Phimosis

What phimosis is.

Phimosis simply means the foreskin cannot be drawn back fully over the glans. In young boys this is normal and resolves on its own with time. In an adult it is not normal, and it usually reflects either tightness that never loosened or scarring that has developed since.

Severity ranges widely. Some men can retract fully when soft but not when erect. Others can retract only partly, with a tight ring that causes discomfort. At the far end the opening is so narrow that hygiene becomes difficult and the stream of urine balloons the foreskin before it escapes.

The grade matters because it decides the treatment. Mild tightness frequently responds to a steroid cream and gentle stretching over several weeks. Scarred, rigid tissue does not, and pretending otherwise simply delays a straightforward day care procedure.

How common is it?

Tight foreskin is one of the most frequent male genital complaints seen in adult practice, and it is the single commonest reason for adult circumcision. It appears in two peaks: young men who find it during their first sexual experiences, and older men in whom diabetes or a skin condition has caused scarring.

Many men live with it for years, assuming it is simply how they are built, and only come forward when it starts to tear, hurt during sex or cause repeated infection.

Symptoms to look out for

Phimosis rarely announces itself. It is usually discovered through hygiene difficulty, discomfort during sex or a repeated infection.

• The foreskin will not retract, or only retracts painfully
• A tight white ring at the tip that will not stretch
• Ballooning of the foreskin while passing urine
• Splitting or bleeding at the tip during erection or sex
• Pain or a tearing sensation during intercourse
• Repeated redness, swelling, itching or discharge underneath
• Difficulty cleaning properly despite good hygiene
• Pale, thickened, rigid skin that has lost its stretch

What causes it

Adult phimosis is either tightness that persisted from childhood, or scarring that developed later. The two look different on examination.

• Natural tightness that never loosened as the body matured
• Scarring from repeated episodes of infection under the foreskin
• Lichen sclerosus, a skin condition that turns the tip pale and rigid
• Diabetes with high blood sugar, which raises infection risk sharply
• Forceful retraction in childhood leaving scar tissue behind
• Injury, a tear that healed badly, or a previous procedure
• Poorly controlled skin conditions such as eczema affecting the area

When to see a doctor

A tight foreskin that causes no trouble at all can reasonably be left alone. These are the signs that it should be looked at.

• Pain or splitting during erection or intercourse
• Two or more episodes of infection under the foreskin
• Ballooning while passing urine, or a weak stream
• Pale, thickened tissue suggesting a skin condition
• You have diabetes and the skin is repeatedly inflamed
• A creamy discharge, odour or persistent itching

How it is diagnosed

Diagnosis is made on examination in a few minutes. Tests are used only to identify a cause such as diabetes or a skin condition.

What to expect after treatment

Mild cases treated with a steroid cream and gentle daily stretching often loosen within four to eight weeks, and no surgery is needed. Where scarring is established, a cream will not change rigid tissue, and a day care procedure gives a permanent result instead.

Where the foreskin can be preserved it sometimes is, using a widening procedure rather than removal. Where it cannot, circumcision surgery is the definitive answer, and modern techniques give a neat, planned scar line agreed with you beforehand.

• Creams help mild tightness but not scarred or rigid tissue
• Day care surgery means home the same day in almost every case
• Desk based work is usually possible again within three to five days
• Sexual activity resumes at four to six weeks once tenderness has gone
• Recurrent infection and painful sex usually stop completely afterwards

What it costs

Cream based treatment costs very little and is always considered first where the tissue allows it. Surgical cost depends on the technique chosen, the anaesthesia used, whether scarring makes the case more complex and whether a frenulum correction is done at the same time. A single figure covering surgeon, theatre, anaesthesia, dressings and follow up is given after examination.