Tight Foreskin (phimosis)
A tight foreskin may be termed as 'phimosis' but this is not necessarily the case. There are various degrees of tight foreskin up to true phimosis, the restriction of the opening of the foreskin may fit any one of the following conditions:
- Foreskin retracts over the glans and onto the shaft of an erect penis and can be pushed back over the glans freely. There is no pain or discomfort but there is a pleasant and stimulating feeling when this happens. This is the ideal situation and of course does not constitute a problem at all.
- Foreskin can be retracted but sits tight on the shaft of an erect penis and causes some discomfort. There is not a problem with sex but it causes pain. The foreskin will cover the glans of its own accord but needs force whilst the penis is erect but glides over the glans when flaccid. This requires attention but is not difficult to cure.
- Foreskin retracts as in (2) above but sits so tight behind the glans that the glans swell and the foreskin gets trapped behind the glans. The foreskin and glans needs considerable manipulation to get the foreskin back over the glans. There is definitely a problem and requires attention but is not an indication for circumcision.
- The foreskin cannot be retracted to expose either all or part of the glans. When urinating the foreskin may 'balloon' as it fills with urine (this is not uncommon in children but often resolves itself in time). There is need to correct this in a teenager or adult case, this is still not an indication for circumcision.
- A baby or young child has a foreskin that cannot be retracted. This is no surprise as a baby's foreskin is attached to the glans and separates into two distinct parts of the penis as the child develops. Attempts by parents to force the foreskin back before it is ready is often the cause of a tight foreskin or infections as the foreskin may be torn from the glans leaving it bleeding or weeping and open to infection. The only person to retract the foreskin is the boy himself as and when he is ready, this may not be until he is seven or older. It is natural for the foreskin of a young boy to be non-retractable again it is not an indication for circumcision.
Progressive treatment
All treatment of non life threatening conditions should be considered in a progressive manner. There is so often a rush to amputate the foreskin for the least excuse. We would be horrified if because we had a swollen thumb or finger if a doctor recommended amputating the affected part without first trying various other treatments first, but, this is what happens with foreskins. First sign of a problem and it's gone forever, this highly sensitive, protective and functional part of the sex organ of a male gets amputated and an internal organ looses over half its sensitivity and the rest is forced to become an external organ.
Treatment of the foreskin should always be in a progressive manner with the aim to preserve it and its functionality. Infections are easily cured with antibiotics and to prevent recurrence the cause needs to be investigated which may be the use of soap, aggressive masturbation, anal sex without a condom and a whole raft of other causes including smoking (which can weaken the immune system). Even conditions such as balanitis, although not curable has been in many cases treated successfully with steroid creams and exposure to laser light of certain wavelengths.
The progressive treatments (currently well known) in order of least invasive first to the last resort are listed below:
 | Stretching techniques involving the gentle but forced expanding of the foreskin opening on a regular and frequent basis over a period of weeks until the problem is solved. |
| Stretching techniques as above but with the aid of a topical steroid cream (e.g. 0.05% Betamethasone) but this should not be done for more than a month without medical review. Some countries do not restrict some types or strengths of steroids but medical advice should always be sought before using. This treatment claims to be effective in 80-90% of cases if done properly. |
| Lateral preputioplasty is the next possible stage where two or more incisions are made over the fibrous rings that cause the foreskin opening to be tight. If required the fibers are cut and the small incisions are drawn together in the opposite way in which they were made and stitched together. This has the effect of lengthening the skin evenly in a circumferential manner. After the patient is encouraged to frequently retract the foreskin during the healing process. One report from cases at the Maidstone Hospital, Kent, England, reported only one failure in thirty boys treated with this method, this equates to about 97% success rate. The report and technique by T.M.Lane and L.M.South can be seen at the following URL: |
http://www.rcsed.ac.uk/journal/vol44_5/4450008.htm
Šelks2002 Page last updated 27th September 2003