Most uncircumcised babies and toddlers will have phimosis, meaning the foreskin cannot be retracted. This is because the glans and the foreskin remain connected for the first few years of life.
In adults, there are a number of risk factors and causes of phimosis, though it only tends to be a problem if it causes symptoms.
In this article, we take a look at the causes of this condition, along with what can be used to treat it when symptoms occur.
Causes and risk factors
There are various potential causes for phimosis, including infections or skin conditions. A diagnosis may be made based on the patient's medical history.
Phimosis only affects uncircumcised males and is more common in boys than men.
Phimosis is normal in uncircumcised babies and toddlers, as the foreskin is still attached to the glans. It will start to detach naturally between 2 and 6 years of age, though it might happen later. It can happen at up to around 10 years old, in some boys.
The foreskin can be pulled back behind the glans in about 50 percent of 1-year-old boys, and almost 90 percent of 3-year-olds. Phimosis will occur in less than 1 percent of teenagers between 16 and 18.
It is most likely to occur in older boys with:
- repeated urinary tract infections
- foreskin infection
- repeated rough handling of the foreskin
- foreskin trauma
In adults, risk factors for phimosis include sexually transmitted infections.
Phimosis may be caused by a skin condition, such as:
- Eczema: A long-term condition that causes the skin to become itchy, red, dry, and cracked.
- Psoriasis: This skin condition leads to patches of skin becoming red, flaky, and crusty.
- Lichen planus: An itchy rash that can affect different areas of the body. It is not contagious.
- Lichen sclerosus: This condition causes scarring on the foreskin that can lead to phimosis. It may be caused by a urinary irritation.
A possible symptom of phimosis is an inability to urinate, or empty the bladder properly.
Phimosis does not always lead to symptoms. When it does, however, these may include redness, soreness, or swelling.
A tight foreskin may interfere with the normal passage of urine. In severe cases, this can prevent the person from emptying their bladder fully.
Symptoms of balanitis include:
- soreness, itchiness, and odor
- redness and swelling
- a buildup of thick fluid
- pain when urinating
During sex, phimosis may cause pain, skin splitting, or a lack of sensation. Wearing a condom and using lubricant can make intercourse more comfortable.
A doctor will take a full history from the person, asking about any previous penis infection or injuries they might have had. They may also inquire about the impact of any symptoms on sexual activity. A physical examination will include them looking at the penis and foreskin.
The doctor may order urine tests to check for urine infections or take a swab from the foreskin area to check for bacteria.
Phimosis is a risk factor for type 2 diabetes. Adults presenting with a tight foreskin may be given blood and urine tests to check their blood sugar levels, as a result.
Balanitis is usually treated with good hygiene, and in some cases steroid creams or ointment.
Treatment options for phimosis depend on the symptoms that occur. Most cases of balanitis are easily treated with good hygiene, creams, and ointments.
People are advised to clean the penis daily with lukewarm water and to dry it gently to improve hygiene. They should avoid using soap, bubble bath or shampoo on their genitals, and dry under the foreskin after urinating.
A doctor may recommend using a steroid cream or ointment to help with the irritation.
If balanoposthitis has been caused by a fungal or bacterial infection, an antifungal cream or a course of antibiotics may be needed.
In cases of severe or repeated balanitis or balanoposthitis, doctors may recommend treating the phimosis itself. They may prescribe steroid creams to help soften the foreskin and make it easier to retract, or surgery may be an option.
Doctors may suggest circumcision, in which all or part of the foreskin is removed, though the procedure carries the risk of bleeding and infection.
An operation to surgically release the areas where the foreskin gets stuck to the glans may also be possible. This will preserve the foreskin, but not necessarily prevent phimosis from occurring again.
Paraphimosis describes when a retracted foreskin cannot go back to its original position. This problem causes the glans to become painful and swollen.
Emergency medical attention is needed to avoid more serious pain and to stop the blood flow to the penis becoming restricted.
Doctors may apply a local anesthetic gel while pressing on the glans and pushing the foreskin forward. In some cases, a small slit may need to be made in the foreskin to relieve the pressure. In severe cases, circumcision may be recommended.
In rare and very severe cases, a lack of blood flow to the penis can cause the tissue to die. If this happens, the penis may need to be surgically removed.
Preventing the symptoms of phimosis relies on good hygiene.
Gently cleaning the penis and under the foreskin, with warm water, every day will help avoid problems. This will facilitate keeping the skin loose and avoiding infection.
Caring for an uncircumcised penis
Men with an uncircumcised penis are recommended to pull back the foreskin and wash underneath it with warm water.
Using a mild or non-perfumed soap will reduce the risk of irritation, as will avoiding the use of talc or deodorant on the area.
Most uncircumcised baby boys have a foreskin that will not pull back because it is still attached to the penis. It will start to detach naturally between 2 and 6 years of age, although it could take longer.
Parents should not try to force the foreskin back before it is ready, as this may be painful and damage the foreskin.
While the symptoms of phimosis may be uncomfortable, the condition itself is not life-threatening. The symptoms of phimosis are easily treated with no lasting effects.
There is some evidence that tight foreskins may encourage tumors to develop in the penis, though more research is needed in this area.