At a glance

  • If someone has phimosis, it's not possible to pull (retract) their foreskin back over the head of their penis, or doing so hurts.
  • Nearly all boys are born with a foreskin that won’t pull back (phimosis).
  • It usually loosens and goes away on its own after a few years.
  • But treatment may be needed if it doesn’t go away or if it is causing problems.
  • Treatment options include steroid creams and ointments or circumcision.


Photo of two boys playing

The foreskin is a flap of skin at the tip of the penis that covers the glans (head of the penis). It can be pulled back to uncover the glans. If it can’t be pulled back or if it is painful, doctors refer to the condition as “phimosis.”

It is perfectly normal that in newborns or young boys the foreskin can’t be pulled back. This is not a cause for concern: Nearly all newborn boys have foreskins that are tight or stuck to the head of the glans (adhesion). This natural “phimosis” protects the sensitive head of the penis from rubbing against things, becoming too dry or coming into contact with germs like viruses or . A tight foreskin should never be forced back. That is painful and may damage the skin.

Within the first few years of life, the stuck skin usually detaches, and tight foreskin usually gradually loosens, making it increasingly easy to pull back without any pain. So it simply takes time. Phimosis should only be treated if it doesn't go away on its own by puberty or if it is causing problems.

Phimosis may also develop in adulthood, sometimes as a complication of .


If someone has phimosis, it's not possible to pull (retract) their foreskin back over the head of their penis, or doing so hurts.

Infants and young children usually have phimosis or adhesion, which typically doesn’t cause any problems.

Illustration: Phimosis: Adhesion between the foreskin and the head of the penis (glans)

A balloon-like swelling may develop under the foreskin from time to time when peeing. This is a result of urine temporarily trapped between the glans and the foreskin because the urine flows out too slowly. But this is no reason to worry.

Phimosis sometimes continues into the child's teenage years or adulthood, or it may first start then as well. That increases the risk of of the glans, leading to complications such as pain, swelling and redness.

Illustration: Phimosis in adults

In some boys and men, phimosis only causes problems when the penis gets bigger and harder (erection) during sexual arousal or while sleeping. If the foreskin is only a little tight, it might no longer fit over the glans when the penis is erect. This can be unpleasant or painful during masturbation or sex.


There two kinds of phimosis: congenital and acquired. If the natural tightness or adhesion of the foreskin doesn't go away by the time the child reaches puberty, it is referred to as congenital phimosis. The causes of this kind of phimosis are unclear.

Acquired phimosis develops later in life and is caused by scar tissue on the foreskin. The scarring may happen as a result of inflammations or certain skin conditions. But it may also happen following injuries, such as small tears that arise when a child’s 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. By the age of seven years about half of all boys have a tight foreskin, and by the age of ten about one out of three.

Only very few boys are still affected in puberty. By the age of 16, only about 1 out of 100 boys have phimosis.

It is not known how common acquired phimosis is.


It is difficult for teenagers and adults with phimosis to clean the head of their penis and the area under the foreskin. This makes bacterial or fungal infections in that area more likely, which increases the risk of of the head of the penis or the foreskin.

If you try to force a tight foreskin back, the skin might tear, resulting in minor injuries and scarring – which can make the foreskin even tighter.

In rare cases it might lead to paraphimosis. This is where the foreskin is stuck behind the glans and can't be pushed forward to its normal position. The blood supply to the glans is restricted as a result, and the glans and foreskin become swollen. There is a risk that the glans tissue may die, so paraphimosis is a medical emergency requiring immediate treatment.

Illustration: Paraphimosis: The blood supply to the glans and part of the foreskin is restricted

One other rare complication is urine building up in the ureters. This can happen if the tight foreskin becomes inflamed and swollen. If you try to pee, the urine doesn’t come out or only a small amount does. Without treatment – typically a small incision (cut) made in the foreskin – the urine may back up to the kidneys and damage them.


It is usually the parents of the child, or in later life older children and teenagers themselves, who notice that the foreskin can’t be pulled back. It might also be noticed during a routine check-up at the doctor’s.

To diagnose phimosis, the doctor will closely examine the penis and carefully pull back the foreskin. They will also ask for how long the foreskin has been too tight and whether there are other related problems.

The doctor can then usually determine how severe the phimosis is and whether the tight foreskin is the result of natural phimosis or due to scarring or a skin condition.


Age, among other factors, will determine whether treatment is necessary. A tight foreskin is normal in babies and young children, and it usually goes away by the time the child reaches puberty. Parents should not try to force the foreskin back. To keep the area clean, it's enough to wash the penis from the outside using warm water and mild soap or shower gel.

Treatment is recommended if the tight foreskin does not go away on its own or if it leads to problems like . In most children, phimosis is treated using a steroid cream. This "conservative" treatment takes several weeks and can help most children. This treatment is also recommended for older boys and men who still have this form of phimosis.

If the cream doesn’t work, a small operation (circumcision) might be considered. This procedure is also a good idea if keeps on coming back, 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 typically done using a general anesthetic in children and a local anesthetic in teenagers or adults.

Further information

When people are ill or need medical advice, they usually go to see their family doctor or pediatrician first. Urologists are specialized in phimosis and other medical conditions affecting the genitals.

In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

Deutsche Gesellschaft für Kinderchirurgie (DGKCH). Phimose und Paraphimose bei Kindern und Jugendlichen (S2k-Leitlinie). AWMF-Registernr.: 006-052. 2021.

Eckert K, Janssen N, Franz M et al. Die nicht-retrahierbare Vorhaut bei beschwerdefreien Jungen: Eine Indikation zur Zirkumzision? [Nonretractable foreskin in boys without complaints: An indication for circumcision?]. Urologe A 2017; 56(3): 351-357.

Moreno G, Corbalán J, Peñaloza B et al. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev 2014; (9): CD008973.

Oetzmann von Sochaczewski C, Gödeke J, Muensterer OJ. Circumcision and its alternatives in Germany: an analysis of nationwide hospital routine data. BMC Urol 2021; 21(1): 34.

Radmayr C, Bogaert G, Burgu B. EAU Guidelines on Paediatric Urology. 2022.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 12, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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