What is phimosis?

This is a condition where the foreskin is tight and not able to pull back to see the head of the penis (glans). Sometimes it is retractable when the penis is flaccid but never able to pull back over the glans when the penis is erect.

Usually, the tight foreskin does not remain the same as with each erection, there is minor trauma to the foreskin. This leads to loss of elasticity due to scarring. In adults, sexually transmitted infections (STIs) or other infections (balanitis) can be associated with phimosis.

Tight foreskin can also be caused by skin conditions:

  1. Lichen sclerosus or Balanitis Xerotica Obliterans (BXO) – scarring skin condition which may involve foreskin and glans (head) of the penis caused progressive tight foreskin
  2. Lichen planus – a non-infectious skin condition which may affect foreskin
  3. Eczema- long term skin problems with itchy, cracks and dry skin
  4. Genital warts: When there are large or multiple warts on the foreskin, circumcision and biopsy are the best options.

Foreskin cleaning is important to avoid infection. Gently washing the foreskin with a mild soap or warm water with sea salt while taking bath or shower.

How to cure phimosis

Treatment of tight foreskin depends on the patient’s age as well as the severity of phimosis.

  • A tight foreskin can be treated with a topical steroid cream like hydrocortisone or stretching exercises in early stages.
  • Phimosis stretching of a scarred foreskin may produce further tearing and scarring. There is no scientific evidence that stretching produces a cure for diseased foreskin.
  • Phimosis creams are used in some cases with limited success.
  • If tight foreskin symptoms become worse with time, BXO must be excluded.
  • Some adults use a condom and lubricants during sexual activities in the presence of mild phimosis.

Sex with Phimosis can be painful and require urgent treatment. Phimosis home treatment is possible without a diseased foreskin by daily washing, stretching exercises and clearing the smegma. Tight foreskin gives balanitis which requires treatment in the form of antibiotics.

Fungal infection causing mild phimosis is treated with a combination anti-fungal cream and steroid cream.  In adults with diabetes with a tight foreskin, circumcision is the preferred treatment due to recurrent fungal infection.

There are alternatives to full circumcision, such as topical steroid cream, “pull and burn” method for frenulum, excision of the frenulum, V-Y preputioplasty, frenuloplasty, partial circumcision or other medical treatments. These are personal preferences and can be discussed further with our specialist- Dr Khan at dedicated specialist adult circumcision clinic, London, UK

When surgery may be needed

A tight foreskin can be stuck behind the head of the penis (glans) due to the presence of a phimotic ring. This is called paraphimosis which requires urgent treatment.

Phimosis cure in adulthood can be done with steroids, preputioplasty and circumcision. Phimosis surgery can retain the foreskin by preputioplasty.

Circumcision remains the standard surgical option for tight foreskin, especially BXO phimosis. We take all patients with tight foreskin from the UK and abroad.

PS: This information is for guidance only. This is not a replacement for professional medical advice. Please call to Dr Khan for the free telephone advice +447527314081 without any obligation.

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