Torn or tight frenulum in men: what to do

Your frenulum is the small band of tissue on the underside of the head of your penis, often called the banjo string. A tight frenulum can hurt during erections or sex, and a torn frenulum can bleed a lot, though most tears heal on their own.

What is the frenulum (banjo string)?

BAUS (the British Association of Urological Surgeons) describes the frenulum as the band of tissue on the underside of the head of the penis, running from below the opening to the inside of the foreskin. Alder Hey Children's NHS Foundation Trust calls it the bridge of skin joining the foreskin to the shaft, also known as the banjo string.

The sexual health charity Brook says the penis frenulum is quite resilient. It can still tear, which some people call a snapped banjo string.

What is a tight frenulum (frenulum breve)?

With a short or tight frenulum, known as frenulum breve, the foreskin can go back over the head of the penis but the frenulum holds it up underneath. Alder Hey says this can cause pain, especially during erections or sex, and BAUS says a tight frenulum may tear, causing bleeding and discomfort.

A short frenulum can feel like a tight foreskin. When men see a GP about a tight foreskin, BAUS says, the problem sometimes turns out to be a short frenulum instead. If you can't pull your foreskin back far enough to uncover the head of your penis, our guide to a tight foreskin (phimosis) is the better fit.

A tight frenulum doesn't always need treatment. For mild cases, BAUS lists observation, with no specific treatment, as an alternative to surgery.

Why does the frenulum tear?

Brook says the frenulum can tear under the pressure of rough sex or vigorous masturbation, and that a torn frenulum can be very painful and bleed a lot. Alder Hey adds that a tight frenulum can tear, sometimes during sex, and that using a lubricant during sex can help avoid this happening.

What should you do if your frenulum tears?

Press on it. For a wound that's bleeding a lot, the NHS first-aid advice is to put pressure on it with a bandage or a clean, folded cloth, adding another on top if blood comes through. Most frenulum tears then heal without any treatment, Brook and Alder Hey say.

1. Press on it with a clean, folded cloth or a bandage. If blood comes through, put another cloth on top and keep pressing.
2. Call 999 or go to A&E if you can't stop the bleeding, or if blood comes out in spurts and is bright red and hard to control. The NHS lists both among its emergency signs for a cut.
3. Clean it gently once the bleeding has stopped. For a small wound, the NHS suggests rinsing it with tap water and patting the area dry with a gauze swab or a clean towel.
4. Take a painkiller if you need one. The NHS says you can take painkillers such as paracetamol or ibuprofen for a painful cut.
5. Leave sex and masturbation until it has fully healed, as Brook advises.
6. Use a lubricant afterwards. Once the tear has healed, Brook suggests using lube during sex and when masturbating, to help stop it tearing again.

If your penis is sore or red after sex without a tear, our guide to a sore or red penis after sex covers the other common causes.

How long does a frenulum tear take to heal?

We couldn't find a set healing time in UK guidance. The NHS says most cuts start to heal within a few days, and Alder Hey and Brook say a frenulum tear usually heals without any treatment. Wait until it has fully healed before sex or masturbation, and see a GP or a sexual health clinic if it doesn't heal.

If it keeps tearing, Alder Hey says you may need a small operation called a frenuloplasty, which makes the bridge of skin longer to reduce the chance of more tears.

What is frenuloplasty?

Frenuloplasty is a small operation to lengthen a short frenulum. BAUS describes dividing the skin across and stitching it lengthways, usually under local or general anaesthetic, and Alder Hey says you should be able to go home the same day. The stitches dissolve, usually within two to three weeks, BAUS says.

Alder Hey says you may need a frenuloplasty if your foreskin splits regularly, or if erections are painful because the frenulum pulls the underside of the foreskin up very tightly. If tearing continues after a frenuloplasty, a circumcision may be suggested.

