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* [[Retraction of the foreskin]]
Wikify.
{{GraphicWarning}}
[[File:Phimosis.jpg|thumb|An erect penis with a case of phimosis]]
'''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. Phimosis Men may or may not require treatmentelect to 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]].==Pathologic 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> Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" /> See section on adult onset phimosis below.
==Physiologic phimosis==Beaugé (1997) states that adult phimosis is caused by unusual methods of [[masturbation]] that fail to stretch the narrow foreskin of [[https://en.intactiwiki.org/wiki/Foreskin#Foreskin_in_infancy_and_childhood| childhood]].<ref name="beauge1997">{{REFjournal
|last=Beaugé
|first=Michel
|url=http://www.cirp.org/library/treatment/phimosis/beauge2/
|accessdate=2020-04-20
}}</ref> The condition may be treated by changing one's method of [[masturbation ]] according to Beaugé.
There are three possible causes of non-retractile foreskin:<ref name='hill2012">{{REFweb
All may be conservatively treated without [[Adolescent and adult circumcision| circumcision]].<ref name='hill2012" />
=== Non-retractable foreskin of infancy and childhood ===
[[File:Oester.jpg|frame|Percentage of boys with fused foreskin by age according to Øster]]
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
|init=GA
}}</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" />
If treatment is deemed necessaryelected, the application of topical steroid ointment to assist manual [[stretching ]] is the most cost-effective treatment.<ref name="vanhowe1998">{{REFjournal
|last=Van Howe
|first=Robert S.
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]].
Many men can have sex, father children, and live happily with a non-retractile foreskin.<refname="young">{{REFweb
|url=http://www.circumstitions.com/Restric/adult-non-retr.html#adult
|title=Adult non-retracting foreskin ("Phimosis")
|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.
}}</ref>
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 [[https://en.intactiwiki.org/wiki/Foreskin#Physiological_functions 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 ====
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
|last=Orsola
|init=A
==== Preputioplasty ====
Should those therapies not yield the desired outcomes, there is a surgical option, namely a [[preputioplasty]].
This surgical method preserves the [[foreskin]].<ref>{{REFjournal
====Circumcision====
Circumcision is 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 is the most expensive treatment.<ref name="vanhowe1998" />
* 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 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>
Kumar et al. (2017) graded phimosis from 0 to 5. They reported argue that circumcision is necessary to treat grades 4 and 5.<ref name="kumar2017">{{REFjournal
|last=Kumar
|first=
|DOI=
|accessdate=2021-01-14
}}</ref>Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]].
== Adult onset phimosis ==
Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for examleexample, a cream that contains [https://www.webmd.com/drugs/2/drug-4316/clotrimazole-topical/details Clotrimazole].
Lichen SclerosisScleroses, formerly called [[balanitis xerotica obliterans]] when it occurs in males, hardens the [[foreskin]] and makes it non-retractable.
In pathological phimosis, the foreskin cannot be retracted over the glans without injury, due to a lack of elasticity caused by scarring or hardening.
Pathological phimosis usually requires treatment.
A [[Adolescent and adult circumcision is | 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.
== Short frenulum (frenulum breve) ==
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.
==Video==
<br>
<youtube>v=NPwFMSZjiII</youtube>
{{SEEALSO}}
* [[Adolescent and adult circumcision]]
* [[Development of retractable foreskin]]
* [[Foreskin]]
* [[Frenulum breve]]
* [[Issues with American urologists and the practice of male circumcision]]
* [[Mitosis]]
* [[Paraphimosis]]
* [[Preputial sac]]
* [[Regret men]]
* [[Sexual effects of circumcision]]
* [[Sex with phimosis]]
* [[Stretching]]
* [[Tissue expansion]]
* [[Foreskin#Physiological_Phimosis|Physiological Phimosis]], described in the [[Circumpendium]]
* [[Foreskin#Pathological_Phimosis|Pathological Phimosis]], described in the [[Circumpendium]]
|url=http://www.cirp.org/library/treatment/phimosis/
|title=Conservative Treatment of Phimosis: Alternatives to Radical Circumcision
|last=Anonymous
|first=
|publisher=Circumcision Reference Library
|date=2006-07-12
|accessdate=2019-11-01
}}
* [https://www.wikihow.fitness/Do-Phimosis-Stretching How to Do Phimosis Stretching]
* {{REFweb
|title=Phimosis and Circumcision (Adult)
|url=https://www.coventryrugbygpgateway.nhs.uk/pages/phimosis-2/
|archived=
|trans-title=
|language=
|last=Blacker
|first=Anthony
|author-link=
|publisher=National Health Service - Coventry and Warwickshire
|website=
|date=2018-05-22
|accessdate=2022-06-24
|format=
|quote=Phimosis is a condition in where the foreskin of the penis is too tight to be pulled back to reveal the glans.
}}
* {{REFweb
|url=https://treatphimosis.com/
|title=treat phimosis
|last=
|first=
|init=
|publisher=
|date=
|accessdate=2023-11-01
}}
{{REF}}