Foreskin problems and circumcision

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What is phimosis

Phimosis is a condition in which the foreskin cannot be retracted over the glans (head) of the penis.

Phimosis may be either physiological, as it is for babies, or pathological, if it causes problems with sexual function or pain or is caused by other health problems.

Paraphimosis is when the foreskin remains retracted from the glans of the penis and cannot be returned to its normal position. Paraphimosis can lead to painful swelling of the foreskin and head of the penis, so if it occurs, you should seek medical help straight away.

Phimosis is normal and present in almost all newborn babies. As boys age, their foreskin becomes progressively easier to retract over the glans.

By adulthood, physiological phimosis affects between 1 in 200 and just over 1 in 8 men1.

The incidence of pathological phimosis in adult males is unknown but is expected to be high in uncircumcised men1.

Symptoms of phimosis

If your foreskin feels tight and is difficult to retract, you may have phimosis. Other symptoms include:

  • Ballooning of the foreskin during urination
  • Pain when urinating or when you have an erection.

Causes of phimosis

Phimosis in babies and young boys is due to normal development. The foreskin and glans of the penis are fused together as they develop and gradually separate after birth.

Scarring of the foreskin from injury, infection, inflammation or skin conditions like lichen sclerosis (balanitis xerotica obliterans), can lead to phimosis.

Phimosis is much more common in men with diabetes than in those without3.

Diagnosis of phimosis

Your doctor will need to examine your penis to diagnose phimosis.

Treatment of phimosis

If you or your child has phimosis, gently retracting the foreskin can help resolve the condition.

Steroid creams can be effective for treating phimosis4, but if this treatment is not effective or if phimosis recurs, circumcision may be necessary.

Health effects of phimosis

If your phimosis is severe, you may have difficulty urinating, or pain or discomfort when you have an erection. Phimosis increases the risk of balanitis, which might be a result of bacterial or fungal infection. Long-lasting balanitis can also be a cause of phimosis.

The warm, moist environment between the foreskin and the head of the penis can encourage the growth of bacteria and other microorganisms. This is why good hygiene is necessary if you aren’t circumcised.

Phimosis increases the risk of penis cancer more than most other associated conditions5.

What to do about phimosis

If your child has physiological phimosis with no complications, there’s no need to do anything other than practice good hygiene.

If you’re experiencing pain or any other problem when urinating or when the penis is erect, it’s worth making an appointment with your doctor. Pathological phimosis should be treated to avoid potentially serious complications.

If you have diabetes or other health problems that increase your risk of phimosis, make sure you do your best to stay on top of them.

What questions should I ask my doctor about phimosis?

  • What is the most likely cause of my phimosis?
  • If I’m going to use steroid cream to treat my phimosis, what’s the best way to apply it, how often and for how long?
  • Do you think I should consider getting circumcised?

[1] Morris et al., 2020. Prevalence of Phimosis in Males of All Ages: Systematic Review. Urology

[2] Favorito et al., 2012. Development of the human foreskin during the fetal period. Histology and histopathology

[3] Bromage et al., 2008. Phimosis as a presenting feature of diabetes. BJU International.

[4] Liu et al., 2016. Is steroids therapy effective in treating phimosis? A meta-analysis. International Urology & Nephrology

[5] Larke et al., 2011. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes & Control