What is Phimosis?

Fact checked by Dr. Abdol Rashid Bin Masrom

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What is Phimosis

closeup face of a man vexed over phimosis

<click to learn how ZSR circumcision can help cure phimosis>

Phimosis is a health condition in which the foreskin cannot be pulled back or retracted beyond the glans. It is most prevalent among males, both pediatric and adults. The tightening of the prepuce [foreskin] is caused by the narrowing of the preputial tissue, causing adhesion between the foreskin and the glans.

Many male babies are born with nonretractable skin. The foreskin is usually attached to the glans, and as they develop, the prepuce loosens and becomes retractable at about three years. That’s called physiological phimosis, but when it causes pain, it is referred to as pathological phimosis, and it may cause problems with erection and sexual penetration among boys of 13-17 years. 

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Causes and Symptoms of Phimosis

Phimosis is a natural condition, and there is no scientific evidence to show why it occurs among some boys and not others. Additionally, it may be caused by forcibly retracting the prepuce, causing scarring and small, tiny injuries. That makes it difficult to pull back the foreskin.

Medical Conditions – Other health conditions can cause phimosis. For instance, if you have diabetes, the chances of getting phimosis are high because diabetes is linked to balanitis, inflammation of the glans penis. Besides, poor hygiene can cause the condition as it results in the infection of the foreskin.

Other skin conditions may lead to the tightening of the prepuce. They include:

  • Eczema: An acute medical condition that causes redness, itchiness, and dryness of the foreskin.
  • Lichen planus: A non-contagious itchy rash that affects different parts of the skin, including the prepuce.
  • Psoriasis: A skin condition in which there are red patches and flaky skin throughout the body.
  • Lichens sclerosus: Scarring of the foreskin caused by urinary irritation; it can lead to phimosis.

Aging – Just like one develops wrinkles on the foreskin because of old age, so does the foreskin. An individual mostly experiences after a few erections.


Symptoms of Phimosis

Not always does phimosis lead to any symptoms. But when one experiences it, it is normally characterized by soreness, swelling, and redness. As mentioned earlier, urinary irritation, where the foreskin interferes with the normal urine passage, causing phimosis. That means that one becomes unable to empty their bladder fully.

Some signs and symptoms of phimosis include:

  • Itchy and sore foreskin with odor
  • Accumulation of a thick fluid
  • Redness and swelling of the glans penis
  • Pain when urinating

When Should You Seek Medical Help for phimosis?

Most cases of childhood phimosis require no medical attention, especially among small babies and young boys. Still, it is recommended to monitor your child’s condition and see if it will lead to any problems. If there are no serious symptoms, then you won’t need to seek medical help. However, if the child develops any symptoms and experiences pain during a healthy erection or urinating, that’s a red flag to take them to the doctor. Ordinarily, the health provider will examine any recurring infections of the glans penis or prepuce. They’ll also evaluate the symptoms and any signs of pathological phimosis.

When it comes to phimosis diagnosis, a doctor will not require any laboratory tests or imaging studies. Providers primarily diagnose the condition clinically. The only time they might require lab tests is when the condition is linked to urinary or skin infections. That said, the treating doctor should be able to differentiate between physiological phimosis and pathological phimosis. There is also a need to grade the severity of the condition and the possible origin or cause to better manage the subsequent treatment procedure.

Who is Most Likely to Have Phimosis?

  • Almost 96% of male infants have non-retractable foreskin because of the natural adhesion between the glans penis and the foreskin caused by the narrowing of the preputial orifice and frenulum breve, a condition in which the part of the skin that connects to the foreskin is shorter than normal. The skin then becomes retractable at variable periods, usually between three and 18 years or beyond.

    However, 2% of males continue to have non-retractable prepuce throughout their life despite being normal. In physiological phimosis, the tight foreskin is healthy and pouts when gently pulled back. With pathological phimosis, even gentle traction can cause the formation of cone-shaped structures with white ends.

    Clinical records show that the morbidity rate of pathological phimosis among boys is about 0.4 per 1000 boys every year. Additionally, 0.6% of boys are likely to develop the condition before they attain 15 years, and it is usually characterized by dysuria, urinary infections, and pain.

What Not to Do If You Have Phimosis?

When you have phimosis, it is not advisable to stretch or pull back the foreskin forcefully. Even with the slightest pull, one can develop scarring and inflammation that can make the condition worse. 

But if you need to stretch the prepuce, ensure you apply phimosis steroid cream to it and practice phimosis stretching exercise and massage the foreskin until the cream penetrates the skin. Start pulling back the foreskin until you start experiencing discomfort. At this point, the tip of the glans will be exposed. Try applying the cream to the tip, so you can easily retract the foreskin without pain.

Treatment of Phimosis

It is always recommended to seek medical help when you have phimosis. Usually, a doctor will send a swab from the glans to the lab to determine the cause of the condition, for instance, balanitis.

In case the condition is caused by a fungal infection, the doctor will prescribe antifungal ointments, but if it is a bacterial infection, s/he will administer an antibiotic.

Nonetheless, some severe cases of phimosis are better treated through circumcision or a similar operation. That includes removing the prepuce/foreskin, usually done during infancy, although it may be performed at any age. A doctor may also recommend circumcision if the patient experiences recurrent balanitis and other urinary infections.

Unfortunately, there have been cases where patients complain about complications following circumcision. That’s why we recommend ZSR Stapler Circumcision technique that relies on the latest tech to perform circumcision quickly, accurately, and effortlessly, which favors the operator and patient. Besides, the technique is versatile, as it can be used for patients of all ages. The circumcision device comes in different types and designs to accommodate men at different ages and life stages.


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