What is phimosis?
Phimosis is a condition of the penis that occurs in some adults and children who aren’t circumcised. If you have phimosis, your foreskin can’t be pulled back (retracted). It may look like your penis has rings around the tip.
There are two types of phimosis:
- Physiologic type of phimosis is associated with childhood and usually resolves as you age.
- Pathologic type of phimosis is associated with a condition called balanitis xerotica obliterans (BXO).
Who does phimosis affect?
The foreskin (also called the prepuce) is tight when babies are born, but usually gets looser by the time the child is 2 years old. During the years between ages 2 and 6, the foreskin loosens up and begins to separate from the head of their penis. Phimosis can also happen after childhood.
Phimosis is found in virtually all newborns, and then the foreskin changes gradually so that it can be pulled back. It’s estimated that only 1% of people still have phimosis when they're 16 years old.
What causes phimosis?
There are various reasons phimosis might develop, including:
- Poor hygiene. This could actually be a cause and a result of phimosis. It might be irritating and painful to try to clean thoroughly, but not cleaning could lead to infection.
- Skin conditions such as eczema, psoriasis, lichen planus and lichen sclerosus.
- Preputial adhesions, or scar tissue, that keep the foreskin attached to the tip (glans) of your penis
- Injuries
- Infections, including sexually transmitted infections (STIs)
What are the symptoms of phimosis?
The symptoms of phimosis can vary in severity and may affect both children and adults. Here are the common symptoms associated with phimosis:
- Redness or discoloration, which may occur when infected/irritated
- Swelling (inflammation), which may occur when infected/irritated
- Soreness
- Pain while urinating (dysuria).
- Pain with erections or with sexual activity.
How is phimosis diagnosed and treated?
Your healthcare provider can diagnose phimosis during a physical examination. In addition, they might order tests to find out if there’s an infection present in urine or penis discharge.
Physiological phimosis (congenital) typically doesn’t need treatment. Usually, your child grows out of it. Your provider might also call this primary phimosis.
Pathological phimosis does need to be treated. Treatment for phimosis depends on the severity and the presence of any complications. Treatment options may include:
- Steroid cream to apply to the skin of your penis.
- Gently start stretching the foreskin after about two weeks of using the steroid cream.
- Surgery. If your child is having difficulty, their provider might make a small cut in the foreskin so you’re able to pull it back.
- Circumcision. If you’re an adult with lots of scar tissue, your provider will probably recommend circumcision. This procedure will remove the foreskin and free the glans.
- Circumcision if balanitis xerotic obliterans (BXO) is causing the phimosis and steroid creams don’t work. Phimosis can make sexual activity uncomfortable for adults. Also, BXO can cause urinary tract problems and is associated with a higher risk of cancer of the penis.
Recovery from circumcision takes about a week to 10 days.
What are risk factors of phimosis treatment?
The complications associated with steroids aren’t usually an issue with the creams used to retract the foreskin. Those issues are mostly related to long-term oral use of steroids.
While circumcision used to be a common procedure performed on newborns, it’s not necessarily done right away anymore. Risks associated with circumcision include:
- Bleeding
- Infection
- Having a foreskin that is too long or too short
- Pain