The Facts About Phimosis

About 80 percent of men in the United States ages 14 to 59 are circumcised. But the trend is moving away from circumcision, which means more babies aren't being circumcised. In 2010, 58.3 percent of newborns in the United States were circumcised during their birth hospitalization. That's down from about 65 percent in 1979, according to data from the Centers for Disease Control and Prevention. More men have to be cognizant of a foreskin condition called phimosis.

Phimosis is a condition where the foreskin on an uncircumcised penis is too tight to be retracted comfortably. For some guys, it's nearly impossible to retract the foreskin. For others, even if the foreskin can be retracted, it can get trapped behind the penis head. This is a related condition called paraphimosis, which is a surgical emergency that requires immediate intervention to ensure healthy blood flow to the penis head.

This difficulty in retracting the foreskin can lead to other complications as well. Small boys who are uncircumcised are often unable to retract their foreskins up to age 3, a normal condition called physiological phimosis. By the time they're 16, though, about 99 percent of them have a foreskin that is fully retractable.

Pathological phimosis is the name for phimosis that develops as a result of injuries, scarring, infections and inflammation.

One cause of pathological phimosis is failure to follow good hygiene practices. Boys and men with foreskin need to get in the habit of retracting the foreskin and cleaning underneath it every day to help prevent infections. They also need to fully retract it during urination. Poor hygiene can lead to scarring of the tissue of the foreskin, which in turn makes it tighter and more difficult to retract.

It's important to remember that this type of phimosis is distinct from physiological phimosis. That's the condition that affects about 96 percent of newborn boys up to 3 years old but usually goes away by the time the boy is 16.

The symptoms of phimosis primarily include a feeling of tightness around the foreskin and penis head. This tightness, in turn, can lead to other symptoms:

• Discoloration or redness that develops when there is an infection or irritation
• Swelling or inflammation that develops when the area is infected or irritated
• Soreness in the foreskin and glans
• Pain while urinating, known as dysuria, especially pain in the urethra and the urethral opening
• Painful erections or pain during sex

It's crucial to note that if you experience pain when your foreskin is retracted and you are unable to easily pull it back down over the penis head, you should seek immediate medical attention.

The most common risks of phimosis include recurring irritation and infection. But keep in mind that these infections are more than a minor annoyance because the foreskin is tender. When it is repeatedly irritated, scar tissue forms over time, making the foreskin even tighter and more prone to getting stuck in the retracted position, which is a more dire risk of phimosis.

This is a condition called paraphimosis, which can cause the circulation to the penis head to be constricted. The condition requires medical intervention before the penis head becomes strangled because necrosis or even gangrene can set in.

Physiological phimosis, the kind that occurs in 96 percent of small boys up to, and sometimes even past, the age of 3, typically doesn't require treatment. However, phimosis in older boys and men may require one or more of the following treatments:

• Your doctor might prescribe a topical corticosteroid cream to be applied to the foreskin.
• You need to gently stretch the foreskin a couple of weeks after you begin applying the steroid ointment.
• Your doctor may suggest surgery next. In general practice, they would likely recommend circumcision. With small children, a doctor might suggest a small cut in the foreskin to make it easier to retract. With older boys and men in whom significant scar tissue has developed, circumcision may be the next recommended step.

If a condition called balanitis xerotica obliterans (BXO) is associated with phimosis and steroid creams don't work, circumcision may also be recommended. BXO can cause urinary tract infections (UTIs) and is associated with a higher risk for penile cancer.

While physiological phimosis occurs in almost all infant boys who remain uncircumcised and is thus unpreventable, there are some steps people with foreskin can take to lower the risk of developing phimosis later in life. Retract the foreskin daily and clean beneath it. This is a simple act and one of the most important ways to prevent phimosis. Also, make sure the area beneath the foreskin remains free of the buildup of smegma, a thick, white substance that forms from dead skin cells and oils in the skin. Smegma can cause irritation and scarring that leads to phimosis.

Also important to keep in mind is that men who have diabetes need to be especially aware of their glucose control. High blood sugar leads to yeast infections, which can make the foreskin difficult to retract.

Maintaining a healthy uncircumcised penis is possible. But you must remember some of the unique challenges of having an intact foreskin, including:

• Infection and irritation if the area underneath the foreskin isn't kept clean
• Phimosis or paraphimosis if scar tissue forms on the foreskin
• Developing balanitis or balanoposthitis, conditions typified by irritation and redness due to fungal or bacterial infections
• Dry skin and yeast infections

In some cases, where significant scar tissue has built up or the foreskin is especially tight and causes frequent discomfort, a doctor may ask the man to consider adult circumcision.

In the past, the procedure was considered painful and a cause of significant discomfort during the healing process. Today, adult circumcision is common even as elective cosmetic surgery, and recovery is relatively easy.

Typically, men require only acetaminophen or ibuprofen—no need for narcotic pain relief—after the procedure. You simply need to change the dressing regularly and keep the area clean. The most uncomfortable part of the early recovery process may be getting erections, especially "morning wood." You need to avoid strenuous activity for several days or, at most, a few weeks. Most men are fully recovered and able to have sex after four to six weeks.

If you have any condition related to your penis or testicles that concerns you, don't hesitate to see a urologist. Any time you notice irritation or inflammation of your penis or foreskin that doesn't resolve itself in a day or two, you should make an appointment to see someone.

If you have discomfort or pain that you suspect may be related to phimosis, you need to see someone right away. For instance, if your foreskin becomes trapped behind the penis head and you are unable to gently slide it back down, see a doctor. It doesn't take long for the glans to become strangled and for the lack of blood flow to begin causing permanent damage to the tissue.

This is an event that requires immediate medical intervention to prevent necrosis (death) of the tissue, which can lead to gangrene.

How serious is phimosis?

Physiological phimosis is a very common condition in infants and young boys and isn't serious at all. More than 96 percent of boys are born with it, but it usually goes away by the time they reach their teens. Pathological phimosis, however—the kind that develops later in life—can be anywhere from a mild annoyance to a serious condition requiring immediate medical intervention.

If you learn how to gently retract and keep your foreskin and penis head clean, a mild case of phimosis is something you can live with. If it is a constant irritation or if your foreskin becomes trapped behind your penis head, you need to seek medical attention.

Why do adults get phimosis?

Adult men with intact foreskins typically develop phimosis as a result of poor hygiene practices. As the foreskin and the area beneath it get irritated and infected repeatedly, scar tissue builds up. This causes the delicate tissue of the foreskin to thicken and tighten even more on the penis. Make sure you learn how to properly clean your penis head and foreskin by gently retracting it and cleaning and drying the area carefully. Do that every day in order to avoid phimosis and its more dangerous cousin, paraphimosis.

How do you fix phimosis?

Phimosis in infants doesn't typically require any intervention, as it usually goes away on its own over time. Adult men who have pathological phimosis have a number of treatment options. They include the application of corticosteroid cream and manual manipulation of the foreskin to help stretch it out. In the worst cases, and for men who grow tired of dealing with phimosis, circumcision may be an option. This is especially the case if the man has had recurring infections and irritation over time that have caused a great deal of scar tissue to build up on the foreskin, making the phimosis even more pronounced.