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Penile Disease
Phimosis is the condition where the foreskin cannot be retracted behind the head of the penis, or “glans”. If circumcised, this is not an issue since there is no foreskin to pull back. In some boys, the circumcision leaves a little skin to ride up over the head, but even so phimosis is very unlikely.
For very small boys less than two years of age, it is normal to not be able to pull the foreskin back. Babies almost never can have the foreskin pulled back without some manipulation and stretching. But when a boy gets older, the foreskin gets thicker and more elastic, and it should be possible. By the time potty training occurs the boy should be taught to pull the foreskin back to bathe and to dry afterward, and when urinating so that the foreskin stays dry most of the time. In this age group adhesions between the glans and the foreskin may prevent pulling the foreskin back, and a urologist can help with advice to alleviate these. Sometimes the adhesions are relieved with daily application of a cream, or by a small procedure.
Older boys and men who have phimosis can try special creams with daily manipulation of the foreskin to stretch it over time. If problems with sexual activity or balanitis (an infection of the foreskin) become more acute, circumcision can be discussed. Balanitis is sometimes present in obese men with poorly-controlled diabetes and these situations are difficult to resolve because suprapubic fat rides up over the penis and complicates the effort to keep the area clean and dry.
Phimosis in older men who never had problems when younger is also relatively common, and is sometimes due to changes in the foreskin epidermis called balanitis xerotica obliterans (BXO). The only relief from BXO is circumcision, or a partial circumcision called a “dorsal slit”.
Priapism is one of the emergencies of urology. It is a prolonged erection, of such duration that reduction of bloodflow to the tissues of the penis can cause oxygen starvation and permanent injury. Most urologists consider four hours too long to maintain an erection without injury. It can be painful, but isn’t always. Priapus was a Greek mythological figure and you can read more about it at Wikipedia. It can be caused by medications (Trazodone, Cialis, Viagra, Levitra), sickle cell crisis, penile artery injury, overstimulation with erectile aids (Triple-mix, Caverject, MUSE), and other causes. If you think you have a priapism, find an emergency room for immediate evaluation.
The foreskin on the end of the penis will trap old sloughed skin and will remain moist if the foreskin is not retracted and cleaned periodically. The white material that collects under the foreskin is called smegma. Fungal infection due to chronic moisture there is a problem for some men. Either or both can have an odor. An infection of the foreskin from bacteria or from fungus is called “balanitis”.
All boys and men after a certain age should be encouraged to retract the foreskin when in the shower or bathtub and to wash this area well. The foreskin should also be pulled back for drying with a towel after washing. Pulling the foreskin back while urinating is also advised so this area stays clean and dry as much as possible all day. But make sure to pull the foreskin over the end when done!
If the foreskin cannot be retracted, that is called “phimosis”. If you pull the foreskin back and leave it that way too long (think hours), then it can swell and not want to go back over the end of the penis. This is called “paraphimosis”. You should think to see a urologist if you have balanitis, phimosis or paraphimosis.