Phimosis – Unusually Tight Foreskin (Video)

How Do I Know If I Have Phimosis (Tight Foreskin)?

Phimosis is a condition of unusually tight foreskin that cannot be drawn back from the head of the penis.
It is a constriction of the opening of the foreskin that – it can’t be drawn back over the tip of the penis.
A simple way to find out is just to try to pull your foreskin all the way back until you see the whole head of the penis.
If you cannot do this or if it hurts to do this, you likely suffer from phimosis (tight foreskin).

How Severe are My Phimosis (Tight Foreskin) Condition?

Score 1: Full retraction of the foreskin, tight behind the glans. ☑
Score 2: Partial exposure of glans, prepuce (not congenital adhesions) limiting factor. ☑
Score 3: Partial retraction, meatus just visible. ☑
Score 4: Slight retraction, but some distance between tip and glans, i.e. neither meatus nor glans can be exposed. ☑
Score 5: Absolutely no retraction of the foreskin. ☑

What are the Risk Factors of Phimosis (Tight Foreskin)?

The tightness of the foreskin may interfere with the normal passage of urine.
In severe cases, this may cause retention of urine and urine infection. It also increases the risk of infections of the foreskin and head of the penis.
This problem is especially severe in people with Diabetes.
Also, it may cause pain during sex. If you have phimosis using a condom during sexual intercourse may make the penis more comfortable.

What are the Possible Treatments of Phimosis (Tight Foreskin)?

Your doctor may give you antibiotics if the swabs did showed signs of infection, or may give you a cream for application.
Sometimes, phimosis can be treated simply by stretching the foreskin. Sometimes, doctors will prescribe a cream to help the foreskin stretch.
If the problem is severe and stretching does not help or if the foreskin is badly scarred, the patient may need a circumcision.
Circumcision for adults is a medical treatment option for patients with recurrent foreskin infections, phimosis (tight foreskin opening), and for religious reasons.

If you think you may be suffering from phimosis, see our doctors for a consultation.

An Overview of Gonorrhoea Symptoms

Gonorrhoea symptoms in Men & Women can include discharge, painful urination and itch. Some people who are infected may not display any signs or symptoms.

What is the Cause of Gonorrhea?

Gonorrhoea is one of the most common Sexually Transmitted Infection (STI) in women.  It can cause infections in the vagina, rectum, and throat.
Gonorrhoea is known to be easily transmittable via both penetrative and oral sex. It can infect the reproductive system and less commonly, the throat or eyes. A maternal to child transmission is also possible here.
Similar to Gonorrhoea, Chlamydia is a common sexually transmitted disease caused by bacteria called Chlamydia trachomatis. Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae.

In women, gonorrhoea affects the cervix and its functions 90% of the time.

via GIPHY

What are the risk factors for contracting Gonorrhea?

  • Multiple sexual partners
  • New sexual partner
  • Unprotected sex
  • Men that have sex with Men (MSM)
  • A sexual partner who has an STI
  • Having concurrent STI

What are the Gonorrhoea Symptoms:

Gonorrhoea can be a silent infection in most of the population. Often time, women and men with Gonorrhea will not display any signs and symptoms.
Gonorrhoea Symptoms & Chlamydia Symptoms can be overlaping.

The Symptoms of gonorrhoea can differ between men and women.

via GIPHY

Gonorrhoea Symptoms in women:

Gonorrhoea Symptoms in Men

  • Penile discharge – colour may vary from white, yellow, green, or occasionally blood-tinged
  • Pain when passing urine
  • Pain in the testicles – rare

Read more about what are the other causes of penile infection & foreskin infection
Depending on the nature of the sexual activity and the severity of the infection, both men and women may experience pain, itchiness or discharge from the anus. They may also have pain, swelling, irritation, or discharge from the eye or both eyes (otherwise diagnosed as conjunctivitis).

How to Treat Gonorrhoea?

