Phimosis

What is phimosis?

Phimosis (fie-MOH-sis) is a condition of the penis that occurs in some uncircumcised adults and children. If you have phimosis, you can’t pull back (retract) the foreskin (prepuce). It may look like your penis has rings around the tip. Under typical circumstances, you should be able to pull back your foreskin easily and see the entire head (glans) of your penis.

Having phimosis isn’t necessarily a problem. Babies have phimosis at birth, and their tight foreskin will usually loosen as they get older without treatment. Phimosis becomes a problem when it causes symptoms, such as a pinhole-sized opening or you can’t pull back your foreskin enough to clean the area underneath.

What are the types of phimosis?

There are two types of phimosis:

• Physiologic phimosis. Physiologic phimosis occurs more often in children. It usually resolves as they get older.
• Pathologic (congenital) phimosis. Infection, inflammation or scarring cause pathologic phimosis. Lichen sclerosus is a common cause.

How common is phimosis?

Nearly all babies assigned male at birth (AMAB) have physiological phimosis. As newborns age, the foreskin changes gradually so it can pull back. Medical professionals estimate only about 1% of people still have physiologic phimosis when they’re 16 or older.

Less than 1% of children have pathologic phimosis.

What are the symptoms of phimosis?

The primary symptom of phimosis is that you can’t pull the foreskin back from the head of your penis. But other phimosis symptoms may include:

• Discoloration (red, purple, dark brown or black), which may occur if there’s irritation or you have an infection.
• Swelling, which may occur if there’s irritation or you have an infection.
• Soreness or pain.
• Pain while peeing (dysuria).
• Weak pee stream.
• Blood in your pee (hematuria).
• Smegma.
• Pain when you get an erection or have sexual intercourse.

What does phimosis look like?

If you have phimosis, it may look like your penis has rings or rubber bands around the tip. Most importantly, you can’t pull back your foreskin.

What is the main cause of phimosis?

If you or your child has pathologic phimosis, the most common causes are infection, including sexually transmitted infections (STIs), or scarring. If you have a foreskin, it’s important to thoroughly clean the glans with mild soap and warm water. Dry the area with a clean towel afterward.

Other phimosis causes may include:

• Skin conditions, including eczema, psoriasis, lichen planus and lichen sclerosus.
• Penile (preputial) adhesions, or scar tissue, that keep the foreskin attached to the tip of your penis.
• Injuries.

Who does phimosis affect?

The foreskin is tight in virtually all newborns. It usually starts to loosen by the time your child is 2. Between the ages of 2 and 6, the foreskin begins to separate from the head of their penis.

What are the complications of phimosis?

Phimosis may cause the following complications:

• Foreskin inflammation (posthitis), glans inflammation (balanitis) or foreskin and glans inflammation (balanoposthitis).
• UTIs (urinary tract infections).
• Foreskin tears (adhesions)
• The foreskin gets stuck or trapped behind the glans and you can’t pull it down (paraphimosis).
• Poor hygiene.

Long-standing phimosis may also increase your risk of developing penile cancer.

How is phimosis diagnosed?

A healthcare provider can diagnose phimosis by reviewing your symptoms and performing a physical exam.

They may also order tests to determine if you have an infection. Tests may include:

• Pee test (urinalysis).
• Urethral discharge culture.

How do you fix phimosis?

Physiologic phimosis usually doesn’t need treatment. In most cases, your child will grow out of it.

The first treatment healthcare providers usually try for pathologic phimosis typically includes a topical corticosteroid cream or gel. You rub these medications directly onto your penis. Providers may also suggest that you start stretching the foreskin about two weeks after starting to use a corticosteroid cream. Pull the foreskin back gently, only as far as you can without it hurting. Keep applying the cream on the areas of your glans that you expose through these foreskin stretching exercises.

They’ll also prescribe antibiotics if you have an infection in your foreskin or glans.

You may need phimosis surgery if a corticosteroid cream doesn’t work. This typically involves a circumcision. During a circumcision, they remove the foreskin to completely expose the glans.

