Many parents feel concerned if their newborn or young boy’s foreskin can’t be pulled back. They may think his foreskin is too tight and that he might need an operation. But it's a little known fact that the foreskins of nearly all newborn boys are tight or stuck to the head of their penis (glans). This natural “phimosis” protects the sensitive head of the penis from rubbing against things, becoming too dry and coming into contact with germs like viruses or bacteria.
Within the first three or four years of life, the stuck skin (adhesion) usually detaches, and tight foreskin usually gradually loosens, making it increasingly easy to pull back without any pain. Phimosis should only be treated if it doesn't go away on its own.
If someone has phimosis, it's not possible to pull (retract) their foreskin back over the head of their penis, or doing so hurts.
Parents might notice a balloon-like swelling from time to time when their child pees. This is a result of urine building up due to the opening being too tight.
Symptoms like pain, swelling and redness usually only develop if the phimosis continues into the child's teenage years or adulthood and complications such as inflammations occur.
Phimosis: Adhesion between foreskin and head of the penis (glans)
There are different kinds of phimosis. If the natural tightness or adhesion of the foreskin doesn't go away within the child's first few years of life, it is called primary phimosis. The causes of this kind of phimosis are unclear.
“Acquired” or “pathological” phimosis is caused by scar tissue on the foreskin. The scarring may happen as a result of recurring inflammations or certain skin conditions. But it may also happen following injuries, such as small tears that arise when the foreskin is forced back.
It is estimated that about 96 out of 100 baby boys are born with natural phimosis. The naturally occurring tightened foreskin goes away in the first few years of their life. Only very few boys are still affected in puberty. By the age of 16, only 1 out of 100 boys have phimosis.
The tightened foreskin can cause problems with peeing (urination). If teenage boys or grown men still have phimosis, they may have painful erections and pain during sex. It's also difficult for teenagers and adults with phimosis to clean the head of their penis and the area under their foreskin. This makes bacterial or fungal infections in that area more likely. These infections can result in inflammations of the head of the penis or the foreskin.
If you try to force a tight foreskin back, the skin might tear, small injuries might arise, and in rare cases it might lead to “paraphimosis.” This is where the foreskin can't be returned to its normal position after being pulled back over the glans. The blood supply to the glans is restricted as a result. In rare cases the glans tissue may die, so paraphimosis is a medical emergency requiring immediate treatment.
It's usually the parents of the child, or older children and teenagers themselves, who notice that their foreskin can’t be pulled back. A doctor can then determine whether the tight foreskin is the result of natural phimosis or due to scarring or a skin condition. Then, based on the diagnosis and depending on the boy's age, he or she will be able to say whether treatment is needed and, if so, what the treatment options are.
There is no need to treat phimosis in babies and toddlers right away. Parents should not try to force the foreskin back. This can be painful for the child and injure the foreskin, leading to scars that could later cause acquired phimosis. To keep the area clean, it's enough to wash the penis from the outside using warm water and mild soap or shower gel.
It's a good idea to seek medical advice if the phimosis doesn't improve on its own and leads to problems when peeing. The doctor will take a closer look and say whether treatment is advisable or whether you can wait and see how things develop.
In most children, phimosis is treated using a steroid cream. This "conservative" treatment takes several weeks and can help most children.
If the cream doesn’t work, a small operation (circumcision) might be considered. This procedure is also a good idea if the foreskin keeps on becoming inflamed, the phimosis has occurred as a result of scarring, or if the foreskin becomes trapped behind the head of the penis (paraphimosis). Circumcisions for the treatment of phimosis are routine operations. They are often done under general anesthetic in children, but sometimes only a local anesthetic is used in teenagers or adults.
When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.
Deutsche Gesellschaft für Kinderchirurgie (DGKCH). S2k-Leitlinie "Phimose und Paraphimose". AWMF-Registernr.: 006-052. September 15, 2017.
Moreno G, Corbalán J, Peñaloza B, Pantoja T. Topical corticosteroids for treating phimosis in boys. 2014; (9): CD008973.
Radmayr C, Bogaert G, Dogan HS, Kocvara R, Nijman JM, Stein R et al. Paediatric Urology. 2015.
Tekgül S, Dogan HS, Erdem E, Hoebeke P, Kocvara R, Nijman R et al. Guidelines on Paediatric Urology. Arnhem, The Netherlands: European Association of Urology, European Society for Paediatric Urology, pp 52-63.
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