Brief Answer:
Either Mometasone Steroid cream OR Circumcision OR Z-Plasty.

Detailed Answer:
Dear XXXXXXX

Cracked foreskin is due to infections of the penis. This is called as posthitis. These infections must be quickly removed using microbicidal creams and gels. You say that you are using candid ointment. This is an antifungal medication. Fungal infections on the foreskin, cause itching, and even after they heal, cause a tightening of the foreskin making it difficult to retract for sexual activities. In addition, this tightening, then goes to the next stage, wherein you report cracks. This makes you vulnerable to further infection and open to transmitting diseases and catching them. Furthermore, this tightening; called a fibrosis has a tendency to be permanent and get worser due to the nature of the foreskin. You are then susceptible to a wide range of undesirable illnesses that range from urinary tract infections to cancer of the glans penis to cancer of the prostate. At this point of time I will ask you to apply a steroid ointment. Mometasone furoate is the best steroid for fibrosis and cracks and will restore your foreskin to looseness and normalcy. The fact is that after 3 weeks of thrice a day application you will not need the cream. However after many months, your foreskin will again start to fibrose and crack and contract. This is a pathological fact. This means, practically, you are dependent on steroids, which is not a very good position to be in.

The best intervention according to me is surgical. Circumcision, means the radical removal of the foreskin and is today encouraged by the center for disease control CDC; of USA. It removes all these issues in one stroke. Circumcision must be performed by a cosmetic and plastic surgeon for best results. It confers resistance to HIV/AIDS, STD's and cancers of the urological tract. In addition to this, it prevents cancers of the cervix in female partners and frequent Urinary tract infections in them.

As of now your best option is something called as a Z plasty. After application of mometasone cream, within 3 weeks, once your foreskin is supple and normal. Ask a plastic surgeon to perform a Z plasty also called as preputioplasty on your foreskin. The surgeon cuts millimeters perpendicular to the fibrosis and reshapes the foreskin. You are indeed awake during the procedure and indeed, in Z plasty
plastic surgeons remove the fibrotic scar according to your level of comfort.

You get to keep your foreskin, the fibrosis is loosened, and you do not need creams and tablets for a lifetime.

It is the best option. Don't you think so? The problem? Finding a good Plastic surgeon.

I encourage your opinions on this.
Feel free to write back to me for doubts and other health queries.

Regards,
Dr. Neel Kudchadkar

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