Frenular Grafting: An Alternative to Circumcision in Men with a Combination of Tight Frenulum and Phimosis


David Ralph, MS, FRCS, The Institute of Urology—Andrology, UCLH 235, Euston Road, London NW1 2PG, UK. Tel: (+44) 795 123 7043; Fax: (+44) 207 286 6362; E-mail:


Introduction.  Men suffering from frenular scarring and stricturing with associated phimosis are traditionally treated with circumcision. In men wishing to retain their foreskin, the treatment options are limited by this dual pathology. Frenuloplasty alone is contraindicated in this clinical setting.

Aim.  To demonstrate the utility of frenular grafting in patients with a tight frenulum and concomitant phimosis who wish to retain their foreskin.

Methods.  Six men were included in the study. Presenting symptoms included bleeding (N = 2) and pain/phimosis (N = 6). Median age is 27 years (25–34 years). All men were healthy and sexually active. We describe a refined technique involving the excision of scarred and redundant frenular tissue and the insertion of a skin graft to the area.

Main Outcome Measures.  All patients were assessed for graft viability, functional/symptom improvement, time to penetrative intercourse, and overall satisfaction.

Results.  All men received an interposition skin graft with 100% viability, with no revision surgery required. Postoperatively, all men were sexually active and able to retract their foreskin.

Conclusions.  Cosmetic outcomes are encouraging and painless sexual intercourse is attainable in this difficult group of patients. Kayes O, Li C-Y, Spillings A, and Ralph D. Frenular grafting: An alternative to circumcision in men with a combination of tight frenulum and phimosis. J Sex Med 2007;4:1070–1073.