What is Phimosis (Tight Foreskin)?

Phimosis (also known as a tightened foreskin), is when the foreskin cannot be retracted or pulled back from the tip of the penis, called the glans. This condition is common in uncircumcised baby boys and toddlers.  

Typically, most boys outgrow any problems with phimosis by the age of 3. The foreskin should start to naturally separate around age 2. However, it takes longer for some boys.

Signs and Symptoms

The main symptom of phimosis is the inability to retract the foreskin. However, a tightened foreskin does not always cause symptoms. If phimosis does not cause symptoms, it is usually not considered serious and may not require treatment.

Possible phimosis symptoms are:

• Swelling
• Redness
• Difficulty urinating
• Soreness
• Itchiness
• Odor
• Painful intercourse
• Lack of sensation

Combined with poor hygiene, phimosis can also lead to inflammation of the penis and foreskin. Inflammation of the penis is called balanitis. Inflammation of both the penis and the foreskin is called balanoposthitis.

Causes

Phimosis only affects uncircumcised males. Baby boys and infants can develop the condition during natural development.

Other potential phimosis causes are:

• Infection of the foreskin.
• Forcing the foreskin to retract.
• Urinary tract infections.
• Foreskin injury or trauma.

Risk Factors

There are several phimosis risk factors. Some of these risk factors mainly affect older boys or adult males.

Tightened foreskin risk factors include:

• Scarring: Especially in older boys and adult males. 
• Sexually Transmitted Diseases: Especially for adult males.
• Skin Conditions: Including eczema, psoriasis, lichen planus, and lichen sclerosus. These conditions cause inflammation, and cracked and itchy skin, that increase the risks of developing phimosis.

Diagnosis

Phimosis diagnosis begins with a routine physical examination. Your doctor may ask questions about your family and medical history, sexual activity, symptoms, and any injury to your penis. Your doctor will also likely examine your penis for signs of a tightened foreskin and related phimosis symptoms.

Additional phimosis tests for phimosis might include:

• Urine tests to check for urinary tract infections.
• Swab tests to check the foreskin for bacteria.
• Blood and/or urine test to measure the blood sugar levels in your body. Phimosis is a risk factor for type 2 diabetes.

Treatment

Treatment for a tightened foreskin depends on the specific cause and symptoms of your condition. In some cases, there is no infection or other disease causing phimosis and the tightened foreskin is a naturally occurring development. There are several treatment options and recommendations available.

Phimosis treatment may include:

• Daily hygiene: Clean your penis daily with lukewarm water and gently dry it. Avoid using shampoo or bubble bath products on your penis or foreskin. After urinating, remember to dry under your foreskin.
• Topical creams and ointments: Your doctor may prescribe a steroid cream or other ointment to reduce inflammation and irritation. This is sometimes referred to as phimosis medication.
• Circumcision: Phimosis surgery, or circumcision, involves removing part or all of the foreskin.

Prevention

Phimosis is preventable with good daily hygiene. Gently cleaning your penis daily helps tremendously with phimosis prevention. Other steps you can take to prevent a tightened foreskin is to avoid rough handling of your foreskin and to practice safe sex to reduce the risk of sexually transmitted disease.

Care for an Uncircumcised Penis

As part of phimosis prevention, your doctor may recommend the following care for an uncircumcised penis:

• Carefully clean your penis with warm water daily.
• Gently clean underneath your foreskin.
• If you use soap to clean your penis and foreskin, use a mild or non-perfumed soap.
• Avoid retracting the foreskin of a baby or infant boy. You might unintentionally cause pain or harm.
• Avoid the use of deodorants and talc on your penis. Talc is a natural mineral ingredient in many cosmetic products such as talcum powder. These products can sometimes cause irritation.

Phimosis vs. Paraphimosis

Phimosis and paraphimosis are two related but separate conditions. In phimosis, the foreskin is tight and has difficulty retracting. The tightened foreskin can be pulled back into place. In paraphimosis, the foreskin is unable to return to its original position. Paraphimosis is a serious and painful condition that requires emergency care.