Sometimes it can be confusing figuring out what’s normal anatomy and what are issues that might need medical attention. If you have a foreskin and you can’t pull it back over the head of your penis you might be dealing with phimosis. Phimosis is a condition in which the foreskin is too tight to be retracted back over the glans. While phimosis isn’t always a problem, if it’s causing difficulties with urinating, pain or discomfort during sexual activity, or complications such as frequent infection, it’s important to get it sorted.
“There’s certainly embarrassment to talk about something that [men] think is not very critical to the overall discussion about health,” Associate Professor of Surgery in the Department of Urology, Princess Alexandra Hospital, Eric Chung says.
Don’t let an awkward conversation put you off getting help to improve your sexual health — here’s what you need to know about phimosis and how to treat it.
What causes phimosis?
Phimosis is normal in uncircumcised children, and as boys age their foreskin will naturally separate from the glans and become easier to pull back. This usually occurs by around eight years old but can happen later. In teenagers and adults, phimosis can be caused by a number of things including injury or trauma, infection, inflammation or skin conditions such as lichen sclerosis.
“We don't really know the true prevalence of this condition, but it’s reasonable to say that is not uncommon,” A/Professor Chung says.
Other symptoms of phimosis include ballooning of the foreskin during urination and pain when urinating or when you have an erection.
“I hadn't heard of it until a particularly painful experience with a high school girlfriend and I realised it couldn't be normal to be in this much pain, even with a beginner, but a quick glance on the web introduced me to it,” Sam*, 22, says. “As an adult, it makes most forms of physical intimacy painful or just downright awkward. The consequences of that have led to a very patchy sex life, low confidence in the bedroom and even a bit of erectile dysfunction.”
Leaving phimosis untreated can increase your risk of potentially serious complications such as balanitis (an infection that can happen when you don’t keep the inside of your foreskin clean) and penile cancer.
Read more: How to properly clean your penis
What are the treatment options for phimosis?
Gently retracting the foreskin over time can help resolve phimosis and steroid creams can also be effective1 in softening the skin and making it easier to move back and forth. However, a tight foreskin should always be treated with the guidance of a medical professional so chat to your doctor before you start any stretching exercises for phimosis.
“You can retract the foreskin [through stretches] but the problem of retracting a foreskin is that sometimes it can be quite tight, then it can cause paraphimosis,” A/Professor Chung says.
Paraphimosis is when your foreskin is pulled behind the head of the penis and can’t go back to its original position. If your foreskin stays in this position, it can cause pain, swelling and can stop blood flow to the penis, so it needs to be treated by a medical professional immediately.
The other option for the treatment of phimosis is circumcision, which is the surgical removal of the foreskin. Circumcision is a common and usually straightforward surgical procedure, but it’s not without complications. As for any medical or surgical procedure, the potential benefits of circumcision need to be weighed against possible harms. These include surgical accidents, complications from anaesthetics, and infection after surgery. However, the benefits of other, less invasive, treatment options are being explored.
“We know there's a lot of literature about circumcision to treat phimosis and the benefit of circumcision, but there's really no good scientific study looking at treating phimosis while preserving the foreskin,” A/Professor Chung says.
A/Professor Chung and Professor David Gillatt are running a world-first clinical trial assessing the treatment of phimosis with a stretching device that slowly and gently stretches the foreskin using a small inflatable balloon.
"By the daily application of the balloon stretching, then the foreskin become more relaxed over time and then you would be able to retract your foreskin easily," A/Professor Chung says.
If you’re based in Sydney or Brisbane you can register your interest to take part in the trial here. If you think you might have phimosis and it’s bothering you, chat to your doctor as soon as possible.
 Liu et al., 2016. Is steroids therapy effective in treating phimosis? A meta-analysis. International Urology & Nephrology