What is phimosis?

Phimosis is a condition in which the foreskin can’t be retracted (pulled back) from around the tip of the penis. A tight foreskin is common in baby boys who aren’t circumcised, but it usually stops being a problem by the age of 3.

Phimosis can occur naturally or be the result of scarring. Young boys may not need treatment for phimosis unless it makes urinating difficult or causes other symptoms. As these boys grow up, the need for treatment may increase.

The main symptom of phimosis is the inability to retract the foreskin by the age of 3. The foreskin usually loosens over time, but this process can take longer in some boys. By around the age of 17, a boy should be able to easily retract his foreskin.

Another common symptom of phimosis is a swelling of the foreskin while urinating.

Phimosis can occur naturally. It’s unclear why it occurs in some boys but not others. The condition can also occur if the foreskin is forcibly retracted before it’s ready. This can harm the skin and cause scarring, making it more difficult to retract the foreskin later on.

Inflammation or an infection of the foreskin or the head of the penis (glans) may cause phimosis in boys or men. Balanitis is an inflammation of the glans. It’s sometimes the result of poor hygiene or an infection of the foreskin.

One of the infections that can lead to balanitis is called lichen sclerosus. It’s a skin condition that may be triggered by an abnormal immune response or a hormone imbalance. Symptoms can include white spots or patches on the foreskin. The skin may become itchy and easily torn.

Some cases of phimosis can go untreated, especially among young boys. You can wait to see if the problem resolves on its own as your son gets older if there are no symptoms or complications. If phimosis interferes with healthy erections or urination, or if there are other symptoms, your son should see a doctor.

Recurrent infections of the glans or foreskin should also be evaluated by a doctor. Signs of an infection may include:

  • changes in the color of the glans or foreskin
  • the presence of spots or a rash
  • pain
  • itching
  • swelling

A physical exam and a review of your son’s symptoms are usually enough to diagnose phimosis or an underlying condition, such as balanitis.

Treating balanitis or another type of infection usually starts with a swab of the foreskin to be studied in a lab. A bacterial infection will require antibiotics, while a fungal infection may require antifungal ointments.

If there is no infection or other disease causing phimosis, and it appears that the tight foreskin is simply a naturally occurring development, there may be several treatment options available. Depending on the severity of the condition, daily gentle retraction may be enough to treat the problem. A topical steroid ointment can be used to help soften the foreskin and make retraction easier. The ointment is massaged into the area around the glans and foreskin twice a day for several weeks.

In more serious cases, circumcision or a similar surgical procedure may be necessary. Circumcision is the removal of the entire foreskin. Surgical removal of part of the foreskin is also possible. While circumcision is usually done in infancy, the surgery can be performed on a male of any age.

Circumcision may also be necessary if your son experiences recurrent balanitis, urinary tract infections, or other infections.

A condition called paraphimosis can also result when the foreskin is retracted, but can’t be moved back into its normal position. This may require emergency medical attention. One complication of paraphimosis is a reduction in blood flow to the end of the penis.

The treatment options for paraphimosis are similar to those for phimosis. Lubricating the glans and the foreskin may help slide the foreskin back up. Before trying this at-home treatment, you should discuss it with a doctor. Have the doctor recommend brands and types of ointments or lotions that are safe. If the paraphimosis continues for several hours, color changes occur, or there is pain, you need to get a medical evaluation immediately.

Circumcision or partial circumcision can eliminate the concerns of foreskin retraction. Be sure to discuss the risks and benefits of this procedure with a doctor. Being uncircumcised places a man at a higher risk of HIV and other infections.

If daily retraction is enough to loosen the foreskin, then pulling it back gently when bathing or urinating should be enough to keep the penis from any hygiene-related complications.

Phimosis can be a serious and painful condition. However, it’s treatable, and outcomes are usually very good. The key is to seek medical attention when symptoms become obvious.

You should also remember that each child develops at a different speed and in many subtly different ways. If one son has phimosis, there’s no reason to think another will have the same condition.