Phimosis is a condition where, in men, the foreskin cannot be fully retracted over the glans penis. In older children and adults it can vary in severity, with some men able to retract their foreskin partially (‘relative Phimosis’), and some completely unable to retract their foreskin even in the flaccid state (‘full Phimosis’).
When phimosis develops in an adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
The foreskin of a newborn boy is always closely contracted around the penis head (glans). Only a small passage allows the urine to pass through. In the first months the foreskin is stuck to the glans and cannot be pulled back and one should not attempt to do so.
During the first couple of years, the foreskin will become gradually looser and in many boys it can in time be pulled back without trouble. Half of all three-year-olds can pull back their foreskin.
It is not advisable to try pulling the foreskin back using force, since this may cause small cuts in the foreskin with scars, which could finally cause scarring of the foreskin.
Who can help?
A health visitor or GP will be able to give advice.
If the foreskin is very tight and stays so, causing recurrent infections and problems when urinating, then it may be necessary to operate.
Which problems may a tight foreskin cause?
A tight scarred foreskin – Phimosis – can last throughout life and not cause any trouble at all.
It’s a normally the patient’s decision whether to have an operation or not. If any problems do arise they usually happen after puberty when sexual activity begins.
- There might be trouble urinating.
- Infections may occur under the foreskin.
- At erection, a contracted foreskin may cause trouble by hurting when an attempt is made to pull the foreskin back. It may not go back over the glans before the penis is limp again. If the foreskin becomes inflamed in this position it may lead to paraphimosis, where the foreskin becomes inflamed and painful. This itself may require surgery to rectify.
- Pain during sexual intercourse.
- Very rarely, a malignant growth can occur in a long-standing phimosis.
How is a contracted foreskin treated?
Many boys can be treated with a cream that contains a weak corticosteroid.
- A GP can provide this treatment. The tip of the penis should be treated with the cream two to three times a day for two to three weeks at a time.
- The foreskin must be pulled as far back as possible without using force before the cream is put on.
- If this treatment does not work, an operation can help.
If treatment with creams has been unsuccessful, and signficicant symptoms remain, then a circumcision will be required in most cases to relieve the symptoms.
The tightness may occur for the first time as an adult and usually requires an operation to remove the foreskin.
A Psychosexual Therapist can help you after the operation to gain more confidence in yourself and give you a masturbatory programme followed by Couple tasks.