title: Male dyspareunia due to short frenulum: the suture-free, "pull and burn" method.
abstract: BACKGROUND
  The presence of a short frenulum is a common cause for dyspareunia in males, often resulting in painful intercourse and trauma to the frenulum. Most of the described techniques use sutures that may sever the frenular artery and lead to meatal stenosis or leave skin tags that create a poor cosmetic result.
  
  
  OBJECTIVE
  The aim of this study is to describe the "pull and burn" method for the correction of a short frenulum with respect to the anatomy of the glans penis.
  
  
  METHODS
  The procedure was performed on 127 young adults presenting with dyspareunia due to short frenulum. Local anesthesia was achieved by application of eutectic mixture of local anesthetic (EMLA) for 15-20 minutes. The point of maximum tension was cut by diathermy and a controlled vertical tear was made on the frenulum by applying gentle but firm retraction on the glans. Minor bleeding was sealed with diathermy. Personal hygiene was advised and no local antiseptics or antibiotics were further used.
  
  
  METHODS
  Achievement of adequate anesthesia with EMLA cream, use of sutures, complications of the procedure, and final cosmetic and functional result.
  
  
  RESULTS
  The application of EMLA for 15-20 minutes was sufficient for local anesthesia. Only one patient with very thick frenulum required further lignocaine infiltration. No sutures were applied except in two cases (1.6%), in which a wide and thick frenulum required approximation of the tear edges for a better cosmesis. At 3 months follow up, no inflammation or meatal stenosis were noted. One patient required further release of a scarry frenulum. Functional and cosmetic results were excellent in all cases.
  
  
  CONCLUSIONS
  The "pull and burn" method is an easy, bloodless, and sutureless procedure for the correction of a short frenulum. Local anesthesia with EMLA is satisfactory, the procedure respects the glans anatomy, and preserves the frenular artery, achieving an excellent functional and cosmetic result.
authors.affiliation: Department of Anatomy, University of Patras, School of Medicine, Rion, Greece. kogyftop@yahoo.gr
authors.forename: Kostis
authors.initials: K
authors.lastname: Gyftopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D004414:Dyspareunia / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D010413:Penis / Q000002:abnormalities / Q000601:surgery*; D013537:Sutures; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult