What is Phimosis?
Medically Reviewed by Dr Aifric Boylan
Last updated on 19.06.2023
What is Phimosis?
Phimosis is the medical word that describes a tight foreskin that cannot be pulled back past the head of the penis (glans).
This is normal in babies and infants (physiologic phimosis), as almost all boys under 2 years of age have a tight foreskin at birth that cannot be pulled back to expose the head. Through repeated erections and developmental changes, the foreskin generally loosens through the ages of 3-16 so that by the age of 16-18, only 1% of boys will still have phimosis (pathologic phimosis).
What causes Phimosis?
One cause of pathologic phimosis is overzealous and forceful pulling back of the foreskin in young children, which can cause adhesions and scarring that leads to the tightness. The foreskin should never be forcibly pulled back as it can also lead to paraphimosis (a medical emergency that occurs when the foreskin has been pulled back, but then cannot be replaced over the head).
Can men develop Phimosis later in life?
Quite apart from ongoing phimosis from childhood, phimosis can develop at any age and after many years of a normally retracting foreskin. This can be a sign of an underlying condition such as:
- Lichen sclerosus (an autoimmune condition also known as balanitis xerotica obliterans). This needs to be aggressively treated by high-potency steroid creams for optimal outcomes and to prevent penile cancer.
- Recurrent balanoposthitis (infections of the foreskin and glans). These can be caused by bacteria or yeasts, and are treated by improving genital hygiene and topical or oral antibiotics.
- Penile cancer. This can lead to scarring, ulceration and changes in the pigmentation, and requires urgent medical care.
In phimosis that has persisted from childhood into adulthood, there may not be any of these underlying causes. In adults who develop phimosis for the first time , it is important to identify the underlying cause because treatments can differ.
What are the symptoms of Phimosis?
Phimosis can lead to symptoms like painful erections, ballooned foreskin while urinating, blood in the urine, cracked and fissured skin around the foreskin and recurrent urinary tract infections. Further, it can lead to psychological harm particularly when it also impedes sexual function and relationships.
One of most common symptoms is difficulty to fully clean under the foreskin where smegma (white secretions) can persist, leading to foul smell and increased likelihood of infection.
Some studies have found an increased incidence of penile cancer in men with phimosis, possibly in relation to difficulty cleaning leading to poorer hygiene and higher rates of HPV (human papilloma virus) infection.
How is Phimosis managed?
A swab to check for infections may be performed by a doctor, and less commonly a skin biopsy if an autoimmune condition or cancer is suspected.
In those with no underlying cause for their phimosis ( i.e. it has just persisted from childhood and there is no recurrent infection or autoimmune condition) treatment involves a trial of steroid cream to loosen the foreskin, good genital hygiene. In those whose foreskins still don’t retract past the glans, surgical treatment (a circumcision) may be offered.
Phimosis is a common condition, and the prognosis is generally excellent for people who don’t delay seeking help from their doctor.
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