This article explains what phimosis is in children, teens, and adults, including the symptoms and causes.
It also explains how phimosis is treated with medications, dilation devices, and surgery.
Phimosis vs. Paraphimosis
Phimosis should not be confused withparaphimosis.
Illustration by Mira Norian for Verywell Health
This can block blood flow to the penis, causing potentially severe tissue and nerve damage.
The foreskin and glans also stick together like pieces of tape to form adhesions.
Reflex (involuntary) erections will also help loosen the foreskin and enable retraction.
This process can vary from one child to the next.
When the penis and foreskin are both affected, it is known asbalanoposthitis.
Among uncircumcised people with a penis over age 18, the rate of phimosis hovers around 3.4%.
Even so, the risk of pathologic phimosis is high.
However, for those whose foreskin is especially tight, phimosis can cause significant pain with erections.
It also can make having sex painful, even in the absence of any complications.
After circumcision, all 59 participants reported satisfaction with how their penises looked.
Even those without ED reported improvement in erectile function after the surgery.
Does Phimosis Reduce Sensitivity?
Though phimosis can cause pain, there is no evidence that it can make the penis less sensitive.
A 2015 review of studies found no difference in penile sensitivity in either circumcised or uncircumcised subjects.
Physical Exam for Phimosis
Phimosis is diagnosed with a physical exam of the penis.
The grade helps determine the appropriate course of treatment.
Age also factors into the diagnosis.
Conservative treatment is generally used for grades 02, while more intensive treatments are prescribed for grades 34.
Treatment options range from watchful waiting and medications to foreskin dilation and surgery.
Over time, most cases resolve themselves on their own.
For babies and toddlers, the main focus is to teach parents how to keep the foreskin clean.
Cleaning typically involves washing the penis with a mild soap and water.
Washing from the outside is usually enough; there is no need for cotton swabs or special cleansers.
If the phimosis doesn’t improve and your child has trouble urinating, call your pediatrician.
Medications
When indicated,topical corticosteroids(steroids) are the first-line drug of choice for phimosis.
This is especially true with children, whose success rates hover between 65% and 90%.
The steroids are applied to the foreskin twice daily for six to eight weeks, accompanied by gentle retraction.
Once retraction is achieved, treatment is stopped.
Unlike topical steroids, foreskin dilation affords permanent results.
Medical devices called preputial dilation retractors can be used at home.
They gently stretch the foreskin over a period of weeks to encourage the release of adhesions.
Once the gadget is comfortably positioned behind the head, you wear it for 72 hours.
Dilation retractors are indicated for teens and adults with grade 2 and possibly grade 3 phimosis.
Surgery
Circumcision is considered the gold standard for treating phimosis.
Among adults in the United States, phimosis is the most common reason for circumcision.
It can be used to relieve phimosis symptoms, to avoid complications, or for cosmetic reasons.
Circumcision is typically performed on anoutpatient basisusinglocalorregional anesthesia.
It is a relatively simple procedure with a low risk of complications (mainly bleeding or infection).
However, circumcision is not the only surgical option for children or adults with phimosis.
Physiologic phimosis is something you are born with.
Pathologic phimosis is something you acquire that develops secondary to scarring of the opening of the foreskin.
Among some of the possible causes of pathologic phimosis are:
Can Phimosis Cause Cancer?
Most people return home on the same day of the procedure.
Swelling and bruising can be expected for the next couple of days.
Place a cloth between the ice pack and your skin to avoid frostbite.
To aid with healing,change the dressingon your penis as directed by your surgeon.
Wear comfortable underwear that holds the penis upright to reduce swelling and pain.
you might usually shower once you no longer need a bandage.
You should also avoid masturbation and sex for six weeks or until your urologist tells you otherwise.
An occasional erection will likely do you no harm, but avoid touching or manipulating the erection.
Physiologic phimosis is a normal condition in children that usually resolves as the child gets older.
Pathologic phimosis is when a disease or disorder causes scarring that reduces the retractability of the foreskin.
Phimosis is diagnosed with a physical exam and a review of your medical history.
For most children, the treatment of phimosis involves watchful waiting, good hygiene, and gentle retraction.
Other children and adults may require topical steroids, dilation devices, or surgery.
Circumcision is considered the gold standard treatment for phimosis.
Fahmy MAB.Anatomy of the prepuce.
In:Normal and Abnormal Prepuce.
University of California, San Francisco.Phimosis.
2021;9:100315. doi:10.1016/j.esxm.2020.100315
Cox G.Penile sensitivity - are we measuring the wrong property?JSM Sexual Med.
2023;7(4):1120.
Carilli M, Asimakopoulos AD, Pastore S, et al.Can circumcision be avoided in adult male with phimosis?
A systematic review and meta-analysis.Skin Health Dis.2021 Mar;1(1): e13.
2017;6(5):785-790. doi:10.21037/tau.2017.05.19
American Cancer Society.Can penile cancer be prevented?
Alberta Health Services (Canada).Adult circumcision: what to expect at home.
