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* The tip of the foreskin is too narrow to pass over the [[glans penis]].
* The inner surface of the foreskin is fused or adherent by a [[synechia]] to the glans penis.
* The [[frenulum]] is too short to permit retraction. The medical name for this condition is ''[[frenulum breve]]''.
==== Manual stretching ====
The growth and hormonal surge during puberty alter both the size and size ratio of the [[penis]] and penile [[skin ]] significantly. Also, the first [[masturbation]] aids in the process of [[stretching]] of the [[skin ]] and detachment of any remaining childhood fusion. Manual stretching causes [[tissue expansion]] and a wider, retractable foreskin.
If, after that, the [[foreskin]] still remains too tight, resulting in pain during sexual activities, and making genital hygiene difficult, treatment is indicated. The individual should engage in stretching exercises, if needed with the aid of corticosteroid cream, which is available by prescription. Depending on the active substances, success rates of 80-90% have been documented.<ref>{{REFjournal
====Frenuloplasty====
[[Frenulum breve]] can prevent foreskin retraction. In many cases, foreskin retraction can be achieved, without treating the foreskin, by treating frenulum breve. One may stretch the frenulum to create tissue expansion or one may have a minor surgical procedure such as [[frenectomy]] or [[frenuloplasty]]. (See discussion below.)
====Circumcision====
In pathological phimosis, the foreskin cannot be retracted over the glans without injury, due to a lack of elasticity caused by scarring or hardening.
Repeated infections of the tight foreskin cause this scarring. Also, forceful attempts to retract the foreskin cause tearing with subsequential scarred [[phimosis]]. [[Balanitis xerotica obliterans| Lichen sclerosus]], that first leads to adhesion and then to shrinking, can also be the cause of [[phimosis]]. This rare, non-contagious chronic [[skin ]] disease is partly genetically caused and considered incurable.<ref>{{URLwikipedia|Lichen_sclerosus|Lichen sclerosus|2019-09-25}}</ref>
Pathological phimosis usually requires treatment.
* Frenectomy, the complete removal of the frenulum
* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically
* Elongation of the frenulum with a [[skin ]] graft.
Circumcision is not appropriate or necessary to treat frenulum breve. Patients must be careful when consulting a urologist, because urologists earn a nice fee from performing a circumcision, so may be quick to recommend inappropriate and unnecesary injurious circumcision to an unwary patient.