Phimosis - Tight foreskin and Paraphimosis
STEROIDS, PREPUTIOPLASTy, FULL OR PARTIAL CIRCUMCISION
What is Phimosis?
Phimosis is the term used for tight foreskin, which means that you cannot pull the foreskin back to see the tip of the penis. Sometimes it folds back when the penis is lax but unable to withdraw when the penis is hard (erect). Usually, phimosis does not remain the same as with each erection. With minor trauma to the foreskin, this leads to a loss of elasticity due to scarring. In adults, sexually transmitted infections (STIs), Balanitis (foreskin infection), or trauma can be associated with phimosis.
Skin conditions can also cause a tight foreskin:
1. Balanitis Xerotica Obliterans (BXO), also called Lichen sclerosis (Read more about BXO)
2. Lichen planus - a non-infectious skin condition that may affect the foreskin
3. Eczema- long-term skin problems
Cleaning the foreskin is vital to prevent infection. It is a good idea to wash the foreskin with mild soap or warm salty water when you take a shower or bath. This will help to keep the foreskin clean.
GRADING OF PHIMOSIS
There are six grades of phimosis, with scores
0. Foreskin pulls back fully
1. foreskin can withdraw, but tight behind the head of the penis
2. Partially exposed of the head of the penis, the tight inner foreskin limits the retraction
3. Partial retraction: the wee hole is just visible
4. Slight retraction, but the head of the penis is fully covered
5. Completely no retraction of the foreskin at all
Scores 4-5 may need a surgical solution
APPEARANCE OF FORESKIN
There are four appearances with the score:
0. Normal foreskin
1. Fissure or skin splitting at the tip of the foreskin
2. Partially surrounded by a white scar
3. Lichen Sclerosis or Balanitis xerotica obliterans: severe scarring, associated with occasionally bleeding
Score 2-3 showed BXO phimosis (Kikirosv et al., PSI (1993) 8:329-332)
How to cure phimosis
Tight foreskin treatment depends on age as well as the degree of phimosis. Phimosis can be treated with the following:
1. Steroid cream or ointment
2. Stretching exercises in the early stages.
3. Stretching by phimosis stretching rings (Phimostretch)
The stretching of a scarred foreskin may produce further tearing and scarring. There is no scientific evidence that stretching makes it better for diseased and unhealthy tight foreskin. Different kinds of phimosis creams are used in some cases with limited success. If phimosis symptoms worsen with time, BXO (scarring condition) must be excluded. Adults can use a condom and lubricants during sexual activities in the presence of mild phimosis.
If sex with phimosis is painful, then you may require urgent treatment. Phimosis home treatment is possible with a healthy foreskin by daily cleaning, washing, stretching exercises and clearing the normal dry secretion called “smegma”. Infection with tight foreskin requires treatment like antibiotics or to exclude sexually transmitted infections disease by GUM clinic (Sexual Health Clinic) or your GP.
Sometimes, a fungal infection is causing mild phimosis. This can be treated with a combination of antifungal and steroid cream. In adults with diabetes with phimosis, circumcision is the preferred treatment due to recurrent fungal infection or possible BXO.
There are alternatives to full circumcisions, such as topical steroid cream, frenulum excision, V-Y plasty operation called preputioplasty, frenuloplasty, partial circumcision or other medical treatments. These are personal preferences and can be discussed further with our specialist - Dr Khan, and London consultant urologists at a dedicated specialist circumcision clinic in London.
When will surgical treatment required?
A tight foreskin can be stuck behind the head of the penis (glans) due to the presence of a phimotic ring. This is called paraphimosis, which requires urgent treatment. Phimosis cure in adulthood can be done with steroids, preputioplasty and circumcision. Phimosis surgery can retain the foreskin by preputioplasty. Circumcision remains the standard surgical option for tight foreskin, especially BXO phimosis. We take all phimosis patients from the UK and abroad.
In summary, phimosis is a condition in which the foreskin is too tight, making it difficult or impossible to retract. This condition can be caused by various factors such as skin conditions (BXO), infections, and trauma. The treatment options for phimosis include using steroid cream, performing stretching exercises and circumcision or preputioplasty. In the case of paraphimosis, where the foreskin is stuck back behind the glans, urgent treatment is necessary. We provide specialist medical advice for the diagnosis and treatment of phimosis.
PS: This information is for guidance only. This is not a replacement for professional medical advice. Please call us for a video consultation for £150 advice at +447527314081 without obligation.