Should I get circumcised if I have phimosis?

Healthcare providers recommend circumcision for adults if:

• Lichen sclerosus causes phimosis.
• The phimosis is severe.
• A corticosteroid cream doesn’t work.
• Sexual intercourse, including masturbation, is painful.

What are the complications or side effects of phimosis treatment?

Topical corticosteroid creams don’t typically have side effects.

Common circumcision complications may include:

• Bleeding.
• Infection.
• Your foreskin is too short or long.
• Pain.

How soon after treatment will I feel better?

It takes about a week to 10 days to feel better after circumcision.

Can phimosis be prevented?

There’s no way to prevent physiological phimosis. Nearly all newborns have it. Circumcision will prevent pathologic phimosis.

It’s also important to keep your child’s penis clean. Infections are the most common cause of pathologic phimosis. Healthcare providers will give parents or caregivers directions on the best way to clean a penis. It’s also important to remember that the foreskin isn’t moveable for the first few years of life. When your child is old enough to bathe on their own, teach them how to clean their penis properly.

For adolescents and adults, the easiest way to prevent phimosis is to care for your penis properly. This includes:

• Retracting your foreskin entirely each time you pee.
• Pulling back your foreskin and cleaning underneath whenever you shower or bathe.

Be sure to pull your foreskin back over the head of your penis when you finish peeing or bathing.

What can I expect if I have phimosis?

With proper phimosis treatment, the outlook is good. Corticosteroid creams with gentle stretching or surgery can treat most cases.

How do I take care of myself if I have phimosis?

Keeping your penis healthy is important, even if you don’t have phimosis. You can promote penis health by:

• Using mild soap and warm water to clean your penis every day. Dry it gently after washing.
• Make sure your hands are clean before you touch your penis.
• Wear clean underwear.

If you’re sexually active, it’s also a good idea to wear a condom and use lots of lubricant (lube) to help reduce friction. If you have phimosis, friction can cause your foreskin to tear.

When should I see a healthcare provider?

Talk to a healthcare provider if you suspect you or your child has phimosis. They can show you how to care for yourself or your child.

When should I go to the ER?

Go to the nearest emergency room if:

• You have pain.
• Your skin looks infected.
• You have symptoms of an infection, such as a fever, chills or headache.
• You have trouble peeing or pain while peeing.

What questions should I ask a healthcare provider?

Questions you may want to ask your provider include:

• Will my phimosis get better?
• What treatment do you recommend?
• What are the pros and cons of circumcision?
• Do I need a partial circumcision or full circumcision?

Can I have sex when I have phimosis?

You can have sexual intercourse if you have phimosis. But it might be uncomfortable. Sexual activity may cause your foreskin to rip. Use a condom and plenty of lube if you have phimosis and decide to have sex.

What is the difference between phimosis and paraphimosis?

Phimosis and paraphimosis are both conditions that affect your foreskin. But paraphimosis is an emergency that requires immediate care. Phimosis isn’t an emergency.

Paraphimosis can happen if you’re partially or completely uncircumcised. The foreskin becomes stuck behind the rounded border at the bottom of your glans (corona) and you can’t move it back toward the tip. Without treatment, your penile tissue may die because it doesn’t get enough blood (gangrene).

Is it OK to keep the foreskin pulled back?

No, you shouldn’t keep your foreskin pulled back. If your foreskin remains behind your penis, it can cause painful swelling that makes it difficult or impossible to pull your foreskin back down.

A note from Cleveland Clinic

Worrying about your child’s health is natural. You love them dearly, and you’re also responsible for their safety and comfort. It’s important to remind yourself that phimosis happens to almost all infants, most children grow out of it and, many times, there’s no reason to treat it. Make sure to regularly clean and dry their penis, and make sure they understand the importance of taking care of their penis when they’re old enough to bathe on their own. If they need treatment, be aware that a common suggestion is circumcision. It’s a big decision. Your child’s healthcare provider understands your feelings, and they can talk you through your options so you can make the best choice for your child.