Difference between revisions of "Phimosis"

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[[File:Phimosis.jpg|thumb|An erect penis with a case of phimosis]]
 
[[File:Phimosis.jpg|thumb|An erect penis with a case of phimosis]]
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'''Phimosis''' (''fɪˈmoʊsɨs'' or ''faɪˈmoʊsɨs'', from the Greek ''phimos'' (φῑμός "muzzle"), is a condition of the [[penis]] where the [[foreskin]] cannot be fully retracted over the [[glans penis]].<ref>{{URLwikipedia|Phimosis|Phimosis|2019-09-25}}</ref> Phimosis is a condition, not a disease, so it does not threaten health. Men may elect to treat it. Some men live their entire lives with a non-retractile foreskin.  They are able to have sexual intercourse and father children.
+
'''Phimosis''' (''fɪˈmoʊsɨs'' or ''faɪˈmoʊsɨs'', from the Greek ''phimos'' (φῑμός "muzzle"), in adults is a natural variant of the [[penis]] in which the [[foreskin]] cannot be fully retracted over the [[glans penis]] to uncover and expose the [[glans penis]] that occurs in about five percent of [[foreskinned]] adult males.<ref>{{URLwikipedia|Phimosis|Phimosis|2019-09-25}}</ref> A medical dictionary defines phimosis as "Tightness of the foreskin (prepuce) of such degree as to prevent retraction. This may be congenital or the result of inflammation. Severe phimosis that interferes with urination is an indication for circumcision. From the Greek <i>phmoun</i>, to gag or muzzle."<ref>{REFweb
 +
|url=https://medical-dictionary.thefreedictionary.com/phimosis
 +
|title=Phimosis
 +
|last=Youngson
 +
|first=
 +
|init=RM
 +
|author-link=
 +
|publisher=https://medical-dictionary.thefreedictionary.com/phimosis
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|date=2005
 +
|accessdate=2025-12-05
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}}</ref>
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 +
Phimosis is classed as [[physiological phimosis]] or [[pathological phimosis]]. The physiological phimosis condition in adults is a natural variant, not a disease, so it does not threaten health. Men may elect to treat it or not treat it. Some men live their entire lives with a non-retractile foreskin.  [[Sex with phimosis| They are able to have sexual intercourse and father children]].
 +
 
 +
==Positive aspects of phimosis==
 +
Artificial intelligence produced this list of advantages:
  
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Beaugé (1997) states that adult phimosis is caused by unusual methods of [[masturbation]] that fail to stretch the narrow foreskin of [[Foreskin#Foreskin_in_infancy_and_childhood| childhood]].<ref name="beauge1997">{{REFjournal
+
* <b>Increased Sensitivity:</b> Some people report heightened sensitivity due to the [[foreskin]] covering the [[glans]], which may enhance pleasure.
 +
 
 +
* <b>Natural Protection:</b> The [[foreskin]] acts as a barrier, potentially reducing exposure to irritants and infections.
 +
 
 +
* <b>Reduced Risk of Certain Conditions:</b> Some studies suggest that [[intact]] foreskin may help maintain moisture and prevent dryness-related issues.
 +
 
 +
* <b>Alternative Intimacy Experiences:</b> Individuals with phimosis sometimes develop unique approaches to intimacy that focus on broader sensual experiences rather than conventional techniques.
 +
==Physiologic phimosis==
 +
[[Michel Beaugé| Beaugé]] (1997) states that adult phimosis persists when the individual uses unusual methods of [[masturbation]] that fail to stretch the narrow foreskin of [[Foreskin#Foreskin_in_infancy_and_childhood| childhood]].<ref name="beauge1997">{{REFjournal
 
  |last=Beaugé
 
  |last=Beaugé
 
  |first=Michel
 
  |first=Michel
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* The tip of the foreskin is too narrow to pass over the [[glans penis]].
 
* 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 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]]''.
 
* The [[frenulum]] is too short to permit retraction. The medical name for this condition is ''[[frenulum breve]]''.
  