Torn or tight frenulum: the options compared

	What it involves.	When it is used.	Worth knowing.
Let a tear heal	Pressure to stop the bleeding, then no sex or masturbation until it has fully healed	A one-off tear	Usually heals without any treatment; see a GP or a sexual health clinic if it does not
Watch and wait	No specific treatment	Mild symptoms from a tight frenulum	A lubricant during sex can help avoid tears
Frenuloplasty	A small operation that lengthens the frenulum, under local or general anaesthetic; usually home the same day	Tears that keep happening, or painful erections because the frenulum pulls tight	Swelling for 7 to 14 days in between 1 in 2 and 1 in 10 patients; no sex for up to 4 weeks (BAUS) or 6 weeks (Alder Hey)
Circumcision	An operation to remove the foreskin	When a frenuloplasty does not help or the tearing continues, or the foreskin is scarred too	Takes 4 to 6 weeks to heal; it usually leads to loss of sensitivity in the head of the penis

From BAUS, Alder Hey Children's NHS Foundation Trust, Brook and the NHS. Your own doctor will say which suits you.

What is recovery from frenuloplasty like?

BAUS says to expect some swelling and bruising for several days. It advises keeping the area dry for 24 to 48 hours, not soaking in a bath, not swimming for one or two weeks, and trying to pull your foreskin back each day, only as far as feels comfortable, to keep the benefit of the surgery. Simple painkillers such as paracetamol can help.

The advice on sex differs. BAUS says no sex or masturbation for up to four weeks, or until the wound has fully healed, while Alder Hey says not to have sex for 6 weeks after the operation. Ask your own surgeon which applies to you.

What are the risks of frenuloplasty?

BAUS gives these chances for its after-effects:

• swelling of the penis lasting 7 to 14 days: between 1 in 2 and 1 in 10 patients
• reduced feeling in the head of the penis: between 1 in 10 and 1 in 50
• bleeding from the cut that needs a hospital visit and more treatment: between 1 in 10 and 1 in 50
• symptoms not improving, which may mean a full circumcision: between 1 in 10 and 1 in 50
• an infection needing antibiotics, a tender scar, or being unhappy with how it looks: each between 1 in 50 and 1 in 250

Alder Hey says lengthening the frenulum can change the way your penis looks and feels, so it's worth talking the decision through with your doctor.

Does frenuloplasty work?

We found two UK studies of how frenuloplasty turns out. In both, most men were satisfied, but the evidence is thin. Surgeons at an Edinburgh hospital looked back over 12 years and 213 frenuloplasties in a 2006 paper. Of the 209 men they wrote to, 48 replied; their median satisfaction score was 8 out of 10, and 23 of the 209 (11%) later had a circumcision.

The authors thought the true circumcision rate was likely to be 15 to 20%, and noted that some men may have had one elsewhere. They called the 23% reply rate disappointing, and it limits what the study can show.

A 2012 case series from King's College Hospital in London collected data over 10 years on 106 men and reached 96 of them (91%) at least a year after surgery. The average satisfaction score was 8.9 out of 10, and the authors put the share who later needed a circumcision at 8% (9 men). They said there was very little data in the urological literature on how the operation is done or assessed.

Do circumcised men have a frenulum?

It depends on how the circumcision was done. A 2015 surgical paper says most conventional circumcision methods divide (cut) the frenulum as well as removing the foreskin, while its authors describe a technique that leaves the frenulum untouched. Our write-up on circumcision and sensitivity looks at what studies say about the operation.

When should you see a GP about your frenulum?

See a GP or a sexual health clinic if a tear doesn't heal or keeps happening, Brook and Alder Hey advise. Ask for an urgent GP appointment or get help from NHS 111 if the wound becomes swollen, red and more painful, pus comes out, or you feel generally unwell or have a high temperature.

• Call 999 or go to A&E if you can't stop the bleeding, or blood comes out in spurts and is bright red and hard to control. Don't drive yourself: ask someone to drive you, or call 999 for an ambulance.
• Get help from NHS 111 online or call 111 if you can't reach your GP. The NHS says 111 can direct you to the best place to get help.
• See a GP if erections are painful because the frenulum pulls tight. Alder Hey says a small operation may help.
• For sores, lumps or a discharge, see a GP or a sexual health clinic. The NHS says sexual health clinics treat problems with the genitals, and many offer a walk-in service.

If the head of your penis is red, swollen or sore, our guide to balanitis explains the common causes.