if it fails… they advocate a “little surgery” (circumcision, but that word is not always used). They rarely mention that there are alternate surgeries.

I was wondering what happens in the US when phimosis is discovered. For a long time, almost all boys were circumcised at birth and many people are used to circumcision as the “normal” way. Do physicians try retractions and creams when seeing phimosis, or do they advocate circumcision immediately?

I imagine it varies wildly from doctor to doctor. My PCP never even touched my penis growing up - she would just look at it and move on. At the same time, though, I've heard stories about pediatricians doing forced retractions or advising circumcision for the slightest tightness so it's probably just who you happen to see and how strongly your parents feel about your foreskin. The first doctor to retract my foreskin was a urologist when I was 14 and I was getting concerned that I hadn't hit puberty yet. I had undiagnosed phimosis as a kid and had actually just forced it back myself a few weeks prior to that appointment. I wish I hadn't now because it's possible I could have gotten circumcised for it but my childish fears about the procedure pushed me to take matters into my own hands.

@Grizzly_Paladin You would have preferred not to have forced it yourself, and gotten circumcised for it?

@Pecan_nutjob Yes, absolutely. At the time I had never been able to retract my foreskin and so I didn't have a good notion of the difference. I'd seen a circumcised penis at Cub Scout camp years earlier but it hadn't really clicked that mine could look like that. As I got older and understood the difference circumcision makes (aesthetic, hygiene, function, all of it), I realized I actually wanted it done. The trouble there is that now I can't afford to take a week off work for recovery, let alone drop $5k for the procedure. Quite frankly, I wish my parents would have gotten it done when I was born, but with that ship having sailed I wish I hadn't been too much of a coward to ask for it.

@Grizzly_Paladin Sounds like it could be cheaper to take a tourist trip to another country and have it done there paying full fare. I see prices around €500 here.

@Grizzly_Paladin Sounds like it could be cheaper to take a tourist trip to another country and have it done there paying full fare. I see prices around €500 here.

That might be something to consider. Are those cash prices or do they assume you're on the national insurance system? US healthcare is fucked so I don't really understand how normal countries do it.

I never had the problem AFIK. Mine was a little tight and would sometimes get stuck behind the glans when I had a hard-on. When I got tired of that I just inserted two fingers and stretched it during my showers for a couple months and that took care of it. I wonder why they always go right to removing the whole foreskin? Wouldn't a little lengthwise cut just enough to relieve the tightness suffice?

@Grizzly_Paladin This is cash fare. Circumcision for other reasons than medical (phimosis etc.) is not covered by French national medical insurance.

$5000 is enormous, it's I think beyond what you would pay here for a baby delivery + subsequent stay in maternity ward if you paid cash fare.

@Grizzly_Paladin This is cash fare. Circumcision for other reasons than medical (phimosis etc.) is not covered by French national medical insurance.

$5000 is enormous, it's I think beyond what you would pay here for a baby delivery + subsequent stay in maternity ward if you paid cash fare.

I wouldn't mind visiting France again. Once I lose some weight and save up a bit that might be the way to go. Thanks for the info.

As far as the American price goes, here's an example of how fucked it is: I fell on ice and tore a ligament in my knee about a month ago. I went to prompt care thinking it was just a bad sprain and they told me go to the emergency room. I was in the ER for about five hours; they did some X-rays and gave me some pain meds with a referral to see an orthopedic specialist the next day. The hospital billed my insurance company $4,173 for my visit. The insurance paid just over $1k and I now owe $3k just for the ER. The surgery I ended up having will likely be a similar cost. Thankfully, the ER was with a Catholic hospital that offers financial aid services so I might be able to get some of that bill knocked off. I'm just screwed on the surgery.

@Grizzly_Paladin It is ludicrous that they charge so high, and that your insurance did not pick up the tab.

I wonder why they always go right to removing the whole foreskin? Wouldn't a little lengthwise cut just enough to relieve the tightness suffice?

A small lengthwise cut or even just removing a tiny bit of the constricting part would be enough if phimosis were approached rationally.

But the thing seems to be that circumcision seems to become a social compulsion in many groups. There is, to begin with, a strong religious component to the practice and since religion implies compulsory adherence to group rules and beliefs, there is little scope for leeway when it comes to the belief in the efficacy of circumcision. It so easily becomes a social belief/norm rather than anything approached in a utilitarian rational manner.

@roscoe, @agracier: In adult life I learned that there are alternative surgeries to circumcision for severe phimosis. Yet they do not seem commonly proposed.

A lady friend of mine was told by her doctor about her son's phimosis that if retraction (with steroids and done by the boy, we are no longer in the 1970s) did not work he would need to be circumcised; there was no talk of alternatives. The same applies to conversations on Zity: the parents of men who were circumcised due to phimosis were told it was the only solution.

Actually, my aunt was not told to have her son “circumcised”: to make surgery palatable, her doctor claimed that it was not real circumcision like the ritual ones, that less is removed. But they still removed the whole foreskin.

I discussed this with somebody on Zity who claims to be a surgeon. He says that partial circumcision is not commonly advised since the phimosis can reinstate itself later on the remainder of the foreskin, so they advise removing everything at once.

What you advise (a cut that frees the foreskin) is not commonly done at all to cure phimosis, perhaps due to aesthetics? I think this kind of cut is done ritually by Polynesians (who mock Europeans as having “cheesy" glans).

In the United States, the medical profession advocates for conducting comprehensive physical examinations at least once a year or when patients see their new doctor for the first time. When examining a male patient, the doctor is very likely to examine his genitalia and observe his circumcision status. If a foreskin is present, the doctor is likely to discuss with the patient or his parents the benefits of having it removed, and if the foreskin is even slightly phimotic, the patient will immediately be referred to a urologist.

In the United States, the preferred method of treatment for phimosis is circumcision.