Phimosis (foreskin problems)
What is it?
When boys are first born, their foreskin is tightly contracted around their penis. The foreskin gradually becomes looser in the next few years, so that eventually it can be pulled back without any discomfort. Phimosis is when the foreskin remains unusually tight and cannot be drawn back from the head of the penis. Some men can have phimosis throughout their life and are still able to have intercourse, although most would probably find it more comfortable without this condition. Not being able to pull back the foreskin also means that it is difficult to clean the penis, meaning that infections may be more likely to occur. Phimosis can also develop later in life, after puberty. It can be caused by thrush infections, which lead to scarring of the penis, or another condition (balanitis xerotica obliterans) that makes the foreskin stick to the penis.
What are the symptoms?
The main symptoms are not being able to pull back the foreskin to expose the head of your penis, and if the foreskin is very tight, erections may be painful. You may also have pain on urinating. You should not try and force the foreskin back yourself, as this can lead to painful cracks on the inside of the foreskin. As these cracks heal, they will form scars, which could make your condition worse.
How is it diagnosed?
If you have difficulty pulling your foreskin back, or have observed that this is a problem in your son, you should consult your GP. Your GP will carry out a physical examination and discuss your treatment options with you.
What is the treatment?
If the cause is balanitis xerotica obliterans, you may be prescribed a steroid cream to apply to the top of the penis. If the steroid cream does not improve the phimosis, or there is a different underlying cause, surgery may be offered. Performed under a general anaesthetic, sometimes a small cut in the foreskin may be enough to loosen it up so that it can be pulled back. However, in adults, the foreskin is usually so scarred and thickened a circumcision may be needed. This is when the foreskin is removed completely.
After a circumcision the top of the penis may be feel exposed and sensitive. It is therefore advisable to wear loose boxer shorts and use a condom during sex for the first two months after the operation to reduce any irritation.
Further information
Your local GP surgery is the best place for you to find information on phimosis, especially if you have specific concerns about your symptoms or treatment. Charities can also be useful sources of information and support.
Men's Health Forum www.malehealth.co.uk