As with most bacterial infections, gonorrhoea is treated with antibiotics. The first choice is a wide spectrum antibiotic. It is, however, proving to be getting more resistant to antibiotics.
Gonorrhoea is also challenging to treat because most people who have this STI also have concurrent sexually transmitted illnesses like chlamydia.

via GIPHY
Also, like with any other sexually transmitted illness, treatment must be extended to all partners, and once treatment is completed, routine testing is highly recommended in view of relapse due to the increasing resistant nature of the gonorrhoea bacteria.
Abstinence is recommended during treatment.

What are the Complications of Gonorrhoea

Rarely, untreated gonorrhoea can spread throughout the body giving rise to skin pustules, infection of the joints (fingers, ankles, knees, and toes), brain or heart valves.

Complications of Gonorrhea in Men

More commonly, in men, infections of the epididymis, prostate and urethra are noted. Gonorrhoea can cause subfertility in some patients.

Complications of Gonorrhea in Women

In women, similar to other sexually transmitted diseases, untreated gonorrhoea may cause pelvic inflammatory disease (via an ascending infection involving the uterus, fallopian tubes, and ovaries) in up to 20% of patients. With inflammation, scarring and/or multiple infections, issues of subfertility and extra-uterine pregnancy will arise.
More annoyingly is the chronic, relapsing pelvic pain. This pain is characteristically stubborn and may require multiple analgesic medications in some women.
Read more about Herpes: Everything You Need to Know!

How is Gonorrhea Test Performed?

In most cases, usually for men, a urine sample will be required for the test. However, for female patients, ideally, the doctor will need to take a sample from the cervix ( neck of the womb).
For this, patients will lie down on the examination couch with knees bent and a small plastic instrument called a speculum will be used to open the vagina, then a soft brush will be used to collect a sample from the cervix. This procedure is very quick and painless, with only some minimal
discomfort.
Depending on sexual history, gonorrhoea swab may also be taken from the throat and rectum, in both men and women.

Any preparation needed before the test?

Vaginal douching and rectal douches, as well as creams, should be avoided 1 day before the test.
For the urine test, it is best to not urinate at least 2 hours before the sample is taken.

How long will the results take?

The test is usually performed together with chlamydia screening and results will be ready by the NEXT DAY. This allows treatment to be given as soon as possible when needed.
We can provide Rapid Chlamydia and Gonorrhea STD Testing. STD Test result will be available the following day.
If you are interested in getting a Rapid STD Testing or treatment for gonorrhoea, please visit our clinics and speak to our male and female doctors.
That’s All Folks!


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Genital Warts: The Cauliflower-Like Lumps on the Genitals

Genital warts are white or flesh-coloured, smooth, small bumps that can appear anywhere in the general area of the genitals. They can also grow larger and appear as fleshy, cauliflower-like lumps on the genitals. Neither of which are more dangerous than the other, it is merely a characteristic and the stage that the illness was noticed.
Genital warts is an STD symptom caused by the Human Papilloma Virus (HPV).

HPV can cause multiple illnesses in the body as there are multiple strains of the virus attributing to different diseases in humans. Out of the hundreds of known strains of HPV, about 30 strains of the virus cause diseases of the genital area. These include warts, or in more sinister cases, cancer of the anus, cervix, vagina, and penis. Read: Causes of Vaginal Lumps & Bumps & Perianal Warts (Peri-Anal Warts)

Most of the other strains have no known effect on humans.


How do I get infected by the Human Papilloma Virus (HPV)?

Human Papilloma Virus (HPV) is a contagious disease that is transmitted through genital skin contact or through direct contact with genital fluids of a person already infected with HPV.
For transmissible illness such as these, using barrier methods of protection for sexual intercourse such as condoms should be emphasised. However, condoms are not very effective against transmitting HPV just because the HPV virus does not require penetrative sex to transmit the virus.

It can also be transmitted from a mother to an unborn child if the mother has an active HPV infection during the course of the pregnancy.


How do I know I am infected with HPV? How can it be detected?

A majority of people infected with HPV do not realise they even have the virus as it does not present with any symptoms.

Some people will notice bumps or warts around the genital area, otherwise known as genital warts. These usually occur one to three months after initial infection with HPV.


