And the devious reason some doctors prescribe them
If a man or boy goes to the doctor and the doctor diagnoses him as having Phimosis – a foreskin where the opening is small thus preventing retraction behind the glans – currently one of the most common treatments is a prescription of steroid cream. Some of the most common ones are Betamethasone, Betamethasone Valerate (Betnovate), Clobetasol Propionate (Dermovate), Triamcinolone, Hydrocortisone, and Mometasone Furoate (Elocon).
Variable results with steroid creams
Some people use steroid creams and achieve sufficient relaxation of the foreskin that they are able to finally retract it, or they are finally able to retract it when erect when previously they’ve only ever been able to retract it when soft. But some people don’t have success in a satisfactory period of time or within the limit of the time the doctor recommends steroid cream being prescribed, and some go on to have circumcision to resolve the Phimosis. Some find they achieve the retraction they are after and stop using the steroid cream, and then over a period of time the Phimosis returns. Some of them also end up getting circumcised. In my experience though, doctors almost NEVER explain the mechanism of action of steroid creams. When you understand how they work, you’ll realise how important that understanding is.
The Optimum Outcome
To clarify, what is ideally needed to resolve Phimosis is for the opening of the foreskin to grow. That means, in an ideal world, the foreskin will retain the same stretchiness characteristic and thickness, but the opening will be large enough that it can be retracted behind the glans. The importance of the stretchiness is that it it will then park behind the ridge formed by the edge of the glans, and stay there during sex. After sex is complete and the man detumesces, the foreskin will either roll forward by itself or can easily be pulled forward to protect the glans when it is not being used for sexual purposes, both for comfort during everyday activities and maintaining the sensitivity.
steroid creams…offer doctors multiple ways to eventually steer a patient towards much more profitable circumcision, while superficially making it appear as though circumcision was a last resort after efforts at conservative treatments have failed, in a bid to protect themselves from legal consequences.
Ultimately, the only way for this to be achieved properly is for the opening of the foreskin to grow. This is achieved by cells in the foreskin splitting into two cells, thus expanding the foreskin slighlty, and this process continuing over a period of time. This is called mitosis, and it is one of the most well-understood natural mechanisms within the body. This is what happens all over your skin when as you grow as your skin stretches because of the tension placed upon it with your bones growing. It’s how people are able to stretch their ear lobes from a pinhole to a large circle. Importantly, when the foreskin grows by mitosis it retains the stretchiness it has that enables it to stay firmly parked behind the head for most guys when they’re having penetrative sex.
How Steroid Creams Actually Work
There is more than one mechanism of action of steroid creams, but for the purposes of resolving Phimosis, they don’t actually grow the foreskin, as such. What happens is that cells in your body have a normal lifecycle and eventually die and are replaced by their progeny. What steroid creams do is to suppress collagen creation in the new cells. What that means is that as cells in your foreskin turn over, where the steroid cream is placed the proportion of cells with collagen decreases as old cells are replaced, which means that area becomes less springy and thus more loose.
However, because steroid creams don’t actually grow the skin, the effect is to make the skin thinner. The effect is essentially exactly the same as gradually destroying the elastic of a sock, which means it will no longer stay up and just falls down to the foot. This will have the same effect on a foreskin, in that the foreskin will enlarge in diameter where the cream is applied, but will become thinner and less stretchy. What that means is that if the foreskin is enlarged sufficiently to retract over the head of the glans, it may no longer have sufficient springiness to stay behind the glans during sex, compared to one that has been solely stretched and grown by mitosis.
When Phimosis Returns
If Phimosis has been resolved with steroid cream, and use of the steroid cream ceases, then as the cells in the foreskin that have had their collagen production suppressed themselves reach the end of their lives and die, they are replaced by new cells. Without the presence of steroid cream, the new cells will grow collagen and become springy adn tighten up the foreskin again – unless it is being continuously stretched. So this is not necessarilly the only reason Phimosis may return, but it is one reason that doctors may say, “Conservative treatment has failed – circumcision is the only option”.
Limited Effect
The limit to the effect steroids can have is that they can only loosen the skin so its maximum existing stretch if there was no collagen in them. So if you start from a very small opening, then it may be impossible for steroids alone to cause the skin to slacken sufficiently to be able to retract it past the glans. This is in effect like an adult taking a baby’s sock and hoping they will be able to get it on their own foot by cutting the elastic. Even without the elastic it can’t stretch past the hard limit of the material without breaking, so if you’re relying on steroid cream from a very small opening, there is a good chance that steroid cream alone will be guaranteed to fail. Some doctors prescribe steroid cream in circumstances where it should be obvious to them that it’s not going to work because it will be impossible for steroid cream to create that amount of slackness from a small opening, and when it fails to do the job as should have been obvious to them, they may say, “Conservative treatment has failed – circumcision is the only option”.
