What is phimosis?

Phimosis: Treatment, causes, and symptoms
By
Amanda Barrell   
Reviewed
by Daniel Murrell, MD
Phimosis describes a condition
in which the foreskin is too tight to be pulled back over the head or glans of the
penis.


Most uncircumcised babies and
toddlers will have phimosis, meaning the foreskin cannot be retracted. This is
because the glans and the foreskin remain connected for the first few years of
life.
In adults, there are a number
of risk factors and causes of phimosis, though it only tends to be a problem if
it causes symptoms.
In this article, we take a
look at the causes of this condition, along with what can be used to treat it
when symptoms occur.
Causes and risk factors


Phimosis only affects
uncircumcised males and is more common in boys than men.
Phimosis is normal in
uncircumcised babies and toddlers, as the foreskin is still attached to the
glans. It will start to detach naturally between 2 and 6 years of age, though
it might happen later. It can happen at up to around 10 years old, in some
boys.
The foreskin can be pulled
back behind the glans in about 50 percent of 1-year-old boys, and almost 90
percent of 3-year-olds. Phimosis will occur in less than 1 percent of teenagers
between 16 and 18.
It is most likely to occur in
older boys with:

  • repeated urinary tract
    infections
  • foreskin infection
  • repeated rough handling of the
    foreskin
  • foreskin trauma
In adults, risk factors for
phimosis include sexually transmitted infections.
Phimosis may be caused by a
skin condition, such as:

  • Eczema: A long-term condition
    that causes the skin to become itchy, red, dry, and cracked.
  • Psoriasis: This skin condition
    leads to patches of skin becoming red, flaky, and crusty.
  • Lichen planus: An itchy rash
    that can affect different areas of the body. It is not contagious.
  • Lichen sclerosus: This
    condition causes scarring on the foreskin that can lead to phimosis. It may be
    caused by a urinary irritation.
Symptoms


Phimosis does not always lead
to symptoms. When it does, however, these may include redness, soreness, or
swelling.
A tight foreskin may interfere
with the normal passage of urine. In severe cases, this can prevent the person
from emptying their bladder fully.
Phimosis can lead to
inflammation of the penis, called balanitis, or inflammation of both the glans
and the foreskin, called balanoposthitis. These conditions both tend to be
caused by poor hygiene.
Symptoms of balanitis include:

  • soreness, itchiness, and odor
  • redness and swelling
  • a buildup of thick fluid
  • pain when urinating
During sex, phimosis may cause
pain, skin splitting, or a lack of sensation. Wearing a condom and using
lubricant can make intercourse more comfortable.

Diagnosis


A doctor will take a full
history from the person, asking about any previous penis infection or injuries
they might have had. They may also inquire about the impact of any symptoms on
sexual activity. A physical examination will include them looking at the penis
and foreskin.
The doctor may order urine
tests to check for urine infections or take a swab from the foreskin area to
check for bacteria.
Phimosis is a risk factor for
type 2 diabetes. Adults presenting with a tight foreskin may be given blood and
urine tests to check their blood sugar levels, as a result.
Treatment


Treatment options for phimosis
depend on the symptoms that occur. Most cases of balanitis are easily treated
with good hygiene, creams, and ointments.
People are advised to clean
the penis daily with lukewarm water and to dry it gently to improve hygiene.
They should avoid using soap, bubble bath or shampoo on their genitals, and dry
under the foreskin after urinating.
A doctor may recommend using a
steroid cream or ointment to help with the irritation.
If balanoposthitis has been
caused by a fungal or bacterial infection, an antifungal cream or a course of
antibiotics may be needed.
In cases of severe or repeated
balanitis or balanoposthitis, doctors may recommend treating the phimosis
itself. They may prescribe steroid creams to help soften the foreskin and make
it easier to retract, or surgery may be an option.
Doctors may suggest
circumcision, in which all or part of the foreskin is removed, though the
procedure carries the risk of bleeding and infection.
An operation to surgically
release the areas where the foreskin gets stuck to the glans may also be
possible. This will preserve the foreskin, but not necessarily prevent phimosis
from occurring again.

Related conditions

Paraphimosis describes when a
retracted foreskin cannot go back to its original position. This problem causes
the glans to become painful and swollen.
Emergency medical attention is
needed to avoid more serious pain and to stop the blood flow to the penis
becoming restricted.
Doctors may apply a local
anesthetic gel while pressing on the glans and pushing the foreskin forward. In
some cases, a small slit may need to be made in the foreskin to relieve the
pressure. In severe cases, circumcision may be recommended.
In rare and very severe cases,
a lack of blood flow to the penis can cause the tissue to die. If this happens,
the penis may need to be surgically removed.
Prevention


Preventing the symptoms of
phimosis relies on good hygiene.
Gently cleaning the penis and
under the foreskin, with warm water, every day will help avoid problems. This
will facilitate keeping the skin loose and avoiding infection.
Caring for an uncircumcised
penis


Men with an uncircumcised
penis are recommended to pull back the foreskin and wash underneath it with
warm water.
Using a mild or non-perfumed
soap will reduce the risk of irritation, as will avoiding the use of talc or
deodorant on the area.
Most uncircumcised baby boys
have a foreskin that will not pull back because it is still attached to the
penis. It will start to detach naturally between 2 and 6 years of age, although
it could take longer.
Parents should not try to
force the foreskin back before it is ready, as this may be painful and damage
the foreskin.
Outlook


While the symptoms of phimosis
may be uncomfortable, the condition itself is not life-threatening. The
symptoms of phimosis are easily treated with no lasting effects.
There is some evidence that tight foreskins
may encourage tumors to develop in the penis, though more research is needed in
this area.
SOURCE:
MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.