If you have difficulty retracting your foreskin , causing discomfort when urinating or even during sexual intercourse, it is something that you have to pay close attention to.
Phimosis is a condition that affects a certain percentage of the male, child or adult population, and must be treated by a specialist (urologist).
In the following article, we share what you need to know about phimosis.
What is phimosis?
Phimosis is defined as the inability to completely retract the foreskin (the skin that covers the entire length of the penis). However, phimosis is not always a pathological process.
During the first few years of life, the foreskin is not retractable at all. This is due to the presence of dense bands of connective tissue that adhere the foreskin to the surface of the glans.
Therefore, parents should not forcibly retract the foreskin of infants. Generally, this physiological phimosis resolves around 5 to 7 years of age. Only 8% of children between the ages of 6 and 7 still have phimosis at this point.
During puberty, especially from the ages of twelve and fourteen, the development of the male genitalia allows this union between the glans penis and the foreskin to disappear.
By age 17, only a small number (1%) develop phimosis. On the other hand, preputial adhesions (incomplete separation of the foreskin over the glans penis) tend to be a little more common and may even occur in 3% of adolescents.
symptoms of phimosis
The symptoms of phimosis tend to be insidious and it is important that you can differentiate it from other possible urological pathologies (such as paraphimosis). Next, we will explain some of the most frequent symptoms.
Difficulty urinating
From a microscopic point of view, phimosis is a scarring condition. In other words, the retractable ability of the foreskin is not present. Because of this, a “band” or “ring” forms at the free end of the foreskin.
When urinating, this can cause discomfort and/or pain when doing so (dysuria). This is an important difficulty, since the person can develop acute urinary retention or nocturnal enuresis (caused by the chronic difficulty).
Pain during sexual intercourse
Under normal conditions, the foreskin should be able to retract behind the glans. Not only this, the foreskin must also be able to ‘slide’ over the glans surface, stimulating the erogenous zones on its surface.
During phimosis, the loss of this preputial function can lead to discomfort and pain during erections. The length of the penis grows, however, the preputial orifice still remains narrow, which is painful for the man.
In a person with phimosis, if a forced retraction of the foreskin occurs during sexual intercourse, it can injure not only the latter, but also the glans. These lacerations can culminate in scarring that worsens the situation.
Inflammation of the glans penis and foreskin
In the inner layer of the foreskin, a series of specialized cells are located, capable of producing a lubricant called sebum (similarly produced in other regions of the skin).
Under normal conditions, the retractable foreskin allows the man to properly clean the penis, removing any excess of this substance. In phimosis, the discomfort generated by trying to retract the foreskin inhibits the man from doing so.
Sebaceous material, smegma, along with sloughed dead cells and any other substance present, can accumulate, especially in the balanopreputial groove . Inflammation is but one possible symptom of this abnormal buildup.
Adherent tissue around the tip of the penis
As we mentioned, phimosis is characterized by the presence of fibrous, inelastic tissue, abundant in the cell layers of the foreskin. But it may also be due to the persistence of the adherent bands that are normally observed in infants and children.
Over time, good foreskin hygiene and the onset of retractions during adolescence separate these adhesions, allowing exposure of the glans. When these persist, especially at the tip of the glans, phimosis occurs.
Bleeding or infection around the foreskin
The man who suffers from phimosis, when trying to force the complete retraction of the foreskin manually or during sex, can break the skin and generate bleeding accompanied by an inflammatory process.
Every time a tissue in our body is injured, the body seeks to repair it by depositing fibrous tissue (the same concept as scars after a cut on the hands, for example). This scarring can even aggravate the situation.
On the other hand, the excessive accumulation of sebum and moisture under the foreskin make it an environment highly conducive to infections ( balanoposthitis ), leading, in turn, to inflammation and other complications.
Causes of phimosis
Phimosis can be caused by a variety of conditions, both congenital (meaning the person was born with them) or acquired at some point in their lives. Next, we leave you some of the aforementioned causes.
Congenital narrowness in the foreskin
During the gestation period, in the fetus, the foreskin grows as a fold from the base towards its root, starting from the ninth week of gestation.
In the infant, the foreskin acts as a protective layer that protects the penis from possible infections that could occur if the penis comes into contact with the infant’s feces when he defecates in the diaper.
Therefore, it is not surprising that only 4% of infants have a retractable foreskin at birth. It is normal for the foreskin to be tight and stick together. But, sometimes, this narrowness can be perpetuated even into adulthood.
Infections in the genital area
We had mentioned that poor foreskin hygiene can cause sebum accumulation, leading to possible fungal or bacterial infections. This can cause inflammation and scarring in the area.
In addition, a connection between certain bacteria and the appearance of lichen sclerosus , a dermatological condition characterized by atrophy, hardening and deformation of the different layers of the skin, has been proposed.
When this condition affects the penis it is known as balanitis xerotica obliterans . However, it can be a multifactorial condition. That is, originated from multiple aspects.
trauma to the foreskin
Phimosis can occur after healing processes. Commonly, this occurs when parents attempt to force the foreskin to fully retract at a very early age, leading to tearing of the skin and formation of adherent tissue.
It can also occur as a possible complication of surgical interventions, such as circumcision, where the foreskin is not handled gently.
phimosis treatment
Phimosis affects both children and adults, the latter may feel that their quality of life is being severely affected, especially in their sexual life, in the same way they may present recurrent infections in their genital area.
Due to this, various treatments have been implemented, which help to solve this health problem that affects a percentage of the male population.
Surgical intervention
The surgical intervention to treat fibrosis is called postectomy or circumcision, and in it a small incision is made to cut and remove the foreskin of the penis, which depending on the case, can be partial or total.
This treatment can be performed in both children and adults. It is an outpatient surgery, which only needs a couple of days of rest, however, you cannot have sexual relations, for at least 4 weeks after the intervention.
Regarding the sexual aspect, as an adaptation on the glans penis, a thin layer is generated on the glans penis, this causes sensitivity to decrease, because some men report feeling less.
On the other hand, there are patients who report that after circumcision they manage to better manage their sexual relations, and since the penis is less sensitive, they can extend the duration of the sexual act.
In this way, since the problems caused by fibrosis have been solved, the decrease in the sensitivity of the glans does not represent a problem in the sexual life of the operated patient.
Treatment with corticosteroids
Not all treatment for phimosis must be invasive. The American Academy of Pediatrics demonstrated that the use of tropical therapies are usually very effective and much cheaper than surgical procedures.
The use of skin creams (for example, betamethasone 0.05% or hydrocortisone 2.5%) for a period of 4 to 6 weeks have shown very favorable results, even up to 95%.
proper hygiene
We reiterate, over and over again, the importance of good genital hygiene. Remember that poor genital hygiene can be a main cause of infections that can lead to phimosis or paraphimosis as a complication.
These must be well washed during each bath. Otherwise, you risk the accumulation of sebum and dead cells, causing infections and inflammation in the area.
Do not forget that if you have any doubts or discomfort you feel about your genitals, you should see a urologist for professional medical help. With a simple inspection, he will be able to guide and answer some of your concerns.
University Professional in the area of Human Resources, Postgraduate in Occupational Health and Hygiene of the Work Environment, 14 years of experience in the area of health. Interested in topics of Psychology, Occupational Health, and General Medicine.