Tearing and Scarring
When foreskin has been made very thin as a result of steroid cream it is easier to tear and create scarring. Scar tissue is also very inflexible and this can create pimosis all on it’s own. This doctors call pathological Phimosis, and this is also often used as a justification for circumcision by doctors saying that it’s the type of Phimosis that won’t stretch. This is not true, but it’s another avenue for stearing you towards circumcision, feeling as though that’s your only choice.
Infections
One of the big side-effects of steroid creams, and in fact it is often a primary reason for prescribing steroids in other circumstances, is that it suppresses your immune system. This itself can lead to infections, whether or not the skin tears, which it is more likely to, which may lead to further scarring and thus a diagnosis of pathological phimosis – thus leading to advice to circumcise.
Steroid Creams and ‘Stretching’
A very common trick is to advise a patient to use both steroid creams and stretching exercises. However, despite the fact that stretching is the ONLY way to actually properly grow the foreskin opening by mitosis, instructions on stretching are often woefully inadequate. In fact, in several instances Captain Hoodie has been exposed to, the stretching instructions were so obviously deliberately inadequate it was clear it was intended by the doctor that they would be ineffective, and thus gave the doctors a chance to justify circumcision on the grounds that ‘conservative treatments (steroids and stretching) have failed’, with the false implication that they could never succeed.
If steroid creams do seem to have had a lasting effect even after the treatment is stopped, it is actually likely to be stretching that is accompanying the steroid cream that achieves that, whether stretching was prescribed or not. So if steroids help a male retract the foreskin behind the glans before the treatment is ceased, the male is then more likely to keep retracting it repeatedly. This repeated retraction, as the effect of the steroid cream wears off as the cells in the foreskin turnover, will be what is then causing the cells to multiple in the direction of tension, and thus maintain the enlarged opening effect that the steroid cream created temporarily. So the steroid cream was never actually necessary in the first place as the effect could have been achieved by stretching alone without steroid cream.
Artificial Deadlines
Another technique is to give the patient an artificial deadline for the phimosis to be resolved. A patient may be told it must be resolved within a month or six weeks or it isn’t going to work. So even if steroids are actually making progress on a (temporary) difference, if the arbitrary time limit is reached that may be too short anyway for the steroid creams to have succeeded, this gives the doctor an opportunity to say it hasn’t worked, and so circumcision is the only option. It is true that steroid creams should not be given for too long because of their potentially harmful side effects, but if they are going to have any useful effect at all, they need sufficient time to work. Imposing an arbitrarily short deadline is really just an excuse to direct the patient towards circumcision and prevent them from achieving retraction.
Lack of cushioning
One of the mostly unspoken benefits of a foreskin is that when masturbating, the thickness of the foreskin acts like a smoothing cushion when rubbing the hand over the glans, distributing the small high spots over a larger area and turning what could be very uncomfortable force into an erogenous pleasure. While some peole’s skin on their hands becomes very hard, even people with very soft skin still benefit from this due to the high sensitivity of a foreskin-protected glans that even a soft-skinned hand and fingers may be too rough for directly. The trouble is, thinning the skin with steroids is that the foreskin is then so much thinner it offers reduced protection of the glans against the roughness and hardness of the hand in comparison with what it can tolerate.
Side Effects
Steroids are not without some potentially serious side-effects. These can include:-
- Local unwanted skin effects – thinning, easier bruising, easier tearing and scarring due to thinness
- acne or rosacea
- burning, itching, scaling and blistering at site where it is applied – potentially, your highly sensitive foreskin
- High blood sugar, weight gain, fluid retention, adrenal suppression
- Immune suppression – Increased susceptibility to infections
- Muscle weakness, osteoporosis, and tendon rupture
- Mood swings, insomnia, and psychosis
- Blurred vision, glaucoma, or cataracts
And sudden cessation of any powerful pharmaceutical product can cause withdrawal symptoms that themselves may be hazardous. This is one of the reasons you are not supposed to use steroid creams on your foreskin for an extended period.
Conclusion
The prescription of steroid creams for Phimosis, whether prescribed alongside stretching exercises or not, offers doctors multiple ways to eventually steer a patient towards much more profitable circumcision, while superficially making it appear as though circumcision was a last resort after efforts at conservative treatments have failed in a bid to protect themselves from legal consequences. Steroids are not effective at permanently growing the foreskin opening in the way that is usually desirable. Mitosis as a result of controlled stretching is the only lasting solution, and steroids are not actually needed at all. However, they are certainly profitable for pharmaceutical companies, and indirectly for doctors by nudging patients towards much more profitable circumcision that they nearly always get away with.
Note: If you ended up circumcised in the last couple of years as a result of medical advice due to having Phimosis and are now feeling you should not have been circumcised and were badly advised, If you are feeling that legal action against the relevant medical professionals may be in order, please feel free to contact Captain Hoodie on mike@pivotalshift.co.uk for support and practical advice.
