Phimosis

What is phimosis?

The foreskin is the thin layer of skin that covers the end of the penis. It’s normal for children to have a tight foreskin, but this doesn’t always mean it’s phimosis.

Phimosis is pathological (meaning does not occur naturally) tightening of the end of the foreskin. You can tell if it’s tight because it can’t be pulled backwards over the head of the penis.

What are the symptoms of phimosis?

A tight foreskin may not cause symptoms. But these symptoms may suggest complications and need investigating by a doctor:

• Swelling

• Pain

• A weak flow when peeing

• Frequent urine infections

• Bleeding or blood in the urine

• An unpleasant smell or discharge

• Painful erections and pain during sex

How common is phimosis?

The end of the foreskin naturally loosens as you get older so phimosis is less common in older children. Only 10% of boys will still have a tight foreskin by the age of 7 and 1% by the age of 17. But if the foreskin is still tight and causing problems by age 5, it’s a good idea to see a doctor.

What causes phimosis?

Phimosis can occur spontaneously and be normal; this is called primary or physiological phimosis. In physiological phimosis there’s no scarring.

In secondary, or pathological phimosis, there is scar tissue formed from:

• Recurrent inflammation of the penis, called balanitis

• Traumatic retraction of the foreskin, such as pulling the foreskin back before it’s naturally loose enough

• An aggressive scarring condition called balanitis xerotica obliterans or lichen sclerosus

How is phimosis diagnosed?

A doctor will ask about your symptoms and examine yours or your child’s foreskin and give a diagnosis based on this. No special tests are required.

How to treat phimosis

If your child’s or your foreskin is tight but isn’t causing any problems, then you can wash the penis regularly using warm water and non-perfumed soap. Do not use perfumed soap, deodorant or talcum powder as it may cause irritation.

If you’re an adult, gently pull back your foreskin to clean underneath, but do not overstretch the foreskin. Do not pull the foreskin back in children.

Physiological phimosis is more likely to resolve naturally and may not require treatment.

Due to the scarring in pathological phimosis, treatment is usually required. The treatments are:

• Steroid cream – this is applied to the foreskin 2-3 times daily for 6-12 weeks. The steroid cream thins the foreskin allowing retraction. This is a safe treatment and has no side effects.

• Surgery – this is normally a circumcision to remove the foreskin, or widen the edge of the foreskin. If this is necessary, a surgeon will discuss your options with you to find the operation that’s most suitable

When should I seek help?

If you or your child has any symptoms, see a doctor. If your child has no symptoms and in the process of puberty, the phimosis may not need medical attention. If the foreskin is still unretractable at the end of puberty, then see a doctor who can discuss this further.

If a tight foreskin gets retracted and cannot be put back, you need to seek immediate medical attention. The tight foreskin can cut off blood supply to the end of the penis causing permanent damage.