 
All may be conservatively treated without [[Adolescent and adult circumcision| circumcision]].<ref name='hill2012" />
 
All may be conservatively treated without [[Adolescent and adult circumcision| circumcision]].<ref name='hill2012" />
  
−
 
+
=== Non-retractable foreskin of infancy and childhood ===
−
== Non-retractable foreskin of infancy and childhood ==
 
 
[[File:Oester.jpg|frame|Percentage of boys with fused foreskin by age according to Øster]]
 
[[File:Oester.jpg|frame|Percentage of boys with fused foreskin by age according to Øster]]
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Boys are almost always born with non-retractable foreskin.<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> The inner surface of the foreskin of a newborn baby is fused by a [[synechia]] to the surface of the glans penis so that is non-retractable.<ref>{{REFjournal
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Boys are almost always born with non-retractable [[foreskin]].<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> The inner surface of the foreskin of a newborn baby is fused by a [[synechia]] to the surface of the glans penis so that is non-retractable.<ref>{{REFjournal
 
  |last=Deibart
 
  |last=Deibart
 
  |init=GA
 
  |init=GA
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  |DOI=10.5402/2012/707329
 
  |DOI=10.5402/2012/707329
 
  |accessdate=2019-11-02
 
  |accessdate=2019-11-02
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}}</ref> Moreover the tip of the [[foreskin]] at birth is usually too tight to permit any retraction.<ref name="gairdner1949"/> Thus normal, natural childhood non-retractable foreskin, which must be distinguished from pathological phimosis,<ref name="shahid2012" /> has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults.<ref name="shahid2012" />
+
}}</ref> Moreover the tip of the [[foreskin]] at birth is usually too tight to permit any retraction.<ref name="gairdner1949"/> Thus normal, natural childhood non-retractable foreskin, which must be distinguished from pathological phimosis,<ref name="shahid2012" /> has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults.<ref name="shahid2012"/>
  
−
Physiological phimosis can be divided into three main categories - symptom-free, in need of therapy, and in need of surgery.
+
[[Physiological phimosis]] is a normal, healthy stage of development in youth that does not require treatment.
  
−
From a medical standpoint, an otherwise symptom-free [[phimosis]], even after dissolution of preputial adhesions, does not require any treatment before the child enters puberty. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point.
+
From a medical standpoint, an otherwise symptom-free [[phimosis]], even after dissolution of preputial adhesions, does not require any treatment before the child enters [[puberty]]. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point.
  
−
Even though the data from [[Jakob Øster]]'s studies have been known for 54 years,<ref name="Øster1968">{{OesterJ 1968}}</ref> some check lists for school doctors‘ examinations still erroneously refer to physiological phimosis as an abnormality.
+
Even though the data from [[Jakob Øster]]'s studies have been known for more than half a century,<ref name="Øster1968">{{OesterJ 1968}}</ref> some check lists for school doctors‘ examinations still erroneously refer to normal, healthy [[physiological phimosis]] as an abnormality.
  
 
In most cases, only watchful waiting is necessary, not surgery or other treatment. Parental reassurance is the only treatment required.<ref name="shahid2012" />  
 
In most cases, only watchful waiting is necessary, not surgery or other treatment. Parental reassurance is the only treatment required.<ref name="shahid2012" />  
  
−
By age 10.4 years, about 50 percent of [[intact]] boys have a retractable foreskin.<ref name="Øster1968"/><ref name-"thorvaldsen2005">{{REFjournal
+
By age 10.4 years, about 50 percent of [[intact]] boys have a retractable [[foreskin]] and about 50 percent do not have a retractable foreskin.<ref name="Øster1968"/><ref name-"thorvaldsen2005">{{REFjournal
 
  |last=Thorvaldsen
 
  |last=Thorvaldsen
 
  |init=MA
 
  |init=MA
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  |DOI=
 
  |DOI=
 
  |accessdate=2019-11-01
 
  |accessdate=2019-11-01
−
}}</ref> Most of the rest develop a retractable foreskin in their teenage years.<ref name="Øster1968"/> About two percent of adult males live with a non-retractable [[foreskin]].<ref name="shahid2012" />
+
}}</ref> Most of the rest develop a retractable [[foreskin]] in their teenage years.<ref name="Øster1968"/> An estimated two percent to 5 percent of adult males live with a non-retractable [[foreskin]],<ref name="shahid2012" /> in which retraction did not spontaneously develop, which is a normal variant.
  
 
If treatment is elected, the application of topical steroid ointment to assist manual [[stretching]] is the most cost-effective treatment.<ref name="vanhowe1998">{{REFjournal
 
If treatment is elected, the application of topical steroid ointment to assist manual [[stretching]] is the most cost-effective treatment.<ref name="vanhowe1998">{{REFjournal
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==Treatment options==
 
==Treatment options==
−
 
+
It appears that Americans may be less tolerant of phimosis than persons from other cultures.
 
