Frenulum breve affects around 5% of uncircumcised men - and can lead to extremely painful cuts and tears in the foreskin. But information about it is hard to come by, as Jonathan Cope found out
Tell someone you've cut your frenulum and the chances are you'll get a blank look. But if you mention - to a man at least - that you've snapped your banjo string, he'll wince in sympathy. It's probably the most sensitive part of the male anatomy: the ridge of skin beneath the head of the penis, joining it to the foreskin.
I've snapped mine twice, the first time during sex seven years ago, when I was 22. It stung, but healed within a week, and I thought nothing more of it - until last summer, when I was washing my penis in the shower and felt a painful twang. On close inspection, there was a barely visible cut on my frenulum. This time it did not heal, and after a week's abstention from sex, my girlfriend twigged.
Reluctantly, I spilled the beans, and we abstained for another couple of weeks but when we tried again my "string" still felt like someone had been picking out Duelling Banjos on it. Like a paper cut, the size of the wound belied the pain it caused. First we turned to NHS Direct for advice, but the creepy adviser's suggestion that we were to blame for having too much sex was unhelpful, upsetting and, as I was to find, nothing to do with the problem.
So I talked to male friends. One or two had suffered and suggested that it would heal, but I didn't like the idea of an indefinite wait. I tried salty baths, Vaseline, Savlon, even Sudacreme - a cream for healing nappy rash - but it didn't heal me. As ever, the internet provided conflicting information, and worryingly, a couple of sites mentioned full circumcision under general anaesthetic and an overnight hospital stay. This was backed up by a nurse I spoke to at Guy's Hospital in London; I didn't like the sound of it at all. I rather like my foreskin.
Two months on, confused and increasingly concerned, I visited my local genito-urinary clinic. The consultant suggested either a herpes sore (I really didn't think so) or a tear due to a short frenulum - "frenulum breve" - literally, a "little bowstring." This, he explained, restricts movement of the foreskin over the head of the penis, leading to soreness, bruising and occasionally a small but painful tear. Apparently it is common, affecting perhaps 5% of uncircumcised men, mostly aged 17 to 30. So why had I never heard of it?
The answer was simple - there is little in the way of published medical research, and people don't talk about it. In 1958, a certain Professor Grewel suggested in the Folia Psychiatrica Neerlandica that the "manifest neglect" of frenulum breve in medical literature is due to a combination of the castration complex among physicians, prudery, and plain masculine pride preventing men from reporting penis problems - as he notes: "When this organ is menaced, fear and anxiety arise." However, my search for the condition using the huge Medline internet database drew a blank.
The GU consultant thought, as I feared, that I might benefit from surgery - not circumcision, thankfully, but something called frenuloplasty. It is difficult to describe in words what this involves, so he drew me a sketch. The frenulum is cut vertically and the two tiny flaps of skin that this creates are sewn into the foreskin with a couple of stitches. These dissolve in a fortnight, and after a couple of weeks most men have fully recovered and are able to resume sexual activity. It may not sound like fun, but it is preferable to the method practised by the Luo tribe of East Africa, which involves the incisors of the male soldier ant.
After a couple more weeks with no improvement, I decided to leapfrog the potential 15-month waiting list and get my privates checked privately. Gordon Muir, the urologist I visited at King's College Hospital, took a glance at my cut and was "80%" sure that frenuloplasty could help. "You've got a design fault," he explained. "The problem is that, even if your cut heals naturally, you'll be left with scar tissue - thicker but more brittle skin which is prone to splitting again.
"Because we're all different, there's no clear way of knowing just what constitutes a problem frenulum, but as a rule of thumb, it's more likely to cause problems or tear if it automatically pulls the foreskin forward over the head of the penis when you have an erection. The operation is far quicker and less traumatic than full circumcision. We do it with a local anaesthetic as an outpatient procedure and you can go back to work as soon as it's done - unless you're a professional sportsman." I assured him that I was merely a gifted amateur.
"Does it leave a scar?" I asked. "Will it show?" "It depends how closely you look. And if you're still worried," he whispered conspiratorially, "don't be - I've had it done myself, and it was filmed by a group of medical students to boot."
Apparently, many men unaware of frenuloplasty seek full circumcision to cure the problem and are relieved to find that they can in fact keep their foreskins. In a small minority of cases, though, circumcision may be required. Despite Muir's assurances, I was still worried and waited in vain for some natural improvement. Finally, in January this year, about six months after the cut first appeared, I decided to bite the bullet.
The operation was over in 10 minutes - painless apart from the local anaesthetic injection just below the head of the penis. Far worse were the ghastly Y-fronts I had to wear to keep a small gauze dressing in place afterwards. Determined to test Muir's theory, I had a cup of tea at the hospital and went straight back to work (ironically, a meeting at the Department of Health), mentally grimacing at the thought of what I had done, but physically fine.
Over the next month, painful erections were a bit of a nuisance, and I felt a bit low - even emasculated. But when the stitches were removed, I had gone from short bowstring to fit as a fiddle. Daily application of E45 keeps the tiny operation scar supple - it's the lanolin, apparently - and after six months of painful sex followed by a month of none at all, the relief is immeasurable.
This article was first published in The Guardian, London, Thurday, February 28, 2002.