WHY IT IS POSSIBLE TO STRETCH THE FORESKIN OPENING
Physiological phimosis due to a tight foreskin opening can be treated with stretching routines[1,2]. But this is no regular kind of stretch: understand what skin expansion is.
MITOSIS
Your skin is made up of different layers of cells and connective tissue. The outer layers constitute the epidermis, while the inner layers make up the dermis. The epidermis is the "barrier", while the dermis contains the "equipment" - things like nerve endings, sweat glands and muscle fibers.
Mitosis is a type of cell division in which a parent cell divides into two identical child cells. In the case of the skin, mitosis usually occurs in the most basal layer of the epidermis, i.e. immediately above the dermis. The epidermis is in continuous renewal, and as old cells die and break down, cells newly created via mitosis take their place. And if the skin is damaged, as in the case of a cut or scratch, mitosis increases in the basal layer of the epidermis of that region to soon close the wound, preventing infections.
GRADUAL SKIN EXPANSION
When the skin is held elongated beyond its physiological limit, mechanisms are activated that convert mechanical stimulus into electrochemical activity. As a consequence, mitosis occurs not only in the basal layer of the epidermis, but in all layers. The skin is not only replenished superficially, but expanded.
Natural skin expansion due to pregnancy
Skin expansion is also a common surgical procedure to grow extra skin through controlled mechanical stretching[3]. This procedure creates skin with the same color, texture and thickness of the tissue around it. It is widely used for the reconstruction of any type of skin tissue lost due to accidents, diseases (breast removal due to cancer, for example), improvement of aesthetic problems, etc.
This scientifically proven technique, often used by dermatologists and plastic surgeons, causes the skin to gradually grow and expand[4]. The principle is based on maintaining a light, constant and safe tension that results in mitosis and consequent creation of new cells. This is usually performed by the implantation of bladders under the skin, which are inflated to elongate the cutaneous tissue and cause it to grow over a given period of time. Because new cells are created, the new functionality of the skin is permanent: it will not return to the initial state when it is no longer subjected to tension, as if it were a piece of rubber.
This scientifically proven technique, often used by dermatologists and plastic surgeons, causes the skin to gradually grow and expand[4]. The principle is based on maintaining a light, constant and safe tension that results in mitosis and consequent creation of new cells. This is usually performed by the implantation of bladders under the skin, which are inflated to elongate the cutaneous tissue and cause it to grow over a given period of time. Because new cells are created, the new functionality of the skin is permanent: it will not return to the initial state when it is no longer subjected to tension, as if it were a piece of rubber.
BUT WHAT DOES IT HAVE TO DO WITH SOLVING MY TIGHT FORESKIN PROBLEM?
Everything. The same type of skin tissue expansion described above occurs when are performed the non-surgical stretching techniques that you will learn shortly. It does not matter if what is generating the tension is inside the body, like an inflatable surgical bladder, or outside. What matters is that the tension is kept for a certain period of time.
When stretching is done in the coronal plane (plane perpendicular to the longitudinal axis of the penis), the resulting effect is an enlargement of the preputial opening. In order for the healthy foreskin (not affected by any pathology) to be enlarged, its opening should be gently tensioned for a good period of time every day, without damaging it. This will stimulate new cell growth.
COLLAGEN AND CORTICOSTEROIDS
Collagen is the most abundant protein in the human body. It is the "glue" that holds the body together, and is present not only in the skin but also in the bones, muscles and tendons. In the dermis, collagen is produced by cells called fibroblasts, and helps form a fibrous network that gives structure and strength to the skin.
Substances called corticosteroids (or simply steroids), when in contact with the skin, cause the fibroblasts to stop producing collagen. As the old collagen fades away, the skin begins to look like that of an elderly person. It becomes thinner, looser, and more malleable.
This change is transient, and the skin will eventually re-exhibit its former characteristics of strength and resistance a few weeks after the discontinuation of steroid application. But if, during that time, you take advantage of the greater malleability to stimulate the formation of new skin tissue through stretching, the gain obtained will be irreversible.
TREATMENT
You now understand why coronal stretching of the foreskin, preferably associated with the application of steroid ointment or cream, is the first thing to try when solving your physiological phimosis. If you are already an adult, the use of steroids without stretching will probably not do any good; but stretching can work even without any steroid ointment or cream, it only takes a little more time. The key is to follow a daily stretching routine. But how?
REFERences
- Dunn HP (1989). Non-surgical management of phimosis. Australian and New Zealand J of Surgery, 59(12):963.
- Ying H, Xiu-hua Z (1991). Balloon dilation treatment of phimosis in boys. Chinese Medical J, 104(6):491-3.
- Brazilian Society of Plastic Surgery - interventions and procedures: tissue expansion.
- Olenius M, Dalsgaard C, Wickman M (1993). Mitotic Activity in Expanded Human Skin. Plastic and Reconstructive Surgery, 91(2):213-6.