====No treatment====
 
====No treatment====
−
Non-retractile or tight foreskin is a condition, not a disease.  It is not life threatening. One may elect to remain as one is, without treatment. Many men do not have an issue with non-retractile [[foreskin]].
+
Non-retractile or tight foreskin is a condition, not a disease.  It is not life threatening. One may elect to remain as one is, without treatment. Many men do not have an issue with non-retractile [[foreskin]]. There may be some variation in the acceptance of phimosis. Other nationalities may be more accepting of phimosis than Americans<ref>{{REFweb
 +
|url= https://www.reddit.com/r/uncircumcised_talk/comments/1iy44ba/uncircumcised_asians_and_foreskin_retraction/
 +
|title=Uncircumcised Asians and foreskin retraction
 +
|publisher=Reddit
 +
|date=2025-02-25
 +
|accessdate=2025-02-25
 +
}}</ref> Some men seem to prefer the protection and sensation that the non-retractile foreskin provides.
  
−
Many men can have sex, father children, and live happily with a non-retractile foreskin.<ref>{{REFweb
+
Many men can have sex, father children, and live happily with a non-retractile foreskin.<ref name="young">{{REFweb
 
  |url=http://www.circumstitions.com/Restric/adult-non-retr.html#adult
 
  |url=http://www.circumstitions.com/Restric/adult-non-retr.html#adult
 
  |title=Adult non-retracting foreskin ("Phimosis")
 
  |title=Adult non-retracting foreskin ("Phimosis")
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==== Manual stretching ====
 
==== Manual stretching ====
 +
<b>Warning: There are reports of physicians who prescribe topical steroid cream to treat a tight or non-retractable foreskin, but fail to advise their patient that <u>manual stretching is required</u>.</b>
  
−
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.
+
=== Fingers ===
 +
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
 
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
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==== Preputioplasty ====
 
==== Preputioplasty ====
−
Should those therapies not yield the desired outcomes, there is a surgical option, namely a [[preputioplasty]].
+
Should those therapies not yield the desired outcomes, there is a surgical option, namely a [[preputioplasty]].<ref name="milos2022-09-19" />
  
 
This surgical method preserves the [[foreskin]].<ref>{{REFjournal
 
This surgical method preserves the [[foreskin]].<ref>{{REFjournal
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====Circumcision====
 
====Circumcision====
−
Circumcision was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />
+
Circumcision (partial penile amputation) once was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Neurotomy]] is a feature of every circumcision and causes severe loss of [[erogenous sensation of the foreskin]]. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />
  
 
* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
 
* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
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* Circumcision exposes the patient to the surgical risks of [[bleeding]], [[infection]], and surgical misadventure, which rarely can include loss of the [[glans penis]], loss of the [[penis]] or [[death]].
 
* Circumcision exposes the patient to the surgical risks of [[bleeding]], [[infection]], and surgical misadventure, which rarely can include loss of the [[glans penis]], loss of the [[penis]] or [[death]].
  
−
* Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision [[lymphoedema]] caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing [[wound dehiscence]]. Sexual and [[Psychological issues of male circumcision| psychological]] issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and infection. Loss of the penis and [[death]] are known.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal
+
* Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its [[Foreskin#Physiological_functions| multiple protective, immunological, sensory, and sexual physiological functions]] are destroyed and has many [[risks and complications]]. The sensitive head of the [[penis]] will be permanently exposed so the [[Glans penis| head]] will rub against clothing. Many men find this to be very painful.
 +
 
 +
* Most men report a permanent substantial loss of [[Sexual sensation of the foreskin| sexual sensation]].
 +
 
 +
* Circumcision results in a permanent, usually two-toned, [[circumcision scar]].
 +
 
 +
* Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision [[lymphoedema]] caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing [[wound dehiscence]]. Sexual and [[Psychological issues of male circumcision| psychological]] issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and [[infection]]. Loss of the penis and [[death]] are known.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal
 
  |last=Williams
 
  |last=Williams
 
  |first=Neville
 
  |first=Neville
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}}</ref>
 
}}</ref>
  
−
* Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its multiple protective, immunological, sensory, and sexual physiological functions are destroyed and has many [[risks and complications]]. The sensitive head of the [[penis]] will be permanently exposed so the head will rub against clothing. Many men find this to be very painful.
+
* Circumcision is irreverible amputation. Circumcision cannot be undone. [[Regret men]] are common.
−
* Most men report a permanent loss of sexual sensation.
 
−
* Circumcision results in a permanent [[circumcision scar]].
 
  
−
<u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u>
+
<b><u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u></b>
  
−
Kumar et al. (2017) graded phimosis from 0 to 5. They argue that circumcision is necessary to treat grades 4 and 5.<ref name="kumar2017">{{REFjournal
+
Kumar et al. (2017) graded phimosis from 0 to 5. They claimed that [[adult circumcision]] is necessary to treat grades 4 and 5,<ref name="kumar2017">{{REFjournal
 
  |last=Kumar
 
  |last=Kumar
 
  |first=
 
  |first=
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  |DOI=
 
  |DOI=
 
  |accessdate=2021-01-14
 
  |accessdate=2021-01-14
−
}}</ref>
+
}}</ref> however that is not certain. Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]]. Circumcision is usually an elective surgical amputation. Men who elect to be [[circumcised]] can only blame themself if they do not like the results. [[Regret men]] are common.
  
