Frenulotomy of the frenulum

The term "frenulotomy" refers to any operation during which the tension of the frenulum is surgically loosened. However, most often this term is used when talking about an operation to loosen the frenulum of the foreskin. In turn, what is a "frenulum"? We are talking about an anatomical element belonging to a particular organ and limiting its motor amplitude. There are several organs in the human body equipped with such an element: these are the organs of the genital area (labia, clitoris, penis), as well as the tongue and lips. Therefore, it is not entirely correct to call only an intervention on the frenulum of the penis a frenulotomy: it is a general term affecting all types of such operations.

Indications for the procedure

Frenulotomy in the form of surgical loosening of the frenulum in male patients (foreskin) is necessary if its length is insufficient to perform certain functions. It is possible to suspect that a person has a shortened frenulum of the foreskin if the following symptoms are present:

• if pain occurs during sexual intercourse;
• in case of premature ejaculation;
• during shortened sexual intercourse;
• in case of frequent injuries and bleeding of the frenulum;
• with a downward bend of the penis during the erection phase.

The frenulum combines a large number of vessels and nerve fibers: during movements of the foreskin, the nerve endings are mechanically irritated, which leads to increased arousal and a state of orgasm. If the frenulum is injured during intercourse, this causes premature ejaculation, pain, and bleeding from damaged vessels.

Why does the frenulum shorten? This may be a congenital anomaly, a cicatricial post-traumatic change. Frenulotomy is indicated for such painful conditions as phimosis and paraphimosis.

There are also several frenulums in the oral cavity, which sometimes require frenulotomy. For example, between the lips and gums there is a small element of mucous membrane, which is also called a frenulum. If this element is too short, then gum inflammation can often develop due to tissue overstretching and gradual “tearing” of the mucous layer of the periodontium from the jaw alveolar process. Frequent inflammatory reactions eventually develop into gingivitis, periodontitis with further disruption of the dental row.

In young children, a frenulum of the tongue that is too short can cause speech impairments, malocclusion, and even digestive system diseases (due to improper chewing of food).

In each of the listed situations, the doctor may recommend a simple operation – frenulotomy.

Preparation

In most cases, frenulotomy does not require any preparatory measures. It is a short and simple operation that is performed under local anesthesia.

It is good if there is an opportunity to choose in advance an experienced doctor who has already made similar corrections and knows all the nuances of the pathology.

In some cases, there is a need for preliminary diagnostics: the doctor may recommend taking a general blood and urine test, as well as excluding HIV, syphilis, and hepatitis.

If a blood clotting disorder is suspected, a coagulogram will be prescribed.

Directly at the clinical facility where the frenulotomy procedure will be performed, the health care worker will conduct a test for the absence of allergy to the anesthetic substance.

All of the above procedures are done, first of all, to determine whether the patient has any contraindications to the operation.

In the morning before the frenulotomy procedure, you must take a shower. If the operation is to be performed in the oral cavity, you should brush your teeth thoroughly, and if in the genital area, you must shave them and put on clean underwear.

Hospitalization after frenulotomy is not required. As a rule, the patient is sent home a few hours after the procedure. After 2 weeks, it is necessary to visit the doctor for a control examination.

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Technique frenulotomy

The frenulotomy procedure is performed using local anesthesia (only in rare cases is general anesthesia used, if indicated).

The entire frenulotomy operation lasts from ten to thirty minutes, depending on the situation. The doctor performs the following actions:

• processes the surgical field;
• makes a transverse incision of the skin junction;
• applies stitches longitudinally.

If during the examination the doctor finds scars that may have remained from previous injuries to the frenulum, he gently excises them with a scalpel.

When suturing a wound, self-absorbing material is often used: it perfectly fixes tissues and does not require subsequent removal of stitches.

After frenulotomy, there is usually no need for the patient to be hospitalized: the person rests for some time and, if he or she feels well, goes home.

Types of frenulotomy

There are two known types of operative frenulotomy - the classic type and laser plastic surgery. Let's briefly consider each of them.

Conventional, classic frenulotomy is the most commonly practiced type of surgery, in which the doctor performs direct access using a scalpel. The surgeon cuts the skin element, thereby lengthening it. The advantages of this method:

• operation available;
• It can be performed by any practicing surgeon.

Disadvantages of this method of frenulotomy:

• there is a risk of infection in the wound;
• the recovery period is accompanied by painful sensations;
• the healing process takes longer;
• During and after surgery, bleeding may occur in the wound.

Laser frenulotomy is easier for patients to accept, but not every medical institution has the equipment for such an operation. The advantages of laser frenulotomy are obvious:

• minimum tissue damage;
• minimum risk of infection in the wound;
• minimally expressed pain;
• absence of postoperative bleeding;
• the intervention itself occurs faster, and the rehabilitation period is significantly shortened.

The disadvantages of this method of treatment are that the penis is an organ that can change its size involuntarily, and the doctor has no way to control this process. What does this affect? It affects the fact that after laser frenulotomy, there will be a risk of microcracks and tissue ruptures for some time.

Frenulotomy of the foreskin is the only way to solve the problem with a short frenulum. Standard plastic surgery of a short frenulum of the foreskin consists of a transverse incision of the skin element, with subsequent application of longitudinal sutures. The intervention is performed on an outpatient basis, without the need for further inpatient treatment. Another plastic surgery option is also possible: an incision is made in the shape of the letter V, and the sutures are applied in the shape of the letter Y, which helps to make the frenulum 10-15 mm longer. It should be immediately noted that the first standard option of plastic frenulotomy is preferable. With the other option, the risk of developing phimosis increases (due to narrowing of the foreskin), and an unaesthetic scar remains after the intervention.

