Tight foreskin (phimosis)

Some parents worry if it is not possible to push back their newborn or young son’s foreskin. 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 within the first few years of the child’s life and the foreskin gradually loosens, becoming ever easier to pull back without pain. Treatment is only advisable if the tightness does not go away by itself.

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, urine is getting briefly trapped due to the opening being too narrow. This is not a reason for concern.

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.

For some boys and men, a tight foreskin only causes problems if the penis becomes stiff and therefore larger (erection) when sexually aroused or sleeping. If the foreskin is only slightly tight, it may only be when the penis is erect that it no longer fits over the head of the penis. This can be unpleasant or painful during masturbation or sex.

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. Injuries can also often lead to scarring and secondary phimosis – for example small tears that occur if the foreskin is pulled back as a child.

It is estimated that about 96% of boys are born with natural phimosis. It goes away of its own accord within the first few years of life.

It is estimated that the foreskin of one in two seven-year-olds and one in three ten-year-olds is still too tight. Toward the end of puberty, just one in 100 boys still has primary phimosis. The prevalence of secondary phimosis is unknown.

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 of the head or foreskin.

Trying to push back a tight foreskin can cause tears or minor injuries. In rare cases, this can lead to paraphimosis, also known as “Spanish collar”. With this condition, people can no longer pull the foreskin back forward over the head of the penis, restricting the blood supply. There is a risk of the clamped tissue dying.

Another rare complication is the back-up of urine in the urinary tract. This can occur if the tight foreskin becomes inflamed and swollen. Little or no urine comes out when attempting to urinate. If not quickly treated – usually with a small incision in the foreskin – the urine can backup all the way to the kidneys and damage them.

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 the phimosis has existed since birth or has other causes, such as skin conditions or scarring. Whether and how the tight foreskin is treated depends on the diagnosis and the boy’s age.

A naturally tight foreskin is normal in infants and does not require treatment. Parents should not try to force the child’s foreskin back. This can not only hurt the child but also damage the foreskin and create scarring that may later result in secondary phimosis. Washing the outside of the penis 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 pediatric doctor should be consulted. Following an examination, the doctor will 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 is usually effective.

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 if

• the foreskin repeatedly becomes inflamed
• the tight foreskin is a result of scarring
• the tightness has led to the foreskin becoming constricted (paraphimosis).

Phimosis surgery is a routine procedure. Children are operated on under general anesthetic, adolescents and adults sometimes also under local anesthetic.

For more detailed information about how to treat a tight foreskin, please visit gesundheitsinformation.de.