 
== Adult onset phimosis ==
 
== Adult onset phimosis ==
 +
Adult onset phimosis is [[pathological phimosis]], which is caused by an abnormal, morbid, diseased condition.
  
−
Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for example, a cream that contains [https://www.webmd.com/drugs/2/drug-4316/clotrimazole-topical/details Clotrimazole].
+
Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for example, a cream that contains [https://www.webmd.com/drugs/2/drug-4316/clotrimazole-topical/details Clotrimazole].<ref name="milos2022-09-19" />
  
−
Lichen Scleroses, formerly called [[balanitis xerotica obliterans]] when it occurs in males, hardens the [[foreskin]] and makes it non-retractable.
+
Lichen Scleroses, formerly called [[balanitis xerotica obliterans]] when it occurs in males, hardens the [[foreskin]] and makes it non-retractable.<ref name="milos2022-09-19" />
  
−
In pathological phimosis, the foreskin cannot be retracted over the glans without injury, due to a lack of elasticity caused by scarring or hardening.
+
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>
 
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.
+
[[Pathological phimosis]] usually requires treatment.
 +
 
 +
A [[Adolescent and adult circumcision| circumcision]] may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving [[preputioplasty]] are promising (for example with chronic [[balanitis xerotica obliterans]]) or have failed in previous attempts.
 +
==Pathological phimosis==
 +
Pathologic phimosis is phimosis caused by lichen sclerosis et atrophicrus (LSA), formerly known as [[balanitis xerotica obliterans]] (BXO), on the [[foreskin]].<ref name="rickwood1980">{{REFjournal
 +
|last=Rickwood
 +
|first=
 +
|init=AMK
 +
|author-link=
 +
|last2=Hemalatha
 +
|first2=
 +
|init2=V
 +
|author2-link=
 +
|last3=Batcup
 +
|first3=
 +
|init3=G
 +
|author3-link=
 +
|last4=Spitz
 +
|first4=
 +
|init4=L
 +
|author4-link=
 +
|etal=no
 +
|title=Phimosis in boys.
 +
|trans-title=
 +
|language=
 +
|journal=Brit J Urol
 +
|location=
 +
|date=1980
 +
|volume=52
 +
|pages=147-50
 +
|url=https://www.cirp.org/library/treatment/phimosis/rickwood/
 +
|archived=
 +
|quote=
 +
|pubmedID=7191744
 +
|pubmedCID=
 +
|DOI=10.1111/j.1464-410x.1980.tb02945.x
 +
|doi=
 +
|accessdate=2024-01-13
 +
}}</ref> <ref name="milos2022-09-19">{{REFweb
 +
|url=https://intactamerica.org/ask-marilyn-can-a-tight-foreskin-be-treated-without-circumcision/
 +
|title=Ask Marilyn—Can a Tight Foreskin be Treated without Circumcision?
 +
|last=Milos
 +
|first=
 +
|init=MF
 +
|author-link=Marilyn Fayre Milos
 +
|publisher=Intact America
 +
|date=2022-09-19
 +
|accessdate=2024-10-24
 +
}}</ref>
  
−
A [[Adolescent and adult circumcision| circumcision]] may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving [[preputioplasty]] are promising (for example with chronic balanitis xerotica obliterans) or have failed in previous attempts.
+
Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" />
  
 
== Short frenulum (frenulum breve) ==
 
== Short frenulum (frenulum breve) ==
 +
[[Frenulum breve]] may prevent retraction and may be mis-diagnosed as phimosis
  
−
If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the foreskin. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.
+
If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the [[foreskin]]. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.
  
 
[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.
 
[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.
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Circumcision is not appropriate or necessary to treat [[frenulum breve]]. Patients must be careful when consulting a urologist, because urologists earn an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.
 
