What to do about phimosis?

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”.

Category: Penile Disease

Comments are closed.