Phimosis - Tight foreskin and Paraphimosis


What is Phimosis

Phimosis is the term used for tight foreskin. You are not able to 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. Usually phimosis does not remain same as with each erection, there is minor trauma to the foreskin. This leads to loss of elasticity due to scarring. In adults, sexually transmitted infections or other infections called balanitis can be associated with phimosis.

Tight foreskin can also be caused by skin conditions:

1.   Balanitis Xerotica Obliterans (BXO), also called Lichen sclerosus (Read more about BXO)

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

3.   Eczema- long term skin problems

Cleaning inside of the foreskin is important 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. 


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 expose of the head of the penis, tight inner foreskin limits the retraction

3. Partial retraction, wee hole is just visible

4. Slight retraction, but the head of the penis is fully covered

5. Completely no retraction of foreskin at all

Score 4-5 may need surgical solution


There are four appearances with the score:

0. Normal foreskin

1. Fissure or skin splitting at the tip of foreskin

2. Partially surrounded with 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 the age as well as the degree of phimosis. Phimosis can be treated with:

1.     Steroids cream or ointment  

2.     Stretching exercises in early stages.

The stretching of a scarred foreskin may produce further tearing and scarring. There is no scientific evidence that it produces treatment for diseased tight foreskin. Different kind of phimosis creams is used in some cases with limited success. If phimosis symptoms become worse with time, BXO 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 without an unhealthy 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 or by your GP.

If there is a fungal infection which is causing mild phimosis. This can be treated with a combination antifungal cream 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 circumcision, such as topical steroid cream, excision of the 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 a dedicated specialist circumcision clinic, London.

When surgery may be needed

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 require 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. 

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