What is the treatment for a penile frenulum tear?

Treatment of Penile Frenulum Tear

For an acute penile frenulum tear, apply direct pressure to control bleeding, allow the wound to heal conservatively with good hygiene, and reserve surgical frenuloplasty for cases with recurrent tearing, persistent pain during intercourse, or significant scarring that limits function.

Immediate Management

• Control bleeding with direct pressure using clean gauze or cloth—most frenular tears will stop bleeding within 10-15 minutes with sustained pressure 1, 2
• Avoid sexual activity and masturbation until complete healing occurs, typically 2-4 weeks 1
• Maintain good personal hygiene with gentle washing; topical antibiotics are generally unnecessary 2

Conservative vs. Surgical Treatment Decision Algorithm

Conservative Management (First-Line)

• Most acute frenular tears heal spontaneously without surgical intervention 1, 2
• Monitor for complete healing over 3-4 weeks with abstinence from sexual activity 1
• This approach is appropriate for first-time tears without underlying frenulum breve (short frenulum) 1

Indications for Surgical Frenuloplasty

• Recurrent tearing during intercourse despite conservative management 1, 2
• Persistent dyspareunia (painful intercourse) due to frenular scarring or shortening 1, 2
• Underlying frenulum breve causing repeated trauma 1, 2
• Patient preference for definitive treatment after initial tear 1

Surgical Technique (When Indicated)

Procedural Approach

• Frenuloplasty using V-Y plasty, Z-plasty, or combination techniques provides high patient satisfaction (8.9/10) with only 8% requiring subsequent circumcision 1
• The "pull and burn" method (controlled vertical tear with diathermy) is an alternative sutureless technique with excellent functional and cosmetic results 2
• Local anesthesia with EMLA cream for 15-20 minutes is typically sufficient 2

Technical Considerations

• Preserve the frenular artery to prevent meatal stenosis and ensure optimal healing 2, 3
• Avoid injury to the glans penis during the procedure 3
• Use interrupted 4-0 absorbable sutures when reapproximating tissue 3
• Apply paraffin gauze with antibiotic paste and light compression dressing for one day post-procedure 3

Expected Outcomes and Complications

Success Rates

• Patient satisfaction averages 8.9/10 with frenuloplasty 1
• 97% of patients would recommend the procedure to others 1
• Only 8% require subsequent circumcision after frenuloplasty 1

Potential Complications

• Minor complications (bruising, infection, partial dehiscence) occur in approximately 8% of cases 1
• Mild to moderate edema may develop but typically resolves spontaneously 2
• Pain from penile erection is common during the healing period 4

Critical Pitfalls to Avoid

• Do not rush to surgery for a first-time acute tear—most heal conservatively without intervention 1, 2
• Do not ignore recurrent tearing—this indicates underlying frenulum breve requiring definitive surgical correction 1, 2
• Consider atypical presentations: if the "tear" appears as an ulcer or doesn't heal as expected, obtain histology to rule out conditions like primary syphilis, which can masquerade as frenular trauma 5
• Avoid aggressive sexual activity before complete healing, as this leads to re-injury and worse scarring 1