Phimosis refers to a tight foreskin that cannot be pulled back to uncover the tip (glans) of the penis. In some cases, the foreskin may retract when the penis is soft but not when it is erect.
Minor trauma, recurrent infections, or certain skin conditions can cause scarring and loss of elasticity, leading to persistent tightness and scarring known as BXO (Balanitis Xerotica Obliterans).
At the London and Cambridge Circumcision Centre, our surgeons specialise in diagnosing and treating phimosis in adults using both medical and surgical methods.
What Causes Phimosis?
Phimosis in adults can result from several factors:
- Balanitis Xerotica Obliterans (BXO): also called lichen sclerosis, a chronic scarring skin condition affecting the foreskin.
Lichen planus: a non-infectious inflammatory skin disorder. - Eczema or dermatitis: long-term skin irritation.
- Recurrent infections: including sexually transmitted infections (STIs) and balanitis, especially in diabetes
- Repeated trauma: during sexual activity, leading to microtears and scarring.
Regular hygiene helps reduce the risk of infection. Wash the foreskin gently with mild soap or warm salty water during daily bathing to keep it clean and prevent inflammation.
Grading of Phimosis
Phimosis is graded from 0 to 5 depending on how much the foreskin can retract:
- Grade 0: Foreskin pulls back fully (normal).
- Grade 1: Foreskin can retract, but feels tight behind the head.
- Grade 2: Partial exposure; inner foreskin limits retraction.
- Grade 3: Only the urine opening (meatus) is visible.
- Grade 4: Minimal retraction; glans remains covered.
- Grade 5: No retraction possible.
Grades 4 and 5 often require surgical treatment such as circumcision or preputioplasty.
Appearance of the Foreskin
Appearance can also indicate the severity of the disease:
- Grade 0: Normal foreskin.
- Grade 1: Small fissure or split at the tip.
- Grade 2: White scarring ring partially surrounding the tip.
- Grade 3: Thick white scarring (BXO or lichen sclerosis) with occasional bleeding.
Scores 2–3 typically suggest BXO phimosis (Kikiros et al., PSI 1993 8:329–332).
Treatment Options for Phimosis
Treatment depends on the degree of tightness, age, and underlying cause.
Non-surgical Treatments
- Topical steroid creams or ointments to reduce inflammation and soften the foreskin.
- Gentle stretching exercises in the early stages.
- Phimosis stretching rings (Phimostretch) under supervision.
- Antifungal or antibiotic creams if infection is present.
However, stretching a scarred foreskin can cause further tearing and worsen the problem. There is limited evidence that stretching reverses severe or diseased phimosis.
Surgical Treatments
- Preputioplasty – a widening operation to preserve the foreskin.
- Frenuloplasty – release of a tight frenulum (“banjo string”).
- Circumcision – complete removal of the foreskin; standard for chronic or BXO phimosis.
- Partial circumcision or V-Y preputioplasty – selective options discussed during consultation.
Men with diabetes or recurrent infections usually benefit from full circumcision due to frequent inflammation or fungal growth.
When Surgery for Phimosis Is Necessary
If the foreskin becomes trapped behind the glans (a condition called paraphimosis), it requires urgent treatment to avoid restricted blood flow.
Surgery is recommended when:
- Pain during intercourse.
- Non-surgical measures fail.
- BXO or scarring is confirmed.
- Repeated bacterial or fungal infection, especially in diabetes
Procedures like preputioplasty can preserve the foreskin, while circumcision remains the most effective and lasting solution for tight or scarred foreskins.
Consultation and Booking
Our consultant surgeons — including Dr A. R. Khan, GMC Specialist Paediatric Surgeon and top London Urologists with over 30 years of experience — provide specialist assessment and treatment for phimosis at our London and Cambridge clinics.
We welcome patients from across the UK and abroad for both medical and surgical care.
We offer professional video consultations for detailed assessment and advice.
For specialist consultation, please call +44 7527 314081 to book a £150 video consultation without obligation.
Note: This page provides general information and should not replace professional medical advice. For accurate diagnosis and treatment, consult one of our urology specialists.