Phimosis

What is phimosis?

Phimosis is a condition of the penis that occurs in some adults and children who aren’t circumcised. If you have phimosis, your foreskin can’t be pulled back (retracted). It may look like your penis has rings around the tip.

Having phimosis isn’t necessarily a problem. It only becomes a problem when it causes symptoms. This could be when phimosis is severe and leaves an opening the size of pinhole.

Actually, there are two types of phimosis: physiologic and pathologic. The physiologic type is associated with childhood and usually resolves as you age. The pathologic type is associated with a condition called balanitis xerotica obliterans (BXO).

Who does phimosis affect?

The foreskin (also called the prepuce) is tight when babies are born, but usually gets looser by the time the child is 2 years old. During the years between ages 2 and 6, the foreskin loosens up and begins to separate from the head of their penis. Phimosis can also happen after childhood.

How common is phimosis?

Phimosis is found in virtually all newborns, and then the foreskin changes gradually so that it can be pulled back. It’s estimated that only 1% of people still have phimosis when they're 16 years old.

What are the symptoms of phimosis?

Someone with phimosis may have the following symptoms:

• Redness or discoloration, which may occur when infected/irritated.
• Swelling (inflammation), which may occur when infected/irritated.
• Soreness.
• Pain while urinating (dysuria).
• Pain with erections or with sexual activity.

What causes phimosis?

If you or your child has pathologic phimosis (which is caused by some type of condition), there are various reasons it might develop, including:

• Poor hygiene. This could actually be a cause and a result of phimosis. It might be irritating and painful to try to clean thoroughly, but not cleaning could lead to infection.
• Skin conditions such as eczema, psoriasis, lichen planus and lichen sclerosus. When it affects your penis, lichen sclerosis is known as penile lichen sclerosis or balanitis xerotic obliterans (BXO).
• Preputial adhesions, or scar tissue, that keep the foreskin attached to the tip (glans) of your penis.
• Injuries.
• Infections, including sexually transmitted infections (STIs).

How is phimosis diagnosed?

Your healthcare provider can diagnose phimosis during a physical examination. In addition, they might order tests to find out if there’s an infection present in urine or penis discharge.

How is phimosis treated?

Physiological phimosis (congenital) typically doesn’t need treatment. Usually, your child grows out of it. Your provider might also call this primary phimosis.

Pathological phimosis, also called secondary phimosis, does need to be treated.

• Your healthcare provider will probably suggest a steroid cream to apply to the skin of your penis.
• Your provider might suggest that you gently start stretching the foreskin after about two weeks of using the steroid cream. You should stretch the skin very gently, pulling it back only as far as you can without it hurting at all. You can use the cream on the part of the glans that's exposed by the stretching exercises.
• The next step would be surgery. If your child is having difficulty, their provider might make a small cut in the foreskin so you’re able to pull it back. If you’re an adult with lots of scar tissue, your provider will probably recommend circumcision. This procedure will remove the foreskin and free the glans.
• Your healthcare provider is almost sure to suggest circumcision if balanitis xerotic obliterans (BXO) is causing the phimosis and steroid creams don’t work. Your provider might suggest it anyway. Phimosis can make sexual activity uncomfortable for adults. Also, BXO can cause urinary tract problems and is associated with a higher risk of cancer of the penis.

What complications are related to phimosis or phimosis treatment?

The complications associated with steroids aren’t usually an issue with the creams used to retract the foreskin. Those issues are mostly related to long-term oral use of steroids.

While circumcision used to be a common procedure performed on newborns, it’s not necessarily done right away anymore. Risks associated with circumcision include:

• Bleeding.
• Infection.
• Having a foreskin that is too long or too short.
• Pain.

How soon will I feel better after circumcision to treat phimosis?

Recovery from circumcision takes about a week to 10 days.

How can I prevent phimosis?

Physiological phimosis can’t be prevented. It’s present in nearly all newborns.

It’s important, though, to keep the penis clean. Parents or caregivers should be given directions on the best way to clean a penis. They should also be told not to worry so much about the fact that the foreskin isn’t movable for the first few years of life. When the children are old enough to take care of themselves, they should be taught to clean their own penis.

What is the prognosis (outlook) for someone with phimosis?

If you have phimosis, your prognosis is good if you get treatment when you need it. This is especially true if your condition is a result of BXO.

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

With or without phimosis, you should try to keep your penis healthy. This starts early on with keeping your genitals clean. Use only gentle soap and warm water to clean your penis every day, and dry it gently after washing. Make sure your hands are clean before you touch your penis and that the underwear you put on is clean, too.

If you’re sexually active, you should wear a condom and use lots of lubricant when having sex. The friction of sex on a penis with phimosis and without a condom could lead to tearing of the foreskin.

When should I see my healthcare provider about phimosis?

Talk to your healthcare provider about phimosis if you’re worried about being able to move your child’s foreskin or your own foreskin. Your provider can make sure you know how to care for your child’s penis. If you or your child have trouble urinating or have pain, contact your provider.

Can I have sex when I have phimosis?

You can have sex when you have phimosis, but it might not feel good. Sexual activity might cause the foreskin to rip. It’s important that you use a condom and lubrication in order to avoid this.

What is the difference between phimosis and paraphimosis?

Phimosis and paraphimosis are both conditions that affect the foreskin. However, paraphimosis is always an emergency, while phimosis is not.

Paraphimosis happens to males who are partially or completely uncircumcised. The foreskin becomes stuck behind the corona of your penis and can’t be moved back toward the tip. It could happen if you’re trying to do phimosis stretching exercises and you pull the foreskin back but can’t put it back in place. Treatment is required so that the tip of your penis isn’t damaged to the point of developing gangrene.

A note from Cleveland Clinic

Phimosis may happen to someone with an uncircumcised penis. The foreskin becomes so tight that you can’t retract it (pull it back) to expose the glans. It happens to almost all infants, and most children grow out of it. Many times, there’s no reason to treat it. Sometimes, though, you might need treatment and a common suggestion is surgery. Talk to your healthcare provider or your child’s provider to make the best choice.