Circumcision is not appropriate or necessary to treat [[frenulum breve]]. Patients must be careful when consulting a urologist, because urologists earn an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.
 +
==Hygiene==
 +
The normal non-retractable foreskin may be easily flushed out with warm water and a [https://www.amazon.com/Syringe-Removing-Syringing-Medi-Grade/dp/B0842B1XMR?sp_csd=d2lkZ2V0TmFtZT1zcF9hdGY&psc=1 rubber-bulb type ear syringe]. Excessive washing and the use of soap should be avoided.<ref name="Birley1991">{{REFjournal
 +
|last=Birley
 +
|init=HDL
 +
|author-link=
 +
|last2=Wasker
 +
|init2=MM
 +
|last3=Luzzi
 +
|init3=GA
 +
|etal=yes
 +
|title=Clinical Features and management of recurrent balanitis; association with atopy and genital washing
 +
|journal=Genitourin Med
 +
|date=1993-10-01
 +
|volume=69
 +
|issue=5
 +
|pages=400-3
 +
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195128/pdf/genitmed00029-0074.pdf
 +
|quote=
 +
|pubmedID=8244363
 +
|pubmedCID=1195128
 +
|DOI=10.1136/sti.69.5.400
 +
|accessdate=2025-12-05
 +
}}</ref>
 +
 
==Video==
 
==Video==
 +
===Four common treatments for phimosis===
 
<br>
 
<br>
 
<youtube>v=NPwFMSZjiII</youtube>
 
<youtube>v=NPwFMSZjiII</youtube>
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* [[Frenulum breve]]
 
* [[Frenulum breve]]
 
* [[Issues with American urologists and the practice of male circumcision]]
 
* [[Issues with American urologists and the practice of male circumcision]]
 +
* [[Longer foreskin is favored]]
 
* [[Mitosis]]
 
* [[Mitosis]]
 
* [[Paraphimosis]]
 
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* [[Foreskin#Physiological_Phimosis|Physiological Phimosis]], described in the [[Circumpendium]]
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* [[Physiological phimosis]], described in the [[Circumpendium]]
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* [[Foreskin#Pathological_Phimosis|Pathological Phimosis]], described in the  [[Circumpendium]]
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|title=treat phimosis
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|url=https://www.reddit.com/r/Pro_Male_Collective/comments/1nrhivj/phimosis_is_not_a_justification_to_circumcise_the/
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|title=Phimosis is not a justification to circumcise the penis
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|last=Anonymous
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|date=2025-09-26
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* {{REFweb
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|url=https://www.reddit.com/r/Intactivists/comments/1nwbfkw/belgium_drops_coverage_for_circumcisions_for/
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|title=Belgium drops coverage for circumcisions for phimosis
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|last=Anonymous
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|publisher=REDDIT
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|date=2025-10
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|accessdate=2025-11-03
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* {{REFweb
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|url=https://www.reddit.com/r/foreskin_restoration/comments/1ozfcdo/i_thought_i_was_fine_after_getting_circumcised/?chainedPosts=t3_1p4gj39
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|title=i thought i was ‘fine’ after getting circumcised for phimosis… and it turns out i wasn’t.
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|last=Anonymous
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|first=
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|author-link=
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|publisher=REDDIT
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|date=2025-11-17
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|accessdate=2025-11-23
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* {{REFweb
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|url=https://www.reddit.com/r/foreskin_restoration/comments/1p2eyfg/i_had_a_little_phimosis_got_circumcised_i_regret/
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|title=I had a little phimosis, got circumcised, I regret
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|last=Anonymous
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|author-link=
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|publisher=REDDIT
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[[Category:Foreskinned life]]
 
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[[Category:From Intactipedia]]
 
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[[de:Phimose]]

Latest revision as of 17:57, 5 December 2025

IntactiWikiGraphicWarning.png

An erect penis with a case of phimosis

Phimosis (fɪˈmoʊsɨs or faɪˈmoʊsɨs, from the Greek phimos (φῑμός "muzzle"), in adults is a natural variant of the penis in which the foreskin cannot be fully retracted over the glans penis to uncover and expose the glans penis that occurs in about five percent of foreskinned adult males.[1] A medical dictionary defines phimosis as "Tightness of the foreskin (prepuce) of such degree as to prevent retraction. This may be congenital or the result of inflammation. Severe phimosis that interferes with urination is an indication for circumcision. From the Greek phmoun, to gag or muzzle."[2]

Phimosis is classed as physiological phimosis or pathological phimosis. The physiological phimosis condition in adults is a natural variant, not a disease, so it does not threaten health. Men may elect to treat it or not treat it. Some men live their entire lives with a non-retractile foreskin. They are able to have sexual intercourse and father children.

Positive aspects of phimosis

Artificial intelligence produced this list of advantages:

  • Increased Sensitivity: Some people report heightened sensitivity due to the foreskin covering the glans, which may enhance pleasure.
  • Natural Protection: The foreskin acts as a barrier, potentially reducing exposure to irritants and infections.
  • Reduced Risk of Certain Conditions: Some studies suggest that intact foreskin may help maintain moisture and prevent dryness-related issues.
  • Alternative Intimacy Experiences: Individuals with phimosis sometimes develop unique approaches to intimacy that focus on broader sensual experiences rather than conventional techniques.

