Phimosis is a condition in which the foreskin (prepuce) – the fold of skin that covers the head of the penis (the glans) – is too tight and cannot be pulled back freely. In young boys this is a normal stage of development, but in teenagers and adult men the narrowing is usually acquired and is caused by scarring from inflammation or skin diseases.
The problem is common and far from merely cosmetic: the narrowing makes hygiene difficult, makes erections and sex painful, keeps causing repeated inflammation and, at an advanced stage, interferes with passing urine. Dr Penev sees and treats adults with phimosis at his private practice in Plovdiv and, by appointment, in Karlovo.
What phimosis is
At birth the foreskin is naturally stuck to the glans and separates gradually over the first years of life. This is physiological phimosis, which in most cases resolves by puberty without treatment – more in the article on phimosis in children. Pathological phimosis is different: the opening of the foreskin is narrowed by scar tissue, often with a whitish, firm ring that does not stretch.
The severity varies – from slight tightness during an erection and a glans that can only be partly uncovered, to a very small opening where the skin balloons when you pass urine and the stream becomes thin.
Symptoms
- pain or inability when pulling the foreskin back;
- tightness, cracks and small tears during an erection or sex;
- a whitish, hard ring along the edge of the foreskin;
- a build-up of secretions, an unpleasant smell and repeated inflammation of the glans – balanitis;
- ballooning of the foreskin when passing urine, a thin or spraying stream;
- itching, redness and burning, especially in men with diabetes.
When it is urgent: if the foreskin has been pulled back and cannot be returned over the glans, it forms a constricting ring and the glans swells and turns bluish. This is paraphimosis – the blood supply is at risk. Do not wait for a booked appointment; go to an emergency department or call 112 (the European emergency number). The same applies if you are completely unable to pass urine.
Causes and risk factors
In adults, phimosis is almost always secondary, meaning it is the result of scarring. The most common causes are:
- repeated inflammation of the glans and foreskin, especially fungal infections;
- lichen sclerosus – a chronic skin condition with whitish, hardened patches and the leading cause of severe phimosis in adults;
- diabetes, which makes fungal infections easier and slows healing;
- forcible retraction of the foreskin, injuries and catheterisation;
- eczema, psoriasis and harsh hygiene with irritating products.
Long-standing phimosis and lichen sclerosus are also risk factors for penile cancer – a rare disease, but one more reason not to leave the narrowing unmonitored.
Diagnosis
The urology consultation starts with a conversation: when the narrowing began, whether erections are painful, whether you have inflammation, difficulty passing urine or diabetes. During the examination Dr Penev assesses how severe the narrowing is, the condition of the skin and the glans, any scars and suspicious areas, and whether there is a short frenulum (frenulum breve), which often goes together with phimosis. Tests are ordered depending on the case: a swab of the discharge if there is inflammation, blood sugar if diabetes is suspected, uroflowmetry or ultrasound if there are problems passing urine, and a biopsy of suspicious skin changes.
Treatment
Non-surgical treatment
For mild to moderate phimosis without dense scarring, the first step is usually a topical corticosteroid cream applied to the narrowed ring once or twice a day for four to eight weeks, combined with gentle stretching after a warm shower. In many men the skin softens and starts to retract freely. Any inflammation and diabetes are treated at the same time. If there is no improvement after a full course, or the narrowing comes back, a surgical solution is discussed.
Circumcision
Circumcision is the definitive solution for marked or recurrent phimosis, lichen sclerosus, repeated balanitis and after an episode of paraphimosis. The narrowed part of the foreskin is removed – completely or partially. The procedure is usually done as an outpatient, under local anaesthetic, and takes about half an hour. Dr Penev performs circumcision with a laser or with the classic technique depending on the case and his clinical judgement, and if there are other medical conditions or a general anaesthetic is needed, the operation is planned at Kaspela University Hospital (UMBAL Kaspela), Plovdiv.
The patient goes home the same day. The swelling settles in one to two weeks, the stitches are dissolvable, and full healing and a return to sex take about four to six weeks.
When to see a urologist
Book a consultation if the foreskin does not pull back freely, if erections or sex are painful, or if you notice a whitish ring, cracks, repeated inflammation or a change in your urine stream. Do not stretch the skin by force and do not put off the consultation – every new tear leaves a scar that narrows the opening even further.
Prevention
Daily hygiene with lukewarm water and gentle retraction of the foreskin, without causing pain; drying after washing; avoiding harsh soaps; controlling diabetes; prompt treatment of any redness or itching; a condom with a new partner. These measures do not widen a scar that has already formed, but they protect against things getting worse.
Phimosis in adults has clear and effective solutions – from a cream to a short outpatient operation. If the narrowing is causing you problems, book an appointment with Dr Penev for an examination and an individual treatment plan.
Frequently asked questions
Can phimosis in an adult go away on its own?
In adults the narrowing is almost always caused by scarring and does not disappear by itself. Mild forms often respond to a cream and gentle stretching, but without treatment the condition usually progresses.
Can phimosis come back after circumcision?
After a full circumcision the narrowing cannot come back, because the foreskin has been removed. After a partial circumcision or preputioplasty (a plastic procedure that widens the opening) it can recur, especially with lichen sclerosus.
Will sensitivity change after circumcision?
For the first few weeks the glans is more sensitive because it is no longer covered, after which sensation returns to normal. Most men do not report any lasting change in sexual satisfaction.
Does my partner need treatment if I have phimosis with a fungal infection?
With recurrent fungal balanitis it is sensible for your partner to see a gynaecologist. The infection can pass in both directions and keep the inflammation going despite treatment.
How many days off work are needed after circumcision?
Usually two to five days for a desk job and about one to two weeks for physical work. You can drive as soon as the discomfort allows.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.