Circumsision due to BXO/ Lichen sclerosus

[JohnyKjo]

It looks like I'm due for a circumsision soon. I have some white patches on the glans because of BXO. Will the circumsision make these patches fade away slightly?

[Hidden]

Have you tried ultra potent corticosteroids to treat the LS? They typically reduce/remove the surface discoloration and papery texture of the skin.

[JohnyKjo in reply to Hidden]

Hello

I have only tried betnovate steroid cream, sadly it did not do much difference.

[Hidden in reply to JohnyKjo]

Betnovate is not really strong enough to treat LS although it’s the standard for assisting with stretching a phimotic foreskin. Is betnovate what your dermatologist prescribed for treating your LS?

[JohnyKjo in reply to Hidden]

My urologist was the one who prescribed the cream.

[Hidden in reply to JohnyKjo]

Ok. I am being treated by a dermatologist in London specialising in genital skin disease. Treatment of LS with corticosteroids is not always successful, c. 50-60% initial success rate, which also requires not using soap, only emollients, and washing and wiping after urinating to prevent any urine being trapped under the foreskin.

Circumcision does appear to be curative in about 90% of cases but post operative treatment with corticosteroids is often also required for a period afterwards.

If you are happy to go ahead with circumcision to cure your LS, you are on the right path, and this may well be your preferred outcome.

If you want to retain your foreskin you need to see a dermatologist or challenge your urologist on the course of treatment. The standard non surgical treatment is Dermovate for 1 - 3 months depending on response.

Please message me privately if you want to discuss further.

[Dmitriy1985 in reply to Hidden]

Sorry for the question. Does your doctor recommend taking a course of steroid almost immediately after circumcision? I cannot get a definite answer to this question. most urologists recommend not using a steroid for at least 6 weeks after circumcision, and Karl Becker recommends starting a steroid 6 days after circumcision.

[Dmitriy1985 in reply to Hidden]

Hello. please tell me, does your dermatologist recommend using steroids immediately after circumcision, or advises you to wait two months after surgery?

[Hidden]

Why are doctors and urologist so quick to promote circumcision? You would think that a dermatologist would be the first port of call. They just seem to say chop the foreskin off that’s it sorted. There are normally a few options before circumcision.

[JohnyKjo in reply to Hidden]

The circumsision is my preferred option since I dont want to bother using steroid creams for the rest of my life. Also a circ has a higher chance of remission than steroid creams.

[Hidden in reply to JohnyKjo]

That’s ok if that’s what you want. I may need to be circumcised but I’m trying everything I can before I agree to it. I really don’t want to get circumcised.

[8thfloorben in reply to Hidden]

You are making the right decision IMHO. If you do need to be circumcised you can say at least I tried all other options first. I did the same so I feel fine about my circumcision. Can I ask why you are against the idea? Happy to give totally honest response neither pro not anti.

[Hidden in reply to 8thfloorben]

I have heard about losing sensation after circumcision a lot of people say that sex and masturbation is not so pleasurable. You can take a lot longer to cum either way. I personally like my foreskin and the way that it looks & glides back and fore. I like how my glans is soft and smooth. Don’t get me wrong if I have exhausted all other options and have no choice I will have to get it done. They say on the nhs you only get circumcised the way that they do it. No options. You can get options if you go private but that would mean a £2300.00 bill here or travel 4 hours each way to another private clinic. Then how much after care would I get being so far away. Circumcision is irreversible once it’s done there is no going back. Some people are prepared to take these risks but what if you hate it after it’s done.

[Hidden in reply to 8thfloorben]

I’m not pro and only anti for routine infant circumcision but I just think it should be a last resort rather than it’s easier just to chop it off because that will cure the problem at the early stages of treatment.

[Hidden in reply to JohnyKjo]

I wish you all the best with your decision. Dermovate will be more effective in dealing with any post operative residual skin issues. It is unlikely to remove all evidence of longer term scarring.

[Hidden in reply to JohnyKjo]

Please remember that circumcision is not guaranteed to get rid of LS and be prepared for that possibility.

[JohnyKjo in reply to Hidden]

Yes I am aware of this. However, the thought of it eventually spreading down the urethra and the operation that follows, is a horrific thought.