The most sinister manifestation of the HPV disease is cervical cancer affecting women in their 30s or 40s. The simplest way to detect cervical cancer is by identifying if an individual is an active risk of getting the disease and doing regular PAP smears. MOH guidelines are also apparent on the timing and interval for PAP smears for women in the reproductive age group. Sometimes a biopsy of unhealthy cervical looking tissue may be needed.

For men-who-have-sex-with-men (MSM), it is recommended that they do an anal PAP smear to investigate for HPV.

We also provide Rapid HPV Testing (next day result) in all our clinics in Singapore.


How can HPV & Genital Warts be treated?

In most cases, the HPV infection is self-limiting therefore no treatment is deemed necessary.

Unless an individual has issues with antibodies or a weak immune system in general, the body should be able to contain and eradicate the virus from the body in due time.
If an individual has an impaired immune system or a weak immune response, a lingering infection or a co-infection with another sexually transmitted illness can occur.

In cases of genital warts, the treatment options are largely dependent on the severity of the infection. The most common treatment options include creams and paint-on ointments. These induce a state of cell death so warts around the genital will eventually wither and fall off the skin.

Some patients may be offered cryotherapy where the wart is frozen then removed. The wart is frozen prior to that so that there will be no transmission of the wart after.
Apart from the above surgical options for wart removal also exist. This is where a surgeon uses electrocautery or a scalpel and surgically excise warts. See: Genital Warts Removal

Unfortunately, the majority of genital warts or other warts can recur very frequently and is rather common to have warts recur post removal. Sometimes, repeated treatments are required for complete remission, but patients should be aware of the recurrence rates in such an infection.


HPV and Cervical cancer

Some HPV viruses are known as high-risk viruses. This is particularly true in virus strains 16 and 18. This is because it induces changes in the cells in the cervix of a woman and causes cervical if not detected early.

It is in this light that it is recommended that all sexually active women are advised to go for regular PAP smear tests, screen for HPV infections and visit your doctor for HPV vaccination in Singapore.


HPV and PAP Smear

Pap smear is a relatively painless test that can be quickly done. It involves inserting a speculum into the vagina of the patient to allow for inspection then a tool is inserted to obtain scraping. The patient should go back to resume activities of daily living with no hindrance once after the procedure completed by our female doctor.
These scrapings and obtained cells are then examined under a microscope to look for abnormal cells.

We also provide Rapid HPV Testing & Pap Smear in all our clinics in Singapore.

HPV and HPV Vaccination

Human Papilloma Virus (HPV) is a group of virus that can cause:

  • Vaginal Cancers
  • Vulvar Cancers
  • Anal Cancers
  • Penile Cancers
  • Oropharyngeal Cancers (cancers of the throat and tongue)
  • Genital warts or Papillomas

HPV vaccination is used to protect against HPV-related diseases and cancers.
To complete the HPV vaccination, 3 doses of injections will be given. The recommended HPV vaccine schedules are:
First dose: During your doctor visit.
Second dose: 1 – 2 months after the first dose
Third dose: 4-5 months after the second dose


Get More protection with New 9-valent HPV vaccine (Gardasil 9)

There are over a hundred strains of HPV and they are each given a designated number e.g. HPV 6 or HPV 16 or HPV52.
HPV strains that cause warts will NOT cause cancers and HPV strains that cause Cancer will NOT cause warts.

Compared to the older Gardasil, the new GARDASIL 9 offers a wider range of protection against HPV strains.
Both Gardasil and Gardasil 9 give you protection against the cancer-causing HPV 16 and 18 and the wart-causing HPV 6 and 11.
Gardasil 9 protects additional 5 other high-risk types: 31, 33, 45, 52 and 58.
Together these types cause about 90% of cervical cancers.

Another HPV vaccine Cervarix, on the other hand, protects only against the commonest cancer-causing HPV 16 and 18. There is no wart protection with Cervarix.
If you are interested in getting the HPV testing & PAP smear, genital warts treatment or HPV vaccine, please visit our STD clinics and speak to our male and female doctors.
If you or your partner are experiencing any possible signs or symptoms of infection, or have had any potential risk exposures, please see our STD doctors today.
Take Care. Be Safe!



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