What is Phimosis: What You Should Know About Tight Foreskin

Phimosis is a fairly common problem, especially in children. An estimated 2% of 17-year-old adolescents suffer from tight foreskin around the penis.

Reviewed and approved by the pharmacist María Vijande.

Written by María Vijande

Last update: 27 May, 2022

Phimosis- or a tight foreskin – is a congenital anomaly that occurs in men in which the foreskin is too narrow to allow the head of the penis or glans to be exposed. 

Newborn boys have an adhesion between the foreskin and the glans that may remain throughout childhood.

Urology experts, such as Dr. Jesus Moreno, explain that, in most males, the foreskin is retractable both in a state of flaccidity and during erection between the ages of twelve and fourteen. Phimosis, or tight foreskin, refers to cases where this is not possible.

Phimosis is quite frequent, especially in children before adolescence. In fact, an estimated 2% of 17-year-old adolescents suffer from phimosis.

In 95% of newborns, preputial retraction is difficult. At 6 months only 20% of the foreskins are retractable. However, by 12 months, 50 % are already retractable, a percentage that increases to 90 % by the time boys reach the age of 3.

The causes of phimosis

Experts believe the cause of phimosis to be congenital, but it can also be due to forced retractions of the babies’ foreskin while parents perform hygiene. These forced movements encourage the creation of fibrous rings in the foreskin and balanopreputial adhesions.

However, adults can also present this anomaly. It may be due to a series of predisposing factors among which are the following:

• Lack of hygiene
• Balanitis
• Dermatological diseases
• Tumors

Thus, the elasticity of the skin in this area decreases, aggravating the patient’s clinical situation. However, this problem in adults can also be a consequence of infantile phimosis that has not been treated in time.

What are the complications of phimosis?

There are a series of processes inherent to keeping the preputial hood intact, generally as a result of improper handling.

Generally, these are benign, simple cases with no major consequences. Among them we find:

• Balanoposthitis: This is one of the most frequent complications in children with an intact foreskin. In the mildest cases, treatment involves the application of a chamomile infusion and cleaning the penis and secretions. More serious cases involve the application of topical or systemic antibiotics and draining the secretions.
• Smegma: This is a consequence of the shedding of skin cells of the desquamation under the foreskin of the penis. In some patients, whitish nodules or pearls may build up. No specific treatment is necessary.
• Paraphimosis: This consists of the trapping of the preputial skin by a constrictive skin ring that retracts in a forced manner, without sufficient dilation beforehand. It’s a urological emergency that requires quick and adequate attention to avoid major complications.
• Balanitis xerotica obliterans: Also known as lichen sclerosis, this is a chronic atrophic dermatitis of unknown etiology. It’s characterized by the presence of atrophic whitish plaques on the preputial skin and glans. Once diagnosed, the treatment is circumcision.
• Recurrent urinary tract infections: Boys who have not undergone circumcision run a higher risk of suffering from urinary tract infections than circumcised boys. In cases of recurrent urinary infections, doctors may suggest circumcision.

Circumcision: Surgery to reverse phimosis and tight foreskin

Circumcision is the surgical procedure that involves the removal of the preputial steonian ring and, to a greater or lesser extent, the preputial skin. The aim of the surgery is to allow adequate retraction of the remaining skin and complete exposure of the glans.

There’s a medical indication for circumcision in those cases in which conservative treatment, using repeated and progressive retractions, together with topical treatment with a corticoid cream, has not been effective in solving the problem.

Normally, it takes place around the age of 5-6 years. However, along with the medical indication, there are also socio-cultural and religious factors that give rise to different practices according to the social context.

For example, in the Jewish tradition, children must undergo this surgery on the eighth day of life. Meanwhile, in the Muslim religion, circumcision must also take place systematically during childhood. All of these practices impact a boy’s likelihood of developing this condition.