[Hidden in reply to JohnyKjo]

To reassure you, urethral structures are not inevitable even in long term, untreated cases however, as Osidge has flagged, progress can still occur post circumcision however treatment with clobetasol/Dermovate internally with a swab or sound has been found to be successful even in this scenario.

[JohnyKjo in reply to Hidden]

But isn't a circumsision a "treated case"?

[Hidden in reply to JohnyKjo]

Mostly yes, but research quoted to me by my consultant, confirmed by other research I have read, suggests that c.10% of cases are not cured by circumcision and up to 25% of cases will require a period of medical treatment. The figures are partly driven by where the disease is located. If only on the foreskin then circumcision is curative by default. If elsewhere, the keratinization of the glans and inner foreskin and the removal of the possibility of urine becoming trapped within the foreskin tends to result in cure albeit sometimes with medical assistance. I again have been told that the c.10% where circumcision is not curative tends to be in cases of buried penis or in overweight individuals such the the flesh acts as a pseudo foreskin.

[Hidden in reply to Hidden]

For me personally, I have a very strong preference to retain my foreskin and therefore I am happy to introduce the medical requirements into my daily routine but I completely understand why that might not be acceptable to all.

[JohnyKjo in reply to Hidden]

Thank your for sharing much valuable information, you seem very knowledgeable about this disease! I am also very fond of my foreskin, but my discontent with this disease outweighs all. My LS is only confimes to the glans and I hate how it looks. Hopefully a circumsision will stop the spreading.

[Hidden in reply to Hidden]

Hi, this paragraph (I again have been told that the c.10% where circumcision is not curative tends to be in cases of buried penis or in overweight individuals such the the flesh acts as a pseudo foreskin.) would this be the same for balanitis?

[Hidden in reply to Hidden]

My understanding is that it is ie. creating a moist environment which some of the causes of balanitis can exploit. Conditions such as diabetes would then compound the problem as retained diabetic urine would offer an even more attractive environment.

[MrMac99]

Hi Man. sorry to hear that you have been diagnosed with LS. circumcision should be curative especially if it's only on your foreskin with a high percentage of success. nothing in life can be guaranteed though. if there are patches on your glans and around your meatus you may need some steroid cream afterwards but not always needed.

[JohnyKjo in reply to MrMac99]

Hello. It is only my glans that is affected at the time being. One scaly white patch and two discolourations. Everyday I study my penis for further spreading of white skin and lately I notice slight discolouration that probably will form up together in the future. I have read your posts and you seem quite knowledgeable about this disease. Do you think a circumsision will stop the spreading of white skin?

[Hidden in reply to JohnyKjo]

You really need to seek medical advice - possibly see a dermatologist?

[JohnyKjo in reply to Hidden]

How come? I have already been given the diagnose by an urologist.

[MrMac99 in reply to JohnyKjo]

Hi Man I found it used to slowly spread some days I thought it was improving but eventually it would get worse again. in my case it improved after the circumcision any discoloration on my glans improved and faded but that's just my experience. You should consider all your options with your urologist and dermatologist they sometimes work with each other in these cases. In the meantime you can try keeping your foreskin retracted as much as possible and dry also make sure to keep using the steroid cream.

[Hidden]

Because treatment of LS lies within that speciality: bad.org.uk/shared/get-file....

[Gridlocked]

I saw a dermatologist in London - was private but first he got me to follow a 4 week regime with dermovate, which didn't clear up the LS, so he then said a circ was the way to go, with a 95% success rate.

[JohnyKjo in reply to Gridlocked]

Thank you for sharing. Where is your LS located?

[Gridlocked in reply to JohnyKjo]

It was on my foreskin. When the 4 weeks were up I saw the dermatologist (actually a tel conv. after sending Prof Bunker the photos), who then recommended a circ., which I had shortly afterwards privately, done by Dr Khan in Luton. I saw the dermatologist 3 months after the op. ( the histology confirmed LS), and he was and I am very happy with the result. No LS now, as much drier around the area.

[Hidden in reply to Gridlocked]

Very similar to my discussion. The response to the dermovate over the next month largely determines way forward. In my case it worked sufficiently well to support continuing medical approach, which was my strong preference.

[Leeno]

Hi!

Have you done circumcision? How is your result on the penis head? Its normal now?

Thanks