Phimosis is the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. The foreskin at the tip of the penis loses its elasticity and appears like a tight rubber band. It can be a severe and painful condition. However, it is treatable, and the outcomes are usually excellent. The treatment could be even conservative initially. But in most cases, we fix it with minor surgery.
Phimosis and its symptoms are more common in boys than men.
The inability to retract the foreskin is the main symptom. The patient cannot expose the glans, and hygiene is impossible. However, recurrent pain, itching and little bleedings at the tip of the penis are possible due to over-infection (balanoposthitis). Swelling of the foreskin while urinating is another common symptom. In advanced cases, this ring is too tight and may obstruct urination.
Phimosis is normal in not circumcised babies and toddlers. It happens because the foreskin is still attached to the glans (adhesions). It starts detaching without any trauma while growing up, and after ten years of age, most boys can retract their foreskin quickly.
Boys with the following conditions are more at risk of developing phimosis:
In adults, risk factors for phimosis include:
We can use cortisone creams and moisturizing to treat only early and not so-advanced cases without surgery. However, the conservative treatment has a high failure rate over time, and circumcision remains the definitive treatment.
We recommend circumcision when the patient has:
Acute urine retention caused by tight and obstructive foreskin is rare but possible complication that requires urgent treatment.
Paraphimosis occurs when the foreskin is tight, the patient pulls over the foreskin, and the narrow ring prevents pulling it forward to cover the tip of the penis again. The retracted foreskin becomes swollen and stuck and may slow until blood flow stops to the tip of the penis. This complication needs urgent treatment.