Marcus, 15, looks very embarrassed as he is brought into the fast track cubicle by his mother. His shuffling gait and poor eye contact suggest he has a ‘personal problem’ but he doesn’t want to discuss it until his mother leaves.
A torn frenulum is common. It heals on its own and will not impact on the adolescent’s future ability to have children.
If you did Latin at school you would know that a frenulum is…?
A frenum is a ‘bridle’ (Latin) and so a frenulum is a ‘little bridle’. It’s a small fold of skin that restricts the motion of an organ.
Other than the penis where might you find a frenulum?
Around the mouth – under the tongue and inside the upper and lower lips. You will also find a clitoral frenulum as well as one in the vaginal fourchette.
A torn frenulum is a common cause for distress in adolescents, how might it occur?
The commonest cause is over-vigorous masturbation, something they don’t want to admit to their parents. But remember a torn frenulum (labial or penile) in a young child may be a marker of abuse. If there is a reasonable explanation then make sure this is clearly documented in the notes.
What do you do about it?
Although distressing, it should heal all on its own. The application of local pressure or ice will stop any bleeding and a topical barrier cream will reduce any stinging when the foreskin is retracted for washing. The patient should refrain from risky activities until it has healed completely (2-3 weeks).
GPs occasionally refer patients with a torn penile frenulum to the ED in order to have ‘a stitch put in’. The boys are very relieved when they are informed that this is not necessary.
Are there any long-term complications?
A tight, scarred frenulum can occasionally lead to dyspareunia later in adolescence. In this case a frenuloplasty may be needed.
You quickly check Marcus out and reassure him that things will heal of their own accord but he should refrain from any solo activities for a few weeks. Embarrassed, but relieved, he leaves to explain to his mother.
Dockray J, Finlayson A, Muir GH. Penile frenuloplasty: a simple and effective treatment for frenular pain or scarring. BJU Int. 2012 May;109(10):1546-50
Kidd AJ, Beattie TF, Campbell-Hewson G. Frenal injury in children is not pathognomic of non-accidental injury. Emerg Med J. 2010 Jan;27(1):52.
How does the tear heal up? What are the signs that it is healing up?