Tight Foreskin? Phimosis?

What is phimosis?

Phimosis is a condition in which a man cannot retract or pull back his foreskin around the tip of penis. Phimosis is normal in babies and toddlers who are not circumcised but it usually will resolve around 3 years old. Young boys usually do not need treatment for phimosis unless they have difficulty urinating.

Symptoms of phimosis

The main symptom of phimosis is when someone is unable to retract the foreskin by the age of 3. Usually, the foreskin will loosen over time and by the age of 17, a boy should be able to retract his foreskin to the tip of penis easily. However, it can take a longer time in some men.

Causes of phimosis

Phimosis can happen if the foreskin is retracted forcibly when it is not ready yet. This can harm the skin and lead to scarring which will cause foreskin difficult to retract. Besides this, poor hygiene can lead to infection of glans of penis or foreskin. This condition is called balanitis or balanoposthitis. Recurrent infection may lead to scarring and cause phimosis in adults.

Other causes:

  • Frequent urinary catheterization that will lead to injury/damage and cause scarring
  • Frenulum breve (an abnormally short frenulum)
  • Sexually transmitted disease (STDs)

When to seek help?

Some men with phimosis will recover without any treatment, especially among those young boys. However, you need to seek medical attention if and when the phimosis causes problems such as recurrent infections, painful urination and so on.

Treatment for phimosis

A physical examination and review of symptoms usually will be performed by doctor in order to diagnose phimosis.

If there are signs of infection, swab of the foreskin needs to be taken and sent to the lab to confirm the type of infection. Antibiotic or antifungal topical medications will be prescribed and usually enough to cure the infection.

If there is no infection, the tight foreskin/phimosis is happened due to naturally occurring development. If this is the case, there are a few treatments option available.

Treatment option for phimosis:
1) Daily gentle traction— by doing this, able to loosen the foreskin slowly
2) Topical steroid

  • One of the side effects of topical steroid is thinning of skin
  • By using topical steroid, it will cause foreskin to become thinner and softer due to the loss of tissue matrix and reorganizing the collagen and elastin fibers inside the foreskin. This will make retraction easier
  • Steroid ointment need to be massage into the area around the glans of penis and foreskin twice a day for several week

3) Circumcision

  • If phimosis is serious, circumcision is needed to solve the problem
  • Circumcision is removal of the foreskin, it can be performed in infant or male of any age

What happen if phimosis is left untreated?

Usually, phimosis will resolve by itself in more than 90% of cases without any intervention. However, some men will face problems or persistent phimosis after some time. When phimosis is persistent or causes problems, this is the time when medical/surgical intervention is needed. If left untreated, some complications will associate with phimosis:

  • Painful urination due to obstruction or infection
  • Painful during sexual intercourse
  • Paraphimosis
  • Penile malignancy

What are the differences between phimosis and paraphimosis?

Phimosis is the condition where foreskin unable to retract or pull back due to the tight foreskin. However, paraphimosis is the condition where the foreskin is retracted but the foreskin unable to move back to its normal position. Paraphimosis is a medical emergency. If paraphimosis left untreated, it will cause reduction of blood flow to the end of penis and eventually lead to gangrene of penis which is death of the tissue due to lack of blood flow.

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