Physiologic phimosis

Beaugé (1997) states that adult phimosis persists when the individual uses unusual methods of masturbation that fail to stretch the narrow foreskin of childhood.[3] The condition may be treated by changing one's method of masturbation according to Beaugé.

There are three possible causes of non-retractile foreskin:[4]

All may be conservatively treated without circumcision.[4]

Non-retractable foreskin of infancy and childhood

Percentage of boys with fused foreskin by age according to Øster

Boys are almost always born with non-retractable foreskin.[5] The inner surface of the foreskin of a newborn baby is fused by a synechia to the surface of the glans penis so that is non-retractable.[6] [7] Moreover the tip of the foreskin at birth is usually too tight to permit any retraction.[5] Thus normal, natural childhood non-retractable foreskin, which must be distinguished from pathological phimosis,[7] has been given the name physiological phimosis to distinguish it from pathological phimosis in adults.[7]

Physiological phimosis is a normal, healthy stage of development in youth that does not require treatment.

From a medical standpoint, an otherwise symptom-free phimosis, even after dissolution of preputial adhesions, does not require any treatment before the child enters puberty. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point.

Even though the data from Jakob Øster's studies have been known for more than half a century,[8] some check lists for school doctors‘ examinations still erroneously refer to normal, healthy physiological phimosis as an abnormality.

In most cases, only watchful waiting is necessary, not surgery or other treatment. Parental reassurance is the only treatment required.[7]

By age 10.4 years, about 50 percent of intact boys have a retractable foreskin and about 50 percent do not have a retractable foreskin.[8][9] Most of the rest develop a retractable foreskin in their teenage years.[8] An estimated two percent to 5 percent of adult males live with a non-retractable foreskin,[7] in which retraction did not spontaneously develop, which is a normal variant.

If treatment is elected, the application of topical steroid ointment to assist manual stretching is the most cost-effective treatment.[10]

Teen intact boys with a non-retractable foreskin may benefit by manual stretching.[3]

Treatment options

It appears that Americans may be less tolerant of phimosis than persons from other cultures.

No treatment

Non-retractile or tight foreskin is a condition, not a disease. It is not life threatening. One may elect to remain as one is, without treatment. Many men do not have an issue with non-retractile foreskin. There may be some variation in the acceptance of phimosis. Other nationalities may be more accepting of phimosis than Americans[11] Some men seem to prefer the protection and sensation that the non-retractile foreskin provides.

Many men can have sex, father children, and live happily with a non-retractile foreskin.[12]

Adequate lubrication has been recommended when penetrating the vagina with a non-retractile foreskin covered penis.

This option preserves the foreskin, its appearance, and most of the protective, immunological, sensory, and sexual [physiological functions], but does not make the foreskin retractable.

If desired, a non-retractile foreskin may be flushed out with warm water with the aid of a rubber-bulb ear syringe or a Water Pik.

Manual stretching

Warning: There are reports of physicians who prescribe topical steroid cream to treat a tight or non-retractable foreskin, but fail to advise their patient that manual stretching is required.

Fingers

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.[13][14][15][16] [17]

Manual stretching preserves the foreskin and its many protective, immunological, sensory, and sexual physiological functions, and renders the foreskin retractable, but may take some months to achieve.

Carilli et al. (2021) tested the PhimoStop device which gradually dilates the foreskin over an extended period of time. Phimosed men were treated for sixty days. The treatment helped 52.1 percent of the men to resolve their phimosis.[18]

Preputioplasty

Should those therapies not yield the desired outcomes, there is a surgical option, namely a preputioplasty.[19]

This surgical method preserves the foreskin.[20] A good cosmetic result and total preservation of the foreskin are achieved. The basic principle of most of those methods consists of making one or more small longitudinal incisions, and then suturing the wound or wounds transversely.

There are several different methods:

  • Dorsal slit with transverse suturing: this technique places a single lengthwise cut into the stenotic ring which is then closed transversely.[21] [22]
  • Lateral preputioplasty: this is a refinement of the dorsal slit with transverse suturing. It consists of two lateral, longitudinal incisions sutured transversely.[23]
  • Triple incision: this is a method of foreskin widening. It typically consists of three incisions across the tight ring. They are closed from side to side, thereby increasing the circumference of the tight ring relative to the length of the cuts. From an aesthetic view, it has results far superior to those of a dorsal slit, and usually yields a good cosmetic result.[24]

Preputioplasty also preserves the foreskin and its many protective, immunological, sensory, and sexual physiologial functions

If after a failed attempt to stretch the foreskin with corticosteroid cream a surgical intervention is necessary, a preputioplasty is always to be preferred over classic circumcision, due to its lower morbidity, lower rate of complications and lower costs.

