Phimosis

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.

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 inflammation of the glans, leading to complications such as pain, swelling and redness.

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 inflammation 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.

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 inflammation. 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 inflammation 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.

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.