SOMETIMES IT CAN be confusing figuring out what’s normal anatomy and what are issues that might need medical attention. But if you have a foreskin and you can’t pull it back over the head of your penis you might be dealing with phimosis, and that falls into the latter camp.
While phimosis isn’t always a problem, if it’s causing difficulties with urinating, pain or discomfort during sexual activity, or complications like frequent infection, it’s important to get it sorted. So, here’s some evidence-based information on the condition to get you started.
What is phimosis?
You know when you try to put on a shirt with the top button or cuffs done up? That’s the sartorial equivalent of phimosis.
Most penises come with foreskins, and these are ‘stuck’ to the head (glans) of the penis at birth. This is normal and it’s called ‘physiological’ or ‘primary’ phimosis. The foreskin gradually separates from the head of the penis until it can be fully retracted, usually by around two years of age in most boys, but physiological phimosis can remain until the mid-teenage years.
Physiological phimosis doesn’t require treatment unless there are associated problems like recurrent urinary tract infections (UTIs) or inflammation of the foreskin and glans (balanoposthitis). Deliberate pulling back of your foreskin when you have physiological phimosis can damage the skin, leading to scarring and ‘pathological’ or ‘secondary’ phimosis.
Phimosis in adulthood
Pathological phimosis is caused by irritation, injury, infection or inflammation of the foreskin leading to scarring and white, hardened patches of skin on the glans and foreskin (a condition known as lichen sclerosis). These changes in the foreskin make it difficult or impossible to retract.
We don’t really know how many people with foreskins have pathological phimosis but it’s estimated to occur in around two to seven per cent of all men.
Pathological phimosis can cause problems with urination, or pain or discomfort during erections and sexual activity, and requires treatment. Complications of untreated phimosis include inflammation of the glans (balanitis) and penile cancer (although this is rare).
How do you treat phimosis?
The least invasive option for treating phimosis is to use steroid creams to reduce inflammation and soften the foreskin, but stopping the use of the cream might result in the problem returning. Stretching the foreskin to reduce its tightness is possible but there’s no evidence that it cures the problem and the foreskin may get damaged and make the problem worse.
Only one treatment for phimosis has good evidence for being effective. It is virtually 100 per cent effective and works for everyone, but it might seem extreme – circumcision.
Circumcision for phimosis
According to Medicare statistics, there are around 4500 circumcisions performed each year in Australian males over 15 years, and just under 60% of those would be expected to be for phimosis (based on studies from Canada and the USA). So, around 2700 Australian males each year are circumcised to treat phimosis.
You can’t get diseases of body parts that you don’t have. That’s why people who were circumcised at birth don’t get phimosis, and why they have lower rates of health problems like balanoposthitis (inflammation of the glans and foreskin), UTIs, and penile cancer than uncircumcised people.
One hundred to fifty years ago, infant circumcision rates in Australia were high but they began decreasing in the 1970s. Now, around one in 10 Australian baby boys is circumcised. It might be expected that, as there are fewer and fewer males in the population who are circumcised, there might be increases in rates of phimosis and other foreskin complications but there’s no evidence for this one way or the other.
Needing to get circumcised can be a bit confronting. The British Association of Urological Surgeons has good information about what’s involved.
Controversy about circumcision relates mostly to when it’s performed for non-medical reasons in children, and relates to cost/benefit considerations, body autonomy, and human rights.
There are certainly plenty of people who are unhappy to have been circumcised, some of whom claim that the procedure has negatively affected their sexual function, and selective use of medical literature seems to support this. However, a systematic review of scientific studies, concludes that male circumcision has no adverse effect on parameters relevant to sexual function, sensation, sensitivity, satisfaction, or pleasure.
How to prevent phimosis
Good hygiene can prevent phimosis and its complications, so if you have a foreskin you should:
- Gently retract your foreskin each time you shower or bathe
- Only use water or very mild soap to wash the glans and the inside of your foreskin
- Make sure the glans and inside of your foreskin are well rinsed
- Gently dry the glans and inside your foreskin
- Return the foreskin to its normal position to avoid paraphimosis
Paraphimosis is when the foreskin gets ‘stuck’ behind the glans of the penis and cannot be returned to its normal position. You should always see your doctor if you have any concerns about changes in the way your genitals look or feel but paraphimosis is a medical emergency that needs immediate attention.
Associate Professor Tim Moss is the Health Content Manager at Healthy Male — an Australian not-for-profit that provides evidence-based information on men’s health. Tim has a PhD in medicine and uses his experience and expertise from more than 20 years of work in medical research and academia to find and interpret reliable, evidence-based information, to challenge dogma, myths and misinformation.
For information on everything from anxiety to fertility, exercise to erections, you can check out Healthy Male here.
Related:
