Phimosis - Tight foreskin and Paraphimosis


What is phimosis

This is condition where foreskin is tight and not able to pull back to see the head of penis (glans). Sometimes it is retractable when penis is flaccid but never able to retract when penis is erect. Usually phimosis does not remain same as with each erection, there is minor trauma to the foreskin. This leads to loss of elastic fibres due to scarring. In adults, sexually transmitted infections (STIs) or other infections (balanitis) can be associated with phimosis. 

Tight foreskin can also be caused by skin conditions: 

1.   Lichen sclerosus or Balanitis Xerotica Obliterans (BXO) - scarring skin condition which may involve foreskin and glans (head) of penis caused progressive phimosis

2.   Lichen planus- a non-infectious skin condition which may affect foreskin

3.   Eczema- long term skin problems with itchy, cracks and dry skin.

Foreskin cleaning is important to avoid infection. Gently washing the foreskin with mild soap or warm water with sea salt while taking bath or shower is important to keep the foreskin clean.  

Grading of Phimosis

There are six grades of phimosis with scores

0. Full retraction, not tight behind glans, or easy retraction limited only by congenital adhesions to the glans

1. Full retraction of foreskin, tight behind the glans

2. Partial exposure of glans, prepuce (not congenital adhesions) limiting factor

3. Partial retraction, meatus just visible

4. Slight retraction, but some distance between tip and glans, i. e. neither meatus nor glans can be exposed

5. Absolutely no retraction

Score 4-5 may need surgical solution

Appearance of foreskin

There are four appearances with score:

0. Normal

1. Crack in prepuce,"skin-splitting"on gentle retraction

2. Small white scar, partial circumferential

3. Balanitis xerotica obliterans or severe scarring ± bleeding

Score 2-3 showed BXO phimosis

Ref: Kikirosv et al, PSI (1993) 8:329-332

How to cure phimosis

Treatment of tight foreskin depends on the patient’s age as well as the severity of phimosis. Phimosis can be treated with topical steroids cream like hydrocortisone or stretching exercises in early stages. Phimosis stretching of a scarred foreskin may produce further tearing and scarring. There is no scientific evidence that it produces treatment for diseased tight foreskin. Phimosis creams are used in some cases with limited success. If phimosis symptoms become worsen with time, BXO must be excluded. Some adults use a condom and lubricants during sexual activities in the presence of mild phimosis.

Sex with Phimosis can be painful and require urgent treatment. Phimosis home treatment is possible without diseased foreskin by daily washing, stretching exercises and clearing the smegma.  Phimosis gives Balanitis which require treatment in the form of antibiotics.

Fungal infection causing mild phimosis is treated with a combination antifungal cream and steroids cream. In adults with diabetes with phimosis, circumcision is the preferred treatment due to recurrence fungal infection. 

There are alternatives to full circumcision, such as topical steroids cream, excision of frenulum, 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 at dedicated specialist circumcision clinic, London.

When surgery may be needed

Tight foreskin can be stuck behind the head of penis (glans) due to presence of a phimotic ring. This is called paraphimosis which require urgent treatment. Phimosis cure in adult can be done by 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. 

PS: This information is for guidance only. This is not replacement of professional medical advice. Please call to Dr. Khan for free telephone advice +447527314081 without any obligation.