Last modified on December 2020
With inputs from Dr.Sabha Faryal, General Physician & Emergency Medicine Specialist
– Phimosis is a condition where the foreskin stretching around the penis becomes tight and cannot be pulled back from the head of the penis.
– It is a painful and serious condition that hinders with the normal passing of urine. This leads to difficulty in emptying the bladder which can further lead to other potential problems.
– It mainly occurs due to poor personal hygiene or as an early symptom of diabetes mellitus
– There are two types of phimosis – physiologic and pathologic.
– Physiologic phimosis is common in boys younger than 3 years and separation of skin naturally happens over time.
– Pathologic phimosis occurs in adults with uncircumsized penises, due to infection, scarring and inflammation.
– Treatments include topical steroid creams and in some cases, adult circumcision may be suggested.
Chapter 1: What is Phimosis?
The penis has a double layered fold of skin, blood vessels and mucous membrane that covers and protects the penis and urinary meatus. Male babies are born with the foreskin that is not retractable in the early years of life. The separation of the skin from the glans naturally occurs over a period of time. In most cases, this separation happens from 2 to 6 years of age. In some cases, it may take upto 10 years for the skin to detach itself from the penis. However, when the same occurs in an adult, the condition is called pathologic Phimosis.
Phimosis in Indian adults, is one of the 3 serious and painful penile conditions in which the foreskin around penis does not stretch or expand in order to pull it back over the head or glans of the penis. This hinders in urination and erection, and also results in scarring, inflammation and infections.
Types of Phimosis:
There are two types of phimosis:
1. physiologic phimosis
2. pathologic phimosis
physiologic phimosis in infants is a natural occurrence in newborns and babies. The skin (prepuce) and the glans are not separated but naturally retract by the time the child is 10 years. pathologic phimosis is an occurrence in older boys and adults. It is caused due to infection, scarring and inflammation of the penis or the foreskin, and needs medical attention to be resolved.
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Chapter 2: What causes Phimosis?:
Phimosis is common in Indian babies and toddlers when the skin has not naturally retracted from the glans. But once the skin has naturally retracted from the penis, there are a number of factors to what can cause the foreskin to tighten. These phimosis causes and treatments are categorised in the following manner:
1. Phimosis causes in adolescent boys:
– History of repeated urinary tract infections
– Infections of the foreskin
– Trauma of the foreskin due to repeated rough handling
2. Phimosis causes in adult men:
– Scar tissue due to infections
– Medical conditions such as diabetes are more likely to cause balanitis in older men.
– Rough handling of foreskin can cause minor tears and inflammation.
– Sexually transmitted infections
3. Phimosis causes due to skin infections:
– Skin infections may flare up at any part of the body. These skin infections may also act as a gateway for phimosis to occur.
– Psoriasis: A condition that causes red, flaky and crusty patches.
– Eczema: A long term condition that may first develop in early childhood. Results in redness, dry and itchy skin patches.
– Lichen sclerosus – primarily may be caused by a urinary infection, this skin disorder causes scarring of the foreskin which can lead to phimosis.
4. Causes of paraphimosis:
– Intercourse: Pulling back the foreskin during sexual intercourse and leaving it pulled back for a long period of time may result in swelling and inflammation of the foreskin.
– Piercings: Piercings may irritate the foreskin and also make it difficult to bring it back to its original location.
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Chapter 3: What are the Phimosis signs and symptoms in Indians?
Phimosis symptoms are not very varied and that is why it is self diagnosable. In some cases, phimosis symptoms are minimum to none. However, the most common phimosis signs and symptoms in Indians are as follows:
- Difficulty pulling back the foreskin from the head of the penis/glans
- Pain and difficulty urinating or unable to empty the bladder completely
- Erectile dysfunction or difficulty in achieving erection due to tight foreskin
- Redness and swelling of the head of the penis or pain in the epididymis
- Fluid build up which tightens the foreskin further
- Paraphimosis, which is a medical emergency in which the foreskin does not go back to the normal location over the head of the penis, once forcefully retracted.
- Balanitis, which is the inflammation of the penis head
- Balanoposthitis, which is inflammation of both the penis and the foreskin.
Phimosis in adulthood may also carry the following phimosis symptoms in rare cases:
- Foreskin expands into a balloon during urination. This is sometimes accompanied by blood.
- Urine stream may seem weaker than normal
- Burning sensation when urinating.
- The opening of the foreskin may have a white ring.
Do these signs seem familiar to you? Consult a urologist to diagnose your symptoms now!
Chapter 4: Treatment of Phimosis:
Phimosis is most common in babies and toddlers when the skin has not naturally detached or retracted itself from the glans. In most cases this happens by the age of 6. In some cases it happens by the age of 10. If phimosis occurs or the foreskin has not retracted from the penis even after the age of 10, self care and personal hygiene can be maintained to make sure it does not turn infectious. It does not particularly need treatment. However, if there are phimosis symptoms like pain, swelling and redness, medical assistance is of utmost importance.
