Is this cause for concern?
Usually, the foreskin of an uncircumcised penis can be pulled back from the head (glans) of the penis. But in rare cases, the foreskin may become too tight and be unable to be retracted. This condition is called phimosis.
Most cases of phimosis resolve before adolescence, but it’s possible for the condition to last into adulthood. Although there aren’t any serious health complications related to phimosis, it’s associated with conditions that can cause soreness, swelling, and difficulty urinating.
Keep reading to learn more about the conditions tied to phimosis, how phimosis is treated, and more.
Causes of tight foreskin
Your age may determine the cause of your phimosis. Children and adults may experience phimosis for different reasons.
In young boys, a tight foreskin is considered congenital, which means it’s something they have at birth. When this happens, it’s categorized as physiologic phimosis. The foreskin usually becomes more pliable over the next few years, with phimosis completely resolving by age 7.
If a boy is circumcised, then phimosis isn’t possible.
The other category is pathologic phimosis. This means that phimosis is due to an infection, inflammation, or scarring from an underling condition. Pathologic phimosis can be caused by the following conditions.
Balanitis is a type of skin irritation that develops on the head of the penis. It’s especially common in males who haven’t been circumcised.
Symptoms include redness, itching, and swelling, which can cause foreskin tightness. Balanitis can also cause pain when urinating.
Practicing good hygiene is usually enough to treat and prevent balanitis. Cleaning the penis with lukewarm water and soap every day, and gently drying it after bathing and urinating, should help. In some cases, your doctor may recommend a topical cream or antibiotic.
This occurs when the glans and the foreskin are inflamed. This inflammation of both foreskin and glans make the foreskin tighter. Although a yeast infection known as candidiasis is often to blame, bacterial or other types of infections can also cause balanoposthitis. Topical creams containing antibiotics or antifungals are often helpful for treating the infection.
Certain sexually transmitted infections (STIs) can cause balanitis. Symptoms of balanitis, such as swelling and inflammation, can then lead to a tight foreskin.
Genital herpes: Balanitis is a common symptom of genital herpes. Other herpes symptoms include pain and small fluid-fill sacs like blisters on the penis and sometimes on the scrotum.
Gonorrhea: This STI may also cause balanitis symptoms, such as swelling and redness. Other gonorrhea symptoms include:
- pain in testicles
- discharge from the penis
- more frequent urination
Syphilis: This STI can cause penis redness and swelling as well. Other syphilis symptoms include:
- mucus patches on the penis
- a rash elsewhere on the body
- muscle aches
- overall unwell feeling
Other skin conditions
Though less common, other skin conditions can also lead to phimosis or cause the condition to worsen. These include:
Lichen planus: This itchy, noncontagious skin disorder can cause shiny, flat bumps to appear on the penis. Topical steroid creams are usually effective at making the rash disappear.
Lichen sclerosus: This can cause white patches to develop on the foreskin and sometimes the glans. Lichen sclerosus can also cause scarring of the foreskin. Corticosteroid ointments may help. In some cases, circumcision may be necessary.
Eczema: This common, long-term skin condition causes dry patches to form on the skin. Certain types of soaps, the way you dry yourself, and other triggers can cause flare-ups. Work with your doctor to learn how to avoid or limit triggers. The doctor may also prescribe corticosteroid ointments and other medications to help manage your symptoms.
Psoriasis: This chronic skin condition can cause crusty, dry patches of skin to form as a result of abnormal skin cell production. Your doctor can help you identify any possible triggers and prescribe corticosteroids to help relieve your symptoms.
The way phimosis is treated depends on its cause and severity. In some cases, no treatment is necessary. But if a tight foreskin causes symptoms, you should consult your doctor about your treatment options.
As both a treatment and preventive measure, gently pull back and move the foreskin. This should be done when cleaning the penis, starting at a very young age.
Be careful not to pull back foreskin that’s still adhered to the glans. If you’re unsure of whether the foreskin is still attached or whether it’s safe to pull back, consult your doctor. Never forcefully retract the foreskin.
Over-the-counter (OTC) medication
OTC corticosteroid creams and ointments such as hydrocortisone can be effective for many skin conditions that cause or worsen phimosis. Even if there are no other conditions present, your doctor may recommend using topical steroids on your foreskin.
Massaging the ointment into the foreskin and manually retracting the skin twice per day may help make the foreskin more supple. Pain relievers such as ibuprofen (Advil) may also be helpful, depending on your symptoms.
Be sure to take the medications as prescribed and for the length of time recommended by your doctor. Stopping antibiotics too soon may allow a bacterial infection to continue and sometimes develop resistance to antibiotics.
A surgical option may be necessary if other treatments aren’t effective. Your options typically include:
Circumcision: This is the surgical removal of all or part of the foreskin. Although circumcision is typically done during infancy, it can be done at any age. It’s usually recommended for cases of severe phimosis or chronic foreskin infection.
Preputioplasty: This procedure involves the cutting and stretching of the foreskin. It’s a less-comprehensive surgery than circumcision. It’s an option for men who still want the appearance of an uncircumcised penis.
Frenuloplasty: Similar to preputioplasty, a frenuloplasty involves the surgical cutting of the foreskin on the underside of the penis. This loosens the foreskin enough to make it easily retractable.
As with any surgery, these procedures carry a slight risk of bleeding and infection.
A tight foreskin can cause discomfort during intercourse, difficulty with urination, and a greater risk of infections. But with successful treatment, those symptoms may disappear completely.
Talk to your doctor about your options. In some cases, topical medications may be all you need. If your doctor recommends surgery, they’ll explain the process and help you understand your next steps.
How to prevent potential complications
Gently pulling back the foreskin and cleaning your penis from the time you’re young may help prevent phimosis later on. If you can’t do it because the foreskin is too tight or because there are adhesions between the foreskin and glans, get your doctor’s advice on proper care.
If you ever develop an infection that affects the penis or foreskin, treat it early and thoroughly. Proper treatment can reduce your risk for scarring, which may help prevent phimosis from developing.