What is Phimosis?
Phimosis (fy-MOH-sis) is defined as an inability to retract the foreskin (prepuce). A patient who has phimosis cannot pull the foreskin back over the glans (head) penis. This can be associated with pain, bleeding, cracking of the foreskin and infections.
What Causes Phimosis:
Phimosis is either natural/physiologic or
Physiologic phimosis is present in newborns and young boys before the foreskin has separated from the glans penis and retraction is a commonplace part of daily bathing and hygiene. By the time most uncircumcised boys are in elementary school, physiologic phimosis has receded.
Pathologic phimosis is more problematic and usually involves adult men and/or men who have gone through puberty. This can be due to repeated episodes infection of the foreskin and glans penis, known as balanitis or balanoposthitis. Such infections are common due to poor personal hygiene (failure to regularly clean under the foreskin). This can be an issue in men with diabetes and often is the first sign of diabetes in some men. In addition, trauma to the foreskin can lead to scarring and phimosis. In some men the skin is unhealthy and can lead to phimosis, a condition called lichen sclerosis is often to blame in these cases.
Recurrent infections to the glans penis, trauma, and chronic inflammation can all lead to scarring of the foreskin tissue that results in phimosis.:
- Diabetes Mellitus – phimosis may be an early symptom of diabetes mellitus.
- Scar Tissue
- Scarring from paraphimosis (when the foreskin is retracted and not replaced promptly)
Phimosis treatment in adults:
Seeking the advice of a urologist is important in managing phimosis. Treatments consist of observation, managing infection, using potent steroids to resolve scar tissue and ultimately circumcision.
Non-Surgical Treatment Options
- Gentle manual retraction daily with bathing and urination
- Topical potent corticosteroid steroid ointment application for 1 to 2 months to help stretch the foreskin. This option often works well in younger men, especially if the foreskin is otherwise healthy and just has a constricting or tight band of tissue. This works poorly for scarred and unhealthy foreskin from repeated infections or trauma.
Surgical Treatment Options
Adult circumcision can be performed to cure phimosis. This is the ultimate management option when non-operative treatments fail or patients want a solution that will solve the issue. Without circumcision, it is possible that the phimosis will recur.
Post-circumcision care involves:
- Using ice packs and refraining from strenuous activity/sexual activity to reduce the risk of bleeding and swelling
- Taking care of the incision to make sure it heals — topical antibiotic ointment/petroleum jelly can be used to keep the incision line from drying out
- If erections occur and are problematic in the first few weeks after surgery, your doctor can prescribe medications to help reduce their frequency
- Do NOT forcefully retract the penis until the wounds have completely healed.
- It often takes 4-6 weeks for the penis to begin to look normal and may take 3-6 months for full healing and the final cosmetic appearance to be known
- Bleeding — the single biggest risk
- Infection of the skin
- Urinary tract infection
- Numbness along the incision or tip of the penis
- Increased sensation of the tip of the penis
- Chordee or bending of the erect penis — happens if too much skin is removed
- Meatal stenosis or urethral injury — rare and more common in infants
- Recurrent Infection — if the phimosis is not resolved, repeated infections can be expected
- Penile Cancer — this is a rare condition, but only occurs in men who are not circumcised
- Poor hygiene — it can be a challenge to keep a phimotic penis clean
- Psychological trauma — phimosis can impact your sex life, body image, and your mental well being
- Discomfort — phimosis can be painful and lead to burning, cracking and injury of the foreskin