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

Circumcision (partial penile amputation) once was the classic treatment for phimosis, but has many disadvantages and drawbacks. Neurotomy is a feature of every circumcision and causes severe loss of erogenous sensation of the foreskin. Circumcision is less performed today, because it is becoming outmoded by newer and better treatments.[7]

  • Circumcision is the most expensive treatment.[10]
  • Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision lymphoedema caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing wound dehiscence. Sexual and psychological issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and infection. Loss of the penis and death are known.[7] [25]
  • Circumcision is irreverible amputation. Circumcision cannot be undone. Regret men are common.

Circumcision should be the treatment of last resort, to be used only after conservative methods of treatment fail.

Kumar et al. (2017) graded phimosis from 0 to 5. They claimed that adult circumcision is necessary to treat grades 4 and 5,[26] however that is not certain. Many men would prefer to live with phimosis in preference to losing one's foreskin to an adult circumcision. Circumcision is usually an elective surgical amputation. Men who elect to be circumcised can only blame themself if they do not like the results. Regret men are common.

Adult onset phimosis

Adult onset phimosis is pathological phimosis, which is caused by an abnormal, morbid, diseased condition.

Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for example, a cream that contains Clotrimazole.[19]

Lichen Scleroses, formerly called balanitis xerotica obliterans when it occurs in males, hardens the foreskin and makes it non-retractable.[19]

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. 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.[27]

Pathological phimosis usually requires treatment.

A circumcision may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving preputioplasty are promising (for example with chronic balanitis xerotica obliterans) or have failed in previous attempts.

Pathological phimosis

Pathologic phimosis is phimosis caused by lichen sclerosis et atrophicrus (LSA), formerly known as balanitis xerotica obliterans (BXO), on the foreskin.[28] [19]

Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for circumcision.[28]

Short frenulum (frenulum breve)

Frenulum breve may prevent retraction and may be mis-diagnosed as phimosis

If the frenulum is too short, it can hinder or even prohibit retraction of the foreskin. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged bleeding. When only small tears appear, it may heal spontaneously.

Frenulum breve is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the frenulum, if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.

To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.

There are 3 surgical variants: [29]

  • 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious circumcision to an unwary patient.

Hygiene

The normal non-retractable foreskin may be easily flushed out with warm water and a rubber-bulb type ear syringe. Excessive washing and the use of soap should be avoided.[30]

Video

Four common treatments for phimosis


See also

External links

  • REFweb Phimosis stretching guide, Phimostretch. Retrieved 19 November 2019.
    Quote: The goal of phimosis stretching is to get to a stage where you can move your foreskin, back and forth, freely over the glans while the penis is erect.

