Phimosis

A condition where the foreskin cannot be fully retracted over the head of the penis

What is Phimosis?

Phimosis is a condition in which the foreskin of the penis cannot be fully retracted (pulled back) over the head of the penis (glans). This can be normal in young boys and usually resolves naturally by age 3-5. However, when it persists beyond this age or develops in adulthood, it may require medical attention. Phimosis can be physiological (normal development) or pathological (due to scarring or infection).

Common Symptoms

Phimosis can cause various genital and urinary symptoms:

Common Causes

Phimosis can be either physiological or pathological:

Physiological Phimosis

  • Normal development: Natural adhesions between foreskin and glans in infants
  • Age-related: Gradual separation occurs naturally over time
  • Hormonal changes: Puberty hormones help loosen the foreskin

Pathological Phimosis

  • Balanitis: Inflammation of the glans penis
  • Balanoposthitis: Inflammation of both glans and foreskin
  • Lichen sclerosus: Skin condition causing scarring and tightening
  • Repeated infections: Recurrent bacterial or fungal infections
  • Forced retraction: Traumatic attempts to retract the foreskin
  • Poor hygiene: Leading to infections and scarring
  • Diabetes: Increased risk of infections and delayed healing

Types of Phimosis

Physiological Phimosis

Normal, non-scarring phimosis present from birth. The foreskin gradually becomes retractable with age and hormonal changes.

Pathological Phimosis

Acquired phimosis due to scarring, infection, or inflammation. The foreskin becomes thick, white, and non-retractable.

Paraphimosis

Emergency condition where retracted foreskin cannot be returned to its normal position, causing swelling and pain.

Severity Grades

Grade 1

Foreskin retracts fully but causes mild discomfort or tight feeling.

Grade 2

Foreskin retracts partially, exposing part of the glans but not the full head.

Grade 3

Foreskin retracts only slightly, showing just the urethral opening.

Grade 4

No retraction possible; foreskin opening may be pinpoint (pinhole phimosis).

Treatment Options

Conservative Treatment

  • Topical corticosteroids: Steroid creams to soften and stretch the foreskin
  • Gentle stretching exercises: Gradual manual stretching with proper technique
  • Good hygiene: Gentle cleaning to prevent infections
  • Treatment of infections: Antifungal or antibiotic treatments as needed
  • Observation: Watchful waiting in young children

Surgical Treatment

  • Circumcision: Complete removal of the foreskin
  • Preputioplasty: Surgical widening of the foreskin opening
  • Dorsal slit: Small incision to widen the foreskin
  • Frenuloplasty: Division of the frenulum if it's restricting retraction

Emergency Treatment (Paraphimosis)

  • Manual reduction: Immediate attempt to reduce the swelling
  • Ice application: To reduce swelling and inflammation
  • Osmotic agents: Sugar or salt to reduce edema
  • Emergency circumcision: If manual reduction fails

When to See a Healthcare Provider

Seek immediate medical attention for:

  • Paraphimosis (foreskin stuck in retracted position)
  • Severe pain or swelling of the penis
  • Signs of infection (fever, pus, severe redness)
  • Inability to urinate or severe difficulty urinating
  • Blood in urine or from the penis

Schedule routine consultation for:

  • Phimosis persisting beyond age 5 in boys
  • Recurrent infections of the foreskin or glans
  • Painful erections due to tight foreskin
  • Difficulty with sexual activity in adults
  • Chronic discomfort or hygiene problems

Potential Complications

  • Paraphimosis: Medical emergency requiring immediate treatment
  • Recurrent infections: Balanitis, balanoposthitis, or UTIs
  • Sexual dysfunction: Pain during intercourse or erectile problems
  • Urinary problems: Difficulty urinating or urinary retention
  • Scarring: From repeated infections or forced retraction
  • Increased cancer risk: Rare, but poor hygiene may increase risk

Prevention

  • Never force retraction of the foreskin in young children
  • Maintain good genital hygiene with gentle cleaning
  • Treat infections promptly to prevent scarring
  • Avoid aggressive cleaning or use of harsh soaps
  • Control diabetes to reduce infection risk
  • Practice safe sex to prevent sexually transmitted infections
  • Seek early medical advice for persistent problems

Proper Hygiene

  • Gently clean the genital area with warm water daily
  • Use mild, unscented soap if needed
  • Dry the area thoroughly after washing
  • Only retract the foreskin if it moves easily and comfortably
  • Always return the foreskin to its normal position after cleaning
  • Change underwear daily and choose breathable fabrics

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