Phimosis Treatment – Symptoms, Causes & Advanced Care at MASSH

About Phimosis

Phimosis is a medical condition in males where the foreskin of the penis is too tight, making it difficult or impossible to retract over the glans (head of the penis). In early childhood, this is usually normal and tends to resolve as the child grows. However, in older children or adults, persistent phimosis can cause discomfort and medical issues.

There are two main types: congenital phimosis, present from birth and often self-resolving, and acquired phimosis, which can result from infections, scarring, or inflammation. If left untreated, phimosis can lead to complications like recurrent infections, painful urination, or paraphimosis, a urological emergency.

Treatment varies based on severity and includes conservative options like topical steroid creams, foreskin stretching, or surgical approaches such as circumcision or preputioplasty.

Signs & Symptoms of Phimosis

The key symptom is inability to retract the foreskin. Additional symptoms may include:

1. Redness and Swelling Around the Foreskin

• Description: Foreskin appears inflamed, especially at the tip.
• Cause: Moisture and smegma accumulation due to poor retraction.
• Details: Redness may extend to the glans if not cleaned properly.

2. Discomfort or Pain During Urination

• Description: Burning or stinging during urination.
• Cause: Tight foreskin causes a ballooning effect or narrow urinary stream.
• Details: May result in split or weak urine stream.

3. Difficulty Maintaining Proper Hygiene

• Description: Inability to clean under the foreskin leads to smegma buildup.
• Cause: Tight foreskin blocks access to the glans.
• Details: Can cause foul odor and increase infection risk.

4. Recurrent Infections or Inflammation

• Description: Frequent balanitis or UTIs with discharge or redness.
• Cause: Bacteria or fungi thrive under unretracted foreskin.
• Details: Chronic infection may cause scarring and worsening phimosis.

5. Painful Erections

• Description: Erections may stretch or tear the tight foreskin.
• Cause: Restricted foreskin movement during arousal.
• Details: In severe cases, it can lead to paraphimosis (medical emergency).

6. Difficulty with Hygiene (Expanded)

• Description: Repetitive cycle of poor cleaning and infection.
• Cause: Tight foreskin makes daily hygiene difficult.
• Details: Impacts comfort, confidence, and sexual well-being.

Causes of Phimosis

Congenital Phimosis

• Present from birth.
• Normal in children up to 5–7 years old.

Acquired Phimosis

Caused by:

• Infections: Chronic or untreated infections.
• Balanitis: Leads to inflammation and scarring.
• Skin Conditions: E.g. lichen sclerosus, eczema.
• Poor Hygiene: Leads to smegma buildup and inflammation.
• Trauma or Injury: Including forced retraction or surgery.

Risk Factors of Phimosis

• Young age (normal in toddlers and infants)
• Family history of tight foreskin
• Repeated infections (balanitis, posthitis)
• Poor genital hygiene
• Forceful foreskin retraction
• Penile trauma or catheter use
• Chronic skin disorders (e.g., eczema, lichen sclerosus)
• Diabetes (increased infection risk)
• Smoking (impairs healing and skin health)

Diagnosis of Phimosis

Medical History

Physician will ask about:

• Onset of symptoms
• Frequency of infections
• Past penile trauma or procedures
• Associated pain or urinary symptoms

Physical Examination

Doctor evaluates:

• Foreskin retractability
• Signs of swelling, redness, discharge
• Pain or discomfort during examination
• Overall penile health

Foreskin Retraction Assessment

• Normal in young boys
• Persistent non-retraction in older children/adults may require treatment

Additional Testing

May include:

• Urinalysis to rule out infection
• Swab test for discharge
• Ultrasound if deeper tissue evaluation is needed

Treatment Options for Phimosis

Stapler Circumcision

A modern, minimally invasive method using a disposable device that cuts and seals the foreskin with surgical staples:

• Performed under local anesthesia (10–20 minutes)
• Less bleeding, no stitches
• Fast recovery (1–2 weeks)
• Minimal discomfort post-procedure

Frenuloplasty

Surgical correction of a tight frenulum:

• Often performed with stapler circumcision
• Local anesthesia (15–30 minutes)
• Recovery in 2–4 weeks
• Enhances foreskin mobility and sexual comfort