The Steps to Treating and Preventing Phimosis

Phimosis is a condition that affects some boys and men—potentially, anyone with an intact foreskin.

The condition involves the foreskin being uncomfortable to retract, either because it is too tight or it has adhesions attaching it to the penis head. Phimosis can cause complications including irritation, infection, redness or discoloration, inflammation, swelling, cracked and bleeding skin, pain while urinating, painful erections and scar tissue formation.

Fortunately, doctors and patients have ways to treat and prevent phimosis that can help avoid the worst outcomes and improve hygiene to better care for an uncircumcised penis.

Medical phimosis treatment

One important distinction to make at the outset of any discussion about treating phimosis is that it doesn't always require treatment.

Take physiological phimosis, for instance. It is a natural condition in young children that usually goes away on its own over time. For someone who's uncircumcised, it's typical for the foreskin to be attached to the penis head for the first several years of life. Consequently, it doesn't retract much, if at all, which is a surprise to some new parents.

"That can take months to years and still be considered normal," said Amanda North, M.D., the director of urology at the Children's Hospital at Montefiore in the Bronx, New York. "People may get upset when the skin doesn't retract by age 4, 5 and 6, but actually, it's normal to not retract all the way. It becomes problematic if the kid starts getting infections, either urinary tract infections or skin infections like balanitis, but it's not really abnormal."

Once a child is a little older, if the skin still won't retract, North often prescribes a steroid cream and recommends gently stretching the foreskin daily to help it become more pliable. She also counsels the kids to practice gently retracting their foreskins every time they urinate in order to keep it clean, as well as to help train the skin to be more stretchy.

"In children, we give steroid cream once they're getting to an age where we feel like it ought to be able to retract more, especially in kids where there's a pinpoint opening in the skin or if the foreskin is ballooning every time they pee because the opening is so small," North said. "It's not painful, but you can get infections. So we give steroid cream with gentle foreskin retraction and we tell families, 'This should not be painful. You're going to gently pull the skin back, and you'll be able to see where the skin is still tight, and you apply the cream twice a day.'"

Natural phimosis treatment

Another phimosis "treatment" a lot of new parents may not know about is a natural one: the formation of smegma. Yes, the cheese-like, whitish stuff that sometimes forms underneath the foreskin has a purpose.

"What smegma is, is you have skin attached to skin when you have those adhesions. And when the skin exfoliates, the skin cells can escape," North said. "So they form kind of little balls, sometimes with a little bit of a yellowish hue to it, but it can be white."

The smegma balls work their way out, and when they do, they may cause irritation. Men can experience some redness and even some swelling, because when smegma balls pop out, the process by which they force the foreskin and the penis to separate is a semi-violent one, North explained.

"The smegma ball works its way out as part of the normal physiology that allows those adhesions to separate," North said.

If a child reaches puberty and the foreskin still is not retractable, then it becomes more of a problem. Steroid cream doesn't work as well at that point—same story with adults—so if a person's phimosis is causing problems, such as frequent infections and irritation that lead to scarring, the best option may become circumcision.

Prevention and hygiene

Phimosis is one of those conditions you can't do much to prevent. You're born with a tighter foreskin or you're not. However, what you can do, either for your newborn or for yourself, is take good care of the area to prevent complications.

Already discussed are the methods pediatric urologists recommend for parents of younger, uncircumcised boys who have phimosis: steroid cream and gentle, daily retraction of the foreskin to stretch it.

What older boys and adults can do is practice good hygiene to prevent their phimosis from spawning other complications. The main issues with phimosis tend to stem from the foreskin getting irritated or infected.

Chronic irritation can cause swelling, which, in turn, can cause the foreskin to form scar tissue, making it even more difficult to retract.

One thing guys can do to help prevent this occurrence is to retract their foreskin when they urinate. Reducing contact with irritating urine can go a long way toward preventing other issues.

A good daily hygiene practice can be observed when you bathe:

• Gently retract the foreskin.
• Clean beneath with mild soap and water.
• Rinse the foreskin and penis head thoroughly.
• Gently return the foreskin to where it belongs.

That final step is crucial, especially if you're teaching young children how to care for themselves, because they face the additional danger of paraphimosis. That's when the foreskin becomes trapped behind the penis head if it isn't put back in place after cleaning.

Care for the uncircumcised penis

Nature designed the human penis to be uncircumcised. Keeping the foreskin or removing it are both valid choices, and neither one is inherently cleaner or healthier than the other.

However, if you or your child does have an intact foreskin, it's important to be vigilant about cleanliness. Getting into the habit of maintaining a daily hygiene routine is a crucial first step.

Another way you can prevent the worst with phimosis is to quickly deal with anything unusual down there. Any kind of ongoing redness, swelling or irritation can lead to the formation of scar tissue, and that tissue damage makes the foreskin even tighter, causing more irritation and so on.

Rather than getting caught up in this vicious cycle, quickly respond when you notice any changes, such as redness or irritation that lasts more than a couple of days, and get your healthcare provider to help you with appropriate treatments.

Teaching young boys not to hesitate to report issues with their genitalia is a great idea, too, as delays can often make the situation worse.

Are you concerned you should see a doctor but don't have one you see regularly? You should. Fortunately, telehealth makes it easy to connect with a healthcare professional who can answer your questions and evaluate your situation. Many physicians offer same-day video visits. Giddy Telehealth is an easy-to-use online portal that provides access to hundreds of healthcare professionals whose expertise covers the full scope of medical care, including men's health.