Tight foreskin (phimosis)

Some parents worry if it is not possible to push back their newborn or young son’s foreskin and think that this “phimosis” means their child will require surgery. What many do not realize is that almost all boys are born with a tight foreskin or areas of stuck skin (adhesions) between the foreskin and the head of the penis. This natural form of phimosis protects the sensitive head of the child’s penis against friction, drying out and harmful factors such as viruses or bacteria in his first few months of life.

The adhesion usually goes away of its own accord by the time the child turns 3 or 4 and the foreskin gradually loosens, becoming ever easier to pull back without pain. A tight foreskin should only ever be treated if it does not go away of its own accord.

Phimosis exists if the foreskin cannot be pulled back over the head of the penis at all or without pain.

Sometimes, a balloon-like swelling can also be seen under the foreskin when urinating: in such cases, the urine is getting trapped due to the opening being too narrow.

A tight foreskin usually only causes issues such as pain, swelling and redness if it remains into adolescence or even adulthood and causes inflammation, for example.

There are various types of phimosis: if the natural phimosis or adhesion does not go away of its own accord within the first few years of life, this is classed as a primary phimosis. The causes of this are unclear.

If a tight foreskin results from scarring, this is medically classed as a secondary phimosis. This type of phimosis can develop due to certain skin conditions or repeated inflammation. Often, injuries can also lead to scarring and secondary phimosis. These can occur if the foreskin is pulled back forcibly, causing small tears, for example.

It is estimated that about 96% of boys are born with natural phimosis, which goes away of its own accord within the first few years of life. Only a few boys are still affected during puberty. Only one in every 100 16-year-olds still has a tight foreskin.

People with a tight foreskin can have problems urinating. If the tightness persists into puberty or even into adulthood, pain can also occur during erection and sexual intercourse. In addition, adolescents and adults with a tight foreskin will find it difficult to wash the head of their penis and the area under the foreskin. This makes it easy for bacteria or fungi to settle here, causing inflammation.

Trying to push back a tight foreskin can cause tears or minor injuries. In rare cases this can also lead to what is known as paraphimosis or “Spanish collar”. With this condition, people can no longer pull the foreskin back forward over the head of the penis, restricting the blood supply. On exceptions, the head of the penis can die. Paraphimosis is an emergency that needs instant medical attention.

In the case of infants, the parents usually notice that the foreskin cannot be pushed back. Children or adolescents usually notice this themselves. To make a diagnosis, the doctor will check whether it is a primary phimosis or has other causes, such as skin conditions or scarring. Whether and how the tight foreskin is treated depends on the diagnosis and the patient’s age.

Infants with natural phimosis do not initially require any treatment. Their parents should not try to force the child’s foreskin back. This can not only hurt the child but also cause injury and create scarring that may later result in secondary phimosis. Washing the penis from the outside with warm water and mild soap or shower gel is enough to keep it clean.

If a tight foreskin does not go away of its own accord and pain is experienced when urinating, for example, a doctor should be consulted. Following an examination, the doctor will then discuss whether treatment is required at the current stage.

In the case of children, a tight foreskin is usually treated with a cortisone ointment. This “conservative” (non-surgical) treatment takes several weeks and resolves the condition in most cases.

If the tight foreskin does not go away after using an ointment, minor surgery is possible. This is known as circumcision. Such surgery is also advisable in other cases, for example if the foreskin regularly becomes inflamed or if the phimosis was caused by scarring or has led to the foreskin becoming constricted (paraphimosis). Phimosis surgery is a routine procedure. In the case of children, it is usually performed under general anesthetic; with adolescents and adults, local anesthetic may sometimes be used.

You can find more detailed information, for example on how phimosis is treated, at gesundheitsinformation.de.