References

  1. ↑ REFweb Wikipedia article: Phimosis. Retrieved 25 September 2019.
  2. ↑ {REFweb |url=https://medical-dictionary.thefreedictionary.com/phimosis |title=Phimosis |last=Youngson |first= |init=RM |author-link= |publisher=https://medical-dictionary.thefreedictionary.com/phimosis |date=2005 |accessdate=2025-12-05 }}
  3. ↑ a b REFjournal Beaugé M. The causes of adolescent phimosis. Brit J Sex Med. September 1997; : 26. Retrieved 20 April 2020.
  4. ↑ a b REFweb Hill G (28 May 2012). Phimosis: Non-retracticle foreskin, wordpress, genitalwholeness. Retrieved 6 December 2020.
    Quote: Development of retractile foreskin in boys is very gradual and occurs over a period of years._The membrane that fuses the foreskin and the glans penis spontaneously disintegrates and the foreskin separates from the glans penis._Also, the opening at the tip becomes wider with increasing maturity.
  5. ↑ a b REFjournal Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  6. ↑ REFjournal Deibart GA. The separation of the prepuce in the human penis. Anat Rec. 1933; 57: 387-99. DOI. Retrieved 1 November 2019.
  7. ↑ a b c d e f g REFjournal Shahid SK. Phimosis in children. ISRN Urology. 2012; 707329 PMID. DOI. Retrieved 2 November 2019.
  8. ↑ a b c REFjournal Øster J. Further Fate of the Foreskin: Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys PDF. Arch Dis Child. 1968; 43(228): 200-3. PMID. PMC. DOI. Retrieved 18 June 2024.
  9. ↑ REFjournal Thorvaldsen MA, Meyhoff HH. [Phimosis: pathological or physiological?]. Ugeskr Læge. 2005; 167(17): 1858-62. PMID. Retrieved 1 November 2019.
  10. ↑ a b REFjournal Van Howe RS. Cost-effective treatment of phimosis. Pediatrics. April 1998; 102: e43. DOI. Retrieved 2 November 2019.
  11. ↑ REFweb (25 February 2025). Uncircumcised Asians and foreskin retraction, Reddit. Retrieved 25 February 2025.
  12. ↑ REFweb Young H. Adult non-retracting foreskin ("Phimosis"), Circumstitions. Retrieved 1 November 2019.
    Quote: The foreskin never retracts, and nor does it cause any kind of problem while having intercourse or masturbating. I have been enjoying a very healthy sex life with my girlfriend since the last two years.
  13. ↑ REFjournal Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000; 56(2): 307-310.
  14. ↑ REFjournal Ashfield JE, Nickel KR, Siemens DR, et al. Treatment of phimosis with topical steroids in 194 children. J Urol. 2003; 169(3): 1106-1108. Retrieved 25 September 2019.
  15. ↑ REFjournal Pileggi Fde O, Vicente YA. Phimotic ring topical corticoid cream (0.1% mometasone furoate) treatment in children. J Pediatr Surg. October 2007; 42(10): 1749-1752. Retrieved 25 September 2019.
  16. ↑ REFjournal Ghysel C, Vander Eeckt K, Bogaert GA. Long-term efficiency of skin stretching and a topical corticoid cream application for unretractable foreskin and phimosis in prepubertal boys. Urol Int. 2009; 82(1): 81-88. PMID. Retrieved 16 October 2019.
  17. ↑ REFjournal Reddy S, Jain V, Dubey M, Deshpande P, Singal AK. Local steroid therapy as the first line treatment for boys with symptomatic phimosis - A long term prospective study. Acta Paediatr. 21 November 2011; Epub ahead of print DOI. Retrieved 25 September 2019.
  18. ↑ REFjournal Carilli M, Asimakopoulos AD, Pastore S, Germani S, et al. Can circumcision be avoided in adult male with phimosis? Results of the PhimoStopTM prospective trial. Transl Androl Urol.. November 2021; 10(11): 4152-60. PMID. PMC. DOI. Retrieved 10 January 2022.
  19. ↑ a b c d REFweb Milos MF (19 September 2022). Ask Marilyn—Can a Tight Foreskin be Treated without Circumcision?, Intact America. Retrieved 24 October 2024.
  20. ↑ REFjournal Hotonu S, Mohamed A, Rajimwale A, Gopal M. Save the foreskin: Outcomes of preputioplasty in the treatment of childhood phimosis. The Surgeon. June 2020; `8(3): 150-3. PMID. DOI. Retrieved 26 June 2021.
  21. ↑ REFjournal Cuckow PM, et al. Preputial plasty: a good alternative to circumcision. J Pediatr Surg. April 1994; 29(4): 561-3. PMID. DOI. Retrieved 24 November 2019.
  22. ↑ REFjournal Arora BK, Arora R, Arora A. Dorsal slit preputioplasty for phimosis: a prepuce conserving surgery. International Surgery Journal. 3 August 2016; 3(3): 1543-6. DOI. Retrieved 22 January 2020.
  23. ↑ REFjournal Lane TM, et al. Lateral preputioplasty for phimosis. J R Coll Surg Edinb. October 1999; 44(5): 210-2. PMID. Retrieved 24 November 2019.
  24. ↑ REFjournal Wahlin N, et al. [107-10 "Triple incision plasty". A convenient procedure for preputial relief]. Scand J Urol Nephrol. 1992; 26(2) PMID. DOI. Retrieved 2 November 2019.
  25. ↑ REFjournal Williams N, Kapila L. Complications of circumcision. Brit J Surg. 1993; 80: 1231-6. PMID. DOI. Retrieved 10 June 2021.
  26. ↑ REFjournal Kumar JN, Neeraj G, Rajesh L, Kumar MS, et al. Phimosis: Nonsurgical Versus Surgical Management. Journal of Medical Science and Clinical Research. February 2017; 5(2): 17556-60. Retrieved 14 January 2021.
  27. ↑ REFweb Wikipedia article: Lichen sclerosus. Retrieved 25 September 2019.
  28. ↑ a b REFjournal Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in boys.. Brit J Urol. 1980; 52: 147-50. PMID. DOI. Retrieved 13 January 2024.
  29. ↑ REFweb Wikipedia article: Frenulum breve. Retrieved 25 September 2019.
  30. ↑ REFjournal Birley HDL, Wasker MM, Luzzi GA, et al. Clinical Features and management of recurrent balanitis; association with atopy and genital washing. Genitourin Med. 1 October 1993; 69(5): 400-3. PMID. PMC. DOI. Retrieved 5 December 2025.
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