Phimosis is a condition in which the foreskin on the penis becomes tight, making it difficult or impossible to pull it past the tip of the penis. In males, the head or tip of the penis is covered with a thin layer of retractable skin, called the foreskin. The foreskin can behave like a sock, allowing it to be pulled down and expose the tip or head of the penis (also called the glans). In some older boys and older men, the foreskin becomes like a rubber band making it tight and not easily moveable. 

Phimosis is a natural occurrence in male babies, during the first few years of life the foreskin is attached to the penis tip. As the child grows older the foreskin naturally separates from the penis and can then be retracted (pulled away). It is estimated that for the majority of boys phimosis usually resolves on its own by the age of 7 and for most others by the age of 10. In adults and adolescent boys, phimosis may occur due to other causes and can lead to severe complications and symptoms. If you suspect that you or your child may have phimosis, speak with your doctor immediately. 

What causes phimosis?  

There are several causes of phimosis in adolescents and adult men. Phimosis can occur when the penis becomes inflamed and enlarged, when the foreskin becomes inflamed or when both these issues occur simultaneously. This can lead to the foreskin becoming tighter making it difficult to stretch and thus preventing easy retraction. In this case, phimosis can only occur in males who are not circumcised. 

It can also occur over the long term, where the foreskin becomes tighter as time passes. In children, this is not an issue and usually does not cause any severe symptoms. In older boys and men, the inability to pull back the foreskin may lead to several symptoms. Here are a few known reasons for phimosis developing in men or continuing to exist in older boys: 

• Rough action on the foreskin repeatedly, leading to damage or scarring of the skin
• Scar tissue that glues the foreskin to the penis head 
• Penis or foreskin trauma due to injury 
• Infection of the penis or foreskin
• Sexually transmitted nfections
• Skin conditions like eczema, psoriasis, lichen planus & lichen sclerosis (foreskin inflammation), balanitis (penis inflammation)
• Poor hygiene leads to infection 
• Type II diabetes leads to extra sugar in the urine, which encourages Urinary Tract Infections 
• Repeated or chronic urinary tract infections 

Phimosis caused by some disease conditions (pathologic phimosis) usually doesn’t resolve on its own and is more prone to cause complications like penile irritation or bleeding, difficulty in urination or painful urination. If you experience any of the above symptoms, please consult a physician.

Dr Ashish Bajaj – M.B.B.S, M.D. in Clinical Pharmacology and Toxicology

Types of Phimosis:

There are 3 main types of phimosis:

• Physiological Phimosis – This is natural phimosis that occurs at birth and usually resolves as the child gets older and does not require medical attention. 

• Pathological Phimosis – This type is caused due to the above reasons and may lead to severe symptoms. Pathological phimosis ranges from grade 1 to grade 5, with the symptoms increasing in severity for each grade. 

• Paraphimosis – A complication that can arise from phimosis where the foreskin is retracted below the tip of the penis tightly and cannot be moved up again. This may lead to injury, inflammation and loss of blood flow to the penis. Paraphimosis is a medical emergency and will require urgent attention. 

Symptoms Of phimosis

Most children with phimosis will not experience any symptoms. In many older boys and adult men, phimosis may not result in any symptoms either. In severe cases, such as when the foreskin almost completely covers the tip of the penis, a few serious symptoms may occur. These may include:

• Inflammation, pain, or swelling in the penis, penis tip, and foreskin
• Strong odours from the penis 
• Painful urination, pain during erection
• Pus, blood or discharge from the penis
• The foreskin undergoes a ballooning effect during urination
• Forceful and messy urination due to the tightness of the foreskin
• Pain during sexual activities 
• Discolouration of the skin in the area 
• Chronic inflammation or infection 

Studies demonstrated that phimosis is present in 8% of 6 to 7-year-olds, 6% of 10 to 11-year-olds and 1% of 16 to 17-year-old boys. By contrast, preputial adhesions remain much more common throughout childhood and adolescence, but by 17-years of age, only 3% will have persisting adhesions.

Dr. M.G. Kartheeka – MBBS, MD(Pediatrics)

Home remedies for phimosis

1. Foreskin stretching

If phimosis has not progressed to a very tight grade, a simple stretching exercise may be recommended by your doctor. You will need to use two fingers to gently and slowly pull the top of the foreskin slightly open and repeat the process several times a day. 

2. Ointments

Your doctor may recommend certain ointments to deal with pain, inflammation, and infection that you can apply by yourself at home. 

3. Phimosis rings

Phimosis rings or flesh tunnels are rings made from silicone or similar materials. These rings can be inserted into the foreskin from time to time, with larger rings being used as the foreskin opening widens. You may be able to find these rings in a complete kit, along with a cream to help with the application. Use this only after talking to a doctor 

4. Retracting exercises

Pulling the foreskin down over the glans (penis head) gently and regularly may also encourage better stretching. However, use extra caution and only pull the foreskin slowly and gently. If you notice any discomfort, pain, skin cracking or bleeding stop immediately. Your doctor will recommend doing this exercise while using topical creams.

5. Avoid painful sexual activities

Damage from sexual activities can be both a cause and a result of phimosis. If you already have phimosis, sexual activities may cause additional foreskin damage and scarring. Using lubrication and avoiding intensive motions may limit damage during sexual activities. 

6. Root cause treatment

If you have a urinary tract infection, it may result in phimosis. In this case, your doctor will address the underlying infection with antibiotics to get rid of the infection.

7. Proper hygiene

Whether you already have phimosis or not, maintaining proper hygiene is a great way to cut down your risk of developing phimosis. Always clean under the foreskin with warm water and very mild soap. Be gentle and dry the area well after washing yourself. Parents should train their young male children on proper personal hygiene methods as the child grows older, being careful to avoid sharp and aggressive pulling of the foreskin. 

8. Coconut oil

Coconut oil is generally safe to use on the skin and may allow you to stretch the foreskin if you have phimosis. However, you need to be very gentle and not stretch or pull quickly or with force. Additionally, speak with your doctor first and always wash the oil off properly after each use. 

When to seek professional help for phimosis?

Do not ignore this problem because painful and serious symptoms may occur due to phimosis. You should immediately consult a doctor if you notice these signs:

• Bleeding, reddening on the penis or foreskin 
• Inability to urinate, difficulty urinating, bleeding while urinating 
• Urinary Tract Infections that come back often 
• Pain 
• Paraphimosis (foreskin tightly stuck in the retracted position)

Parents of children with phimosis do not need to worry about this condition unless it is causing pain and other symptoms for the child (rare). 

Conclusion

There are options to deal with phimosis and its symptoms and surgery may not always be required. Teaching proper hygiene to young boys and maintaining it in adulthood may reduce the risk of phimosis in some cases. Although circumcision and similar procedures are available to permanently fix phimosis. Speak with your doctor to find out what solution works best for your particular condition.  

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Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.