What to expect during diagnosis:
While child phimosis or physiologic phimosis naturally resolves itself, adult phimosis or pathologic phimosis must be treated by a medical practitioner only. There are no phimosis home treatments and self diagnosis is not an option for pathologic phimosis.
A doctor shall first make a record of all previous urinary tract infections or sexually transmitted diseases, if any. Further record of rough impact during sexual intercourse or masturbation shall be enquired. An adult urologist or pediatric urologist shall then conduct a physical examination to look for any redness, swelling and fluid build up in your foreskin or penis.
In the majority of the cases, no lab tests are conducted. However, in some cases, a urine test shall be suggested to check for urine infections. Adults will also be suggested to take a blood test to check for type 2 diabetes, as phimosis is an indicator of diabetes in adults. Furthermore, a swab from the foreskin area shall also be taken to check for bacteria in the glans.
Phimosis treatment options:
The Phimosis treatment options depend on the type of phimosis symptoms of the condition. Most cases of phimosis, balanitis, and balanoposthitis can be treated with good hygiene, steroid creams and lotions. For phimosis natural treatment, you will be asked to clean the penis and the foreskin with lukewarm water after every visit to the restroom. You will be asked to refrain from using soap, shampoos and any other cleanser on your genitals. If irritation does not subside, the doctor shall prescribe the following treatments:
- For balanoposthitis or balanitis cure, caused by bacteria or fungus, antifungal/bacterial creams or a course of antibiotics shall be prescribed.
- Creams for phimosis such as steroid creams and/or corticosteroids, will be prescribed to reduce inflammation and loosen the foreskin to help retract it without any force.
- For repeated cases of balanitis and balanoposthitis, a partial or full circumcision may be suggested.
- For paraphimosis, since it is a medical emergency, the condition is treated in the emergency room. A doctor may use one of the following techniques for phimosis cure without surgery, to retract your foreskin:
1. They may use a solution to reduce the swelling and retract the foreskin.
2. They may cut an incision in the foreskin to loosen it and retract it.
3. In severe cases, they may ultimately suggest a phimosis operation, i.e circumcision, to retract the foreskin.
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Chapter 5: Risks of Phimosis: Answering ‘Is Phimosis Dangerous?
Men with phimosis are at a higher risk of developing penile cancer. Phimosis turns to be extremely dangerous if left untreated and may result in the removal of the glans or penis.
Maintaining good personal hygiene and being gentle with the foreskin are the two most important factors in preventing this painful condition. Avoid using harsh cleansers and soaps and clean your organs after every visit to the restroom. Use lukewarm water to clean the insides of your foreskin.
Consult a urologist on MFine to understand how to cure phimosis effectively
Chapter 6: Frequently asked questions on Phimosis Causes in Indians:
1. Is phimosis curable?
Phimosis is curable at all ages provided it has not been left untreated for a long period of time. physiologic phimosis in infants and young children is naturally occurring and resolves on its own. Pathologic phimosis in adulthood requires medical attention and is generally cured within 4-8 weeks.
2. How is phimosis treated?
Phimosis is treated based on the symptom of the condition. For scar tissues, ointments and steroid creams for phimosis are prescribed. This softens and loosens the foreskin and eases retraction. For severe cases, phimosis operation may be suggested where the foreskin is medically detached from the penis. This however can be temporary and there is no guarantee that the condition will not reoccur. For permanent relief, circumcision may be suggested.
3. What happens if phimosis is not treated?
If not treated, phimosis can lead to penile cancer from extreme inflammation, infections and scarring. The condition may cause extreme pain, bleeding and shall also result in needing removal of the glans.
4. Can phimosis cause cancer?
Yes, phimosis can lead to penile cancer if left untreated and result in removal of the organ to prevent it from spreading to other parts of the body.
5. At what age is phimosis a problem?
Phimosis in babies and young children is not a matter of concern. The foreskin or prepuce is naturally retracted as the child grows. Most children are able to fully retract the foreskin by the age of 10. Even after the age of 10, if the skin has not retracted, it is not considered a problem until the symptoms of phimosis start to show. Older children or young adults shall be asked to maintain good personal hygiene. If phimosis symptoms like redness, swelling and pain start to show, medical assistance is required.
6. What is phimosis and paraphimosis?
Phimosis in adulthood is caused due to poor personal hygiene, infections, inflammation and scarring. This may also be caused due to rough handling of the foreskin. Paraphimosis is a medical emergency where the foreskin does not go back up to its original location after being retracted. For treatment of phimosis, kindly read phimosis treatment options above. For treatment of paraphimosis, the condition is treated in the emergency room, since it is a medical emergency. A doctor may use one of the following techniques to retract your foreskin:
- They may use a solution to reduce the swelling and retract the foreskin.
- They may cut an incision in the foreskin to loosen it and retract it.
- In severe cases, they may ultimately suggest a circumcision, to retract the foreskin.
7. What is phimosis diabetes?
With high blood sugar levels, a minor infection can be a breeding ground for phimosis. Phimosis in adult men can be an indicator of type 2 diabetes and needs to be treated immediately.