Phimosis

Dr. Rajalakshmi VK (AIIMS)MBBS

August 08, 2020

August 08, 2020

Phimosis
Phimosis

Phimosis is a condition in which a male is unable to retract the foreskin from the tip of the penis, also known as the glans. Although not a painful condition generally, it can lead to pain during an erection among teenagers and adults as the foreskin is too tight to be pulled back.

Read more: Penile pain

The foreskin of the penis doesn't retract in babies and very young children, as the tip of the penis and the foreskin are connected to each other in the first few years of the child's development. However, the separation occurs a few years down the line.

In people with this condition, the foreskin can sometimes swell up or inflate while urinating as the foreskin remains tightly closed, blocking the urine from being released.

Phimosis is a common condition among boys up to the age of three, unless they have been circumcised. A study published in the journal Pediatric Urology in 2020 found that anywhere from 0.5% to 13% of men below the age of 18 years have phimosis, while about 3.4% of men in general are said to be at risk of phimosis.

In some cases, phimosis is also caused due to a skin infection that may have resulted in scarring in older children. But phimosis can also subside unless there are other symptoms that begin to show up as a result of it. Symptoms can include problems such as redness, a feeling of soreness or swelling.

Phimosis usually resolves on its own, and by the time a boy reaches the age of 17, the foreskin shohttps://www.myupchar.com/en/disease/infectionsuld be able to retract fully without any pain or discomfort. If phimosis in a teenager or an adult is causing pain or difficulty in urinating, it is a good idea to get it checked by a doctor.

Types of Phimosis

Phimosis is characterised by two different types:

  • Physiologic phimosis, which is the naturally occurring condition of phimosis in newborns and babies
  • Pathologic phimosis, where the foreskin could be retracted earlier but not any more. This type is usually seen after reaching puberty, or due to scarring of the foreskin

Paraphimosis may also be related to this condition, though it is different. In paraphimosis, the foreskin is unable to return to cover the tip or glans of the penis after being retracted or pulled back, which can also lead to symptoms such as swelling and pain.

Read more: Penis disorders

In severe cases, paraphimosis could also lead to a restriction in the blood flow to the penis and may require urgent medical attention.

In severe cases in both conditions, circumcision or a small slit is created in the foreskin to allow it to retract without applying any external pressure. Although paraphimosis isn’t an untreatable problem, a severe case of it can lead to dead tissues in the penis—the condition may eventually require a drastic measure such as surgically removing the penis altogether.

Phimosis symptoms

On most occasions, phimosis does not cause pain and can go unnoticed for a long time. However, the inability to retract the foreskin behind the glans or the foreskin being too tight may cause problems urinating or while having sex. Some of the symptoms of phimosis include:

  • Inability to retract the foreskin: This is the most common sign of the condition, usually noticeable in the early years of a young boy's physical development.
  • Swelling: The foreskin can balloon up as it gets filled with urine. The tight foreskin remains shut over the tip of the penis, not allowing the urine to pass through.
  • Pain: Extremely tight foreskin can lead to pain while trying to pull it back behind the tip of the penis while urinating or during sex.

Phimosis causes

Although phimosis is primarily seen in the early years of a baby boy's life, the condition can occur in later stages too. On some occasions, phimosis can also occur if the foreskin has been retracted by force before its natural separation from the glans took place, leading to scars or skin problems.

An infection on the head of the penis or on the foreskin may also be the cause behind phimosis. The inflammation in those areas is known as balanitis. On some occasions, there is discharge within the foreskin, and the subsequent inflammation on the glans as well as the foreskin is also known as balanoposthitis.

While the above-mentioned causes usually occur in children, adults may also develop this condition, due to health problems such as:

  • Sexually transmitted diseases or infections (STDs)
  • Eczema; reddening, drying or cracking of foreskin causes itching.
  • Psoriasis; flaky, crusty skin covered with scales on the foreskin.
  • Lichen sclerosis; scarring on the foreskin due to irritation from urine among boys and men
  • Lichen planus; another kind an itchy rash that appears on other parts of the body as well.
  • Smegma or the build-up of dead skin cells under the foreskin and over the tip of the penis is not harmful on its own, though it may lead to infections if not routinely cleaned.

While there are a number of causes behind the occurrence of phimosis among males, timely diagnosis and treatment can help overcome this condition.

Read more: Penile yeast infection

Prevention of phimosis

Essentially, keeping the genital area clean is important to avoid the occurrence of infections and other problems such as phimosis. During infancy, no special care is needed for the foreskin, and it is best to let it develop naturally—the application of force to retract the foreskin must be avoided in the early years of a boy's life.

However, retracting the foreskin over the head of the penis with very gentle force can be practised later on, while giving the child a bath or while changing their diapers. The gentle application of force can help the child being able to fully retract the foreskin over time. (Read more: How to clean your baby's genitals)

Older boys and men must wash their penis with soap and water while having a bath. One can gently retract the foreskin and rinse it from underneath as well with water. While these recommendations are primarily for uncircumcised boys and men, those who are circumcised must also follow these practices on a daily basis, to keep infections at bay.

Diagnosis of phimosis

One of the primary reasons why conditions of the genitalia go undiagnosed is due to the awkwardness or shame attached to them. However, much like any other part of the body, infections and conditions can develop around the genitals as well.

Phimosis can also go unnoticed due to lack of awareness, or people waiting for the condition to go away on its own, but if the problem persists, you should take your child to the doctor. If the condition is leading to pain during erections or while urinating, it should be a cause for concern and reason enough to visit a physician or urologist to get it examined.

Some of the signs that one must be on the lookout for include swelling, itching or rashes, pain or a change in the colour of the tip of the penis or the foreskin. The presence of balanitis, as mentioned above, should also be cause for alarm—it is a common infection if one has diabetes.

Phimosis treatment

A urologist is able to diagnose problems such as phimosis and recommend the treatment for the child's condition, based on the symptoms, causes and the medical history of the patient.

In most cases, phimosis or the underlying problem causing it can be treated with the help of over-the-counter topical creams and ointments, along with maintaining good hygiene of the penis. In the case of bacterial infections or fungal infections on the foreskin, antibiotics or antifungal creams may be advised. On some occasions, topical steroids in the form of creams or gels may also be recommended that help to soften the foreskin and enable it to retract easily.

In more severe cases of phimosis, the urologist may also suggest that the boy get a circumcision, which requires a part or all of the foreskin to be removed from the penis. However, this option is considered only after other treatments haven't been helpful or the problem has returned.

In the case of younger boys having trouble with phimosis, surgery may be performed to un-attach the foreskin from the glans to ease the pain and discomfort, but the problem may return at a later stage in life.

Phimosis complications

In most cases, phimosis is not a life-threatening condition and it can be treated rather easily. However, there has been some evidence of tight foreskins leading to the development of cancerous tumours in the penis. According to the American Cancer Society, penile cancer is more common in men with phimosis, although more research needs to be done on this.



References

  1. Department of Urology: UCSF [Internet]. California, San Francisco, USA. Phimosis
  2. National Health Service [Internet]. UK; Tight foreskin (phimosis and paraphimosis).
  3. Morris BJ et al. Prevalence of Phimosis in Males of All Ages: Systematic Review. Pediatric Urology. 2020 Jan; 135: 124-132.
  4. Balaji BS et al. Acceptability and outcomes of foreskin preservation for phimosis: An Indian perspective. Journal of Family Medicine and Primary Care. 2020; 9(5): 2297-2302.
  5. Kanematsu A. Management of phimosis as a risk factor of urinary tract infection: An Asian perspective. Urological Science. 2016 Dec; 27(4): 190-192.

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