Treatment, Care, and Advice for Phimosis

Phimosis in children usually resolves spontaneously during the first 3 years of life. If this condition appears later, or in adult life, the main treatment is surgery.
Treatment, Care, and Advice for Phimosis

Written by Edith Sánchez

Last update: 16 June, 2022

There are several ways treatments available for phimosis. The option to choose depends, in particular, on the severity. Sometimes it’s only necessary to carry out certain actions to overcome the problem, while in other cases surgery is required.

Until recently, phimosis was almost always treated with surgery. Nowadays there are more reservations about this alternative.

Generally, a gradual approach is taken and surgery is only performed if there’s no other option. However, it’s up to the urologist or pediatrician to determine the best option.

What is phimosis?

Phimosis can be defined as the inability to retract the skin of the penis to expose the glans penis. This creates an uncomfortable sensation, as if there’s a ring at the tip of the penis that prevents the normal sliding of the skin.

It’s common for babies to have this condition at birth. However, as time goes by, the penile skin loosens until it becomes normal at around 3 years of age. Despite this, in some cases, phimosis remains present into adulthood and causes discomfort.

It’s also possible for phimosis to be acquired. It occurs when there are recurrent infections in the genital area. This causes chronic inflammation that leads to scarring of the foreskin. As a result, it becomes narrow.

Genital infections are more common in people with diseases such as diabetes. Also in those who are immunosuppressed, either by a pathology or by a treatment such as chemotherapy.

Types and degrees

Phimosis can occur in different types and degrees. This is an important factor in choosing the appropriate treatment.

The grades range from I to IV, depending on how much the foreskin can retract. The types are as follows:

  • Punctiform: The orifice of the foreskin is minimal. It causes great difficulty in urinating.
  • Non-retractable or scarring annulus: When the skin surrounding the foreskin orifice is thickened. It’s due to recurrent infections.
  • Retractable annulus: All cases of phimosis that don’t fit into the other two categories are classified in this group.
How to prevent phimosis.
In infants, phimosis is normal. It’s an a physiological situation.

Treatments for phimosis

There are 4 main treatment options for phimosis. The pediatrician, in the case of children, or the urologist in the case of adults, will be the people qualified to indicate the best alternative.

1. Exercises

Phimosis can be treated with exercises. These are slow movements of the foreskin to cover and uncover the glans. Doctors recommend this type of practice when the condition is very mild. However, this type of exercise can lead to small tears or cuts in the foreskin. As they heal, they worsen the already existing phimosis. Therefore, they should always be performed under medical indications.

Read more here: What Is Paraphimosis?

2. Steroid ointments

The use of steroid ointments to treat phimosis is also controversial. The general opinion is that it may be effective in some children, but it isn’t recommended for adults. These ointments contain corticosteroids, substances that help soften the skin of the foreskin.

They’re applied with clean hands, massaging gently for 30 seconds. The application should be done once or twice a day, for a period of 4 to 8 weeks. The truth is that there are also cases in which it has no major effect on boys. Instead, the adverse effect may be a thickening of the skin of the foreskin and difficulties in case surgery has to be performed. They’re always applied on boys older than 4 and under medical supervision.

3. Surgical intervention

Surgery is a common treatment for phimosis. It’s known as circumcision and its aim is to remove the excess skin on the foreskin. It’s an outpatient procedure and is almost always performed under local anesthesia. It takes about 45 minutes to 1 hour. Usually, in the case of boys, it requires a couple of days in hospital. However, they can return to their activities in 3 or 4 days. It is usually performed in children between 7 and 10 years of age.

Adults require 2 or 3 days of rest. They’re advised not to have sexual intercourse for the following month. This method solves phimosis definitively in all cases, but sometimes has a certain negative psychological impact on adults.

4. Devices

A fourth option for the treatment of phimosis is the use of certain devices for that purpose. The best known is the plastic ring. This is placed through minor surgery that doesn’t require anesthesia. The ring is inserted under the foreskin and around the glans, without compressing the tip of the penis. As the days go by, this ring cuts the skin, which finally falls off after 10 days. It generates some discomfort, but doesn’t involve as much aftercare as surgery.

Surgery for phimosis.
Surgery is quite fast in phimosis and completely solves the problem.

Care after surgery

Surgeries for phimosis aren’t always the same. Therefore, the doctor will indicate the measures to be followed in each case. However, general care is usually recommended, such as the following:

  • Keeping the wound clean: The area should be cleaned every day with warm water in the shower. Gauze and 9% saline may also be used to clean the area. Then apply the antiseptic.
  • Use neutral products: it is best to use a neutral soap and not other products such as creams or gels, unless your doctor tells you to do so.
  • Drying the wound: The penis should be dried with gauze or a specific towel for this purpose. Gentle touches should be applied and never friction.
  • Protection of the area: It’s best to put a gauze around the glans to avoid friction and irritation.
  • Underwear: Tight-fitting underwear should be worn, keeping the penis facing upwards. The rest of the clothing should be loose-fitting.
  • Avoid sports: Exercise should be avoided, especially if they’re very demanding, for a month after surgery.
  • Don’t go to beaches and swimming pools: It isn’t advisable to use swimming pools or beaches in the four weeks following surgery.

After surgery, one shouldn’t be afraid to urinate. This can be done without any problems. If bleeding is observed, it’s best to consult a doctor.

Prevent phimosis

To prevent secondary phimosis, that is, the one that occurs after birth, the best thing is to adopt correct hygiene habits. In particular, during the shower, the foreskin should be pulled back and water should be applied to the glans to avoid accumulations that can cause infections.

Likewise, safe sex should be practiced. It’s best to use a condom.

If phimosis isn’t treated, it can cause complications such as frequent urinary tract infections, increased risk of acquiring sexually transmitted diseases and pain during sex. It also increases the risk of penile cancer.

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