Urology Care

Phimosis

Understanding Diagnosis, Treatment, and Management of Phimosis

Illustration showing phimosis condition and normal foreskin retraction

What is Phimosis?

Phimosis (fie-MOH-sis) is a penis condition that occurs in some uncircumcised adults and children. If you have phimosis, you can't pull back (retract) your foreskin (prepuce). It may look like your penis has rings around the tip.

Under typical circumstances, you should be able to pull back your foreskin easily and see the entire head (glans) of your penis.

Important to know: Having phimosis isn't necessarily a problem. Babies have phimosis at birth, and their tight foreskin will usually loosen as they get older without treatment. Phimosis becomes a problem when it causes symptoms, like a pinhole-sized opening or you can't pull back your foreskin enough to clean the area underneath.

What are the types of phimosis?

There are two types of phimosis:

Physiologic Phimosis

Physiologic phimosis occurs more often in children. It usually resolves as they get older without any treatment. This is the natural state in infants and young boys.

Pathologic (Congenital) Phimosis

Infection, inflammation or scarring cause pathologic phimosis. Lichen sclerosus is a common cause. This type usually requires medical treatment.

Symptoms and Causes

What are the symptoms of phimosis?

The primary symptom of phimosis is that you can't pull the foreskin back from the head of your penis. But other phimosis symptoms may include:

Common symptoms include:

Discoloration (red, purple, dark brown or black)
Swelling of the foreskin or penis tip
Soreness or pain in the affected area
Pain while peeing (dysuria)

Weak pee stream
Blood in your pee (hematuria)
Accumulation of smegma
Pain during erection or sexual intercourse

What are the complications of phimosis?

Phimosis may cause several complications if left untreated:

Immediate Complications

Foreskin inflammation (posthitis)
Glans inflammation (balanitis)
Combined inflammation (balanoposthitis)
Urinary tract infections (UTIs)

Serious Complications

Foreskin tears or adhesions
Paraphimosis (trapped foreskin)
Poor hygiene leading to infections
Increased risk of penile cancer

Note: Long-standing phimosis may increase your risk of developing penile cancer. It's important to seek medical attention if you experience persistent symptoms.

Diagnosis and Tests

How is phimosis diagnosed?

A healthcare provider can diagnose phimosis by reviewing your symptoms and performing a physical exam.

Physical Examination

Visual inspection and assessment of foreskin retraction ability

Urine Test

Urinalysis to check for urinary tract infections

Culture Test

Urethral discharge culture to identify infections

When to see a doctor

If you cannot retract your foreskin at all
If you experience pain during urination
If there's swelling, redness, or discharge
If you notice blood in your urine
If you have pain during sexual activity

Prevention and Management

How can phimosis be managed or prevented?

Practice proper genital hygiene

Gentle daily stretching exercises

Use of topical steroid creams

Regular medical check-ups

Prompt treatment of infections

Consider circumcision if severe

Important: For physiologic phimosis in children, no treatment is usually needed as it often resolves naturally. Never force the foreskin back in children as this can cause scarring and worsen the condition. Always consult with a healthcare provider for proper diagnosis and treatment recommendations.