If a man has had frequent ruptures of the frenulum, as a result of which multiple cicatricial changes have formed on it, then he is recommended to remove this element. Such an operation already has another name: frenulectomy. This type of operation is performed by a transverse incision along the diametrical circle of the penis (or part of it), which allows to loosen the tension of the prepuce. The tissue is sutured longitudinally: a scar is formed at the site of the skin fold, which coincides with the natural suture running in the lower segment of the penis.

In cases of phimosis, frenulectomy does not always lead to a positive result, so most specialists recommend surgical circumcision, more commonly known as “circumcision”.

Frenulotomy of the upper lip frenulum is also one of the surgical options that is performed to correct bite and speech problems in children. In this case, the procedure is performed on the fold of mucous tissue responsible for attaching the lower and upper lips to the jaw bones. This intervention is also performed under local anesthesia: the frenulum is cut and connected to the required area.

Frenulotomy of the tongue is a no less common procedure in pediatrics. It is necessary to resort to it if the baby has a disordered sucking function: the child has difficulty sucking the breast normally, his appetite is disturbed, he loses weight. In this situation, the use of frenulotomy is more than justified.

A shortened frenulum of the tongue is called ankyloglossia in medicine - it is a congenital maxillofacial defect that leads to a limitation of the motor ability of the tongue. In general, there are three frenulums in the mouth, in relation to which frenulotomy can be applied: this is the sublingual fold, as well as the frenulum of the upper and lower lips.

Contraindications to the procedure

A surgical procedure such as frenulotomy will not be performed in the following situations:

• during active infectious processes in the body;
• if the patient is diagnosed with diseases such as hepatitis, HIV or venereal disease;
• for cancer;
• with impaired blood clotting;
• for inflammatory processes of the genitourinary tract.

Some of the listed contraindications to frenulotomy are relative. Therefore, a potential patient should not make independent conclusions about the possibility or impossibility of performing the intervention. Any doubts should be discussed with the doctor: frenulotomy, although simple, is still an operation, during which various unforeseen complications may arise.

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Consequences after the procedure

Frenulotomy is considered a relatively simple procedure among surgeons, with unpleasant consequences occurring quite rarely. However, every patient should be aware of the risks they are exposed to when undergoing such an operation.

Undesirable consequences after frenulotomy may include:

• the addition of infection, the development of inflammation (balanoposthitis);
• seam divergence;
• bleeding;
• allergic reaction to the agents used for local anesthesia.

Insufficient postoperative treatment of the wound after frenulotomy, weakened immunity, and infection from the urogenital tract can cause the development of an inflammatory reaction. Most often, such a reaction occurs in the form of balanoposthitis - an inflammatory process affecting the head and foreskin of the penis.

Balanoposthitis, as a consequence of frenulotomy, manifests itself with the following painful symptoms:

• redness of the skin in the head area;
• tissue swelling (swelling);
• pain sensations;
• the appearance of an unpleasant odor;
• inflammation of the nearby lymph nodes.

If at least one of the above symptoms appears after frenulotomy, you need to see a doctor as soon as possible. If you ignore the development of balanoposthitis, or try to cure the problem yourself, other, more serious complications will arise:

• purulent inflammatory processes;
• inflammation of the urethra, bladder, etc.

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Complications after the procedure

Any surgical intervention has a certain degree of probability of complications - for example, after operations there is a risk of bleeding or infection. After frenulotomy, fortunately, there can be no life-threatening blood loss, because there is no large vascular network in the frenulum area, but only capillaries.

But with wound infection, the situation is different: bacteria can actually get into the surgical wound, both during the intervention and after it (the latter happens much more often).

In order to avoid inflammatory and infectious complications against the background of frenulotomy, it is necessary to carefully follow all the doctor's instructions regarding the care of the operated area. In most cases, the doctor recommends systematically treating the wound with antiseptics, hydrogen peroxide, antibacterial ointments, etc.

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Care after the procedure

Uncomfortable or painful sensations after frenulotomy are considered normal postoperative symptoms. They usually last no more than a couple of days. The patient may experience particular pain during erections, for example, in the morning. To relieve the pain, the patient is advised to walk around the room, take a few deep breaths, and distract himself. Sometimes, to improve the condition of the patient, the doctor prescribes special sedatives and analgesics. In addition, in most cases, the use of external antiseptics and oral antibacterial drugs is indicated.

During the first 24 hours after frenulotomy, a bandage must be applied to the penis. Direct care is carried out using running warm water with detergent.

The stitches are removed after approximately 10 days (unless self-absorbing material was used).

Complete tissue healing occurs in about 20 days. After this time, you can resume sexual activity - but, as they say, without fanaticism, carefully. If the unpleasant sensations return, you should wait a few more weeks. It is believed that discomfort can theoretically persist for up to 4-8 weeks. If the pain does not go away during this period, you should make an appointment with a doctor.

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Reviews

Almost all patients who had to resort to frenulotomy surgery speak about the procedure only in positive tones: the problem with a short frenulum is completely solved.

The quality of a man's intimate life depends on many different factors, and the anatomical features of the penis are of no small importance. At the same time, even such a small element as the frenulum performs one of the main functions. The longitudinal skin connection between the head of the penis and the foreskin ensures the exposure of the head and the return of the foreskin to its original position.

If the frenulum is too short, it can cause not only discomfort, but also pain, which over time builds up into endless psychological barriers in sexual terms. Frenulotomy can really solve such a problem: after the procedure, the motor ability of the foreskin increases, and previously disturbing painful symptoms disappear.