Phimosis : A guide to Circumcision

Phimosis is a condition in which the foreskin cannot be retracted (pulled back) due to a too narrow opening. But if there is no problem with urination, sexual intercourse or infections then treatment is not required.

What normally happens is that at birth, the foreskin and glans (head of the penis) are fused together but normally separate from each other during childhood (at the age of 3). Almost all boys achieve a retracted foreskin by the time they reach their teens.

Most cases of phimosis are mild but a tiny percentage of boys will develop a severe form which manifests itself as a bulging foreskin during urination. The edge of the foreskin may have a pale, scarred appearance and it will be unable to crease when pulled back.

Symptoms of phimosis

These include:

• Pain during urination
• Bleeding or irritation around the foreskin
• Urinary retention (unable to pass urine)

This type of phimosis usually occurs in infants; but if it occurs in an adult male who previously was able to retract his foreskin then it is termed ‘acquired phimosis’.

Causes of acquired phimosis

Most cases of phimosis occur at birth but there is another type called acquired or ‘pathological’ phimosis. This type of phimosis is caused by any number of factors which include:

• Balanitis
• Balanoposthitis
• Excessive pulling back of the foreskin
• Masturbation
• The frenulum is too short which restricts the foreskin (frenulum breve)
• Diabetes
• Frequent catheterisation (insertion of a urinary catheter)
• Poor hygiene
• Infection

Phimosis is often confused with the condition frenulum breve but the main difference is that phimosis causes a band of scar tissue to form on the foreskin whereas frenulum breve means that your frenulum (banjo string) is too short. In both cases this prevents you from pulling the foreskin back.

Find out more about the frenulum in our frenulum breve section.

Treatment for phimosis

Phimosis is usually resolved in infants and young boys by the time they reach their third birthday. The foreskin will loosen which enables the foreskin to be retracted so treatment will not be needed.

However, if it is causes problems with urination or results in an infection then treatment will be required. This is also required to prevent it turning into paraphimosis or balanitis xerotica obliterans.

Acquired phimosis can cause problems with sexual intercourse in adult men.

Treatment can be surgical or non-surgical. These include:

• Stretching the foreskin using a balloon or another device
• Steroid creams
• Preputioplasty
• Circumcision

Opinion is still divided about the efficacy of circumcision to treat phimosis. Some argue that it is an effective means of treatment as well as prevention; but others state that the results are inconclusive.

Complications of phimosis

Phimosis can lead to complications such as:

• Pain and discomfort during urination
• Pain and discomfort during sexual intercourse
• Paraphimosis
• A risk factor for penile cancer

Phimosis usually resolves itself in more than 90% of cases without the need for treatment –surgical or non-surgical.