Phimosis

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What is phimosis?

Phimosis is a painful condition that makes it difficult to retract the foreskin of the penis. It occurs in boys and men who have not undergone circumcision (removal of the foreskin covering the tip of the penis). Tissue damage can occur if the foreskin is forcibly retracted. Phimosis is common in newborn males because the skin covering the tip of the penis is still tight and less pliable, and it is fairly normal for most babies and toddlers to have initial difficulties with retracting the foreskin. Phimosis typically resolves or improves on its own with age. Most boys can retract their foreskin completely by the age of three (Source: LPCH).

Another condition affecting the foreskin is called paraphimosis, in which repositioning of the foreskin to the unretracted position is not possible, and this limits or stops blood flow to the penis. It is a more serious condition because it affects blood supply and must be treated in an emergency setting.

If phimosis is not resolved by adolescence, circumcision may be necessary since the condition can cause pain or discomfort during urination and difficulty with sexual intercourse.

Phimosis is not typically associated with serious complications unless urination is not possible, but paraphimosis is an emergency. The inability to reposition or unretract the foreskin to its proper position is potentially dangerous because it can deprive the penis of blood flow. Seek immediate medical care (call 911) if you or your child is unable to reposition the foreskin and experience symptoms of swelling, tightness and constriction, or the inability to urinate.

What are the symptoms of phimosis?

Symptoms of phimosis may vary in severity among affected individuals.

Common symptoms of phimosis

Common symptoms of phimosis include:

  • Bulging of the foreskin (especially during urination)
  • Difficulty urinating
  • Inability to pull back the foreskin
  • Pain
  • Swelling of the tip of the penis

Common symptoms of paraphimosis

  • Common symptoms of paraphimosis include:
  • Difficulty ejaculating
  • Difficulty urinating
  • Discoloration or bruising of the tip of the penis
  • Inability to return the foreskin to the unretracted position
  • Swelling of the tip of the penis

Symptoms that might indicate a serious condition

Paraphimosis is a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Discoloration or bruising of the penis tip
  • High fever (higher than 101 degrees Fahrenheit)
  • Inability to reposition the foreskin to the unretracted state
  • Inability to urinate
  • Tenderness around the scrotum

What causes phimosis?

The cause of phimosis is not known. It occurs in uncircumcised males and tends to occur in infants and toddlers. Phimosis typically improves and resolves itself with age.

What are the risk factors for phimosis?

Several factors increase the risk of developing phimosis. Not all boys and men with risk factors will get phimosis. Risk factors for phimosis include:

  • Being uncircumcised
  • Diabetes
  • Frequent diaper rash as an infant
  • Poor hygiene
  • Young age

    How is phimosis treated?

    Boys and men who have suspected cases of phimosis with an inability to urinate or paraphimosis should be evaluated by a health care professional right away. Treatment is necessary to prevent discomfort and further injury. The overall health and age of children will factor into consideration of the treatment options.

    Treatment for phimosis

    Most cases of phimosis are typically treated with a topical steroid treatment to the foreskin to loosen and manipulate it. Rare cases may require circumcision, for example, if the swelling is interfering with urination. Treatments include:

    • Circumcision (if the child has reached an advanced age and the swelling is preventing urination)

    • Steroid creams to loosen the foreskin

    Treatment for paraphimosis

    Treatments for paraphimosis include:

    • Circumcising the penis (in advanced cases that do not respond to treatment)

    • Gently and minimally incising the foreskin to reduce bulging or swelling

    • Manipulation and lubrication of the foreskin for repositioning

    What you can do to improve your phimosis

    The following self-care measures may help ease discomfort for you and your child:

    • Applying over-the-counter creams (under a physician’s care)

    • Taking an anti-inflammatory medication, such as ibuprofen (Advil) or naproxen (Aleve) for pain and inflammation. Always seek a health care provider’s guidance when giving over-the-counter medications to children; children should not be given aspirin due to the risk of Reye’s syndrome, a potentially fatal disease that may occur in children after aspirin use.

    • Using a warm, damp washcloth to soothe the area

    What are the potential complications of phimosis?

    Complications of untreated phimosis can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of phimosis include:

    • Adverse effects of treatment

    • Difficulty ejaculating

    • Difficulty urinating

    • Gangrene

    • Infertility

    • Pain during sexual intercourse

    • Posthitis (inflammation of the prepuce)

    • Recurrent infections

    • Scarring of the penile opening

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2021 Jan 18
    View All Men's Health Articles
    THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
    1. Phimosis and paraphimosis. Lucile Packard Children’s Hospital at Stanford. http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/urology/pandp.html.
    2. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: approach to the phimotic foreskin. Can Fam Physician 2007; 53:445.
    3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.