Phimosis (Tight Foreskin)

Everyone's body develops differently, and changes to the foreskin can occur at different stages of life. Phimosis can happen for several reasons, including:

• natural development (physiological phimosis) – this is most common in children under the age of 5, where the foreskin gradually becomes more retractable with age

• infection, scarring or inflammation (pathological phimosis) – conditions like balanitis (inflammation of the glans), balanoposthitis (inflammation of the foreskin and glans), and lichen sclerosus can lead to infection, scarring and inflammation, resulting in tightness

• poor hygiene – lack of or improper cleaning can lead to infections, which over time can cause scarring or tightness

• repetitive trauma or forced retraction – forcibly pulling back the foreskin can cause microtears in the tissue, which can lead to scarring and tightening

The primary symptom of phimosis is tightness of the foreskin, which restricts retraction, makes it difficult to urinate, and can cause ballooning of the foreskin. It can also look like your penis has rubber bands or rings or around the tip.

Other symptoms you may experience if you have phimosis include:

• discolouration of the skin
• swelling
• soreness or pain
• pain while urinating
• weak urine flow
• blood in your urine
• smegma
• pain when erect or during intercourse

What are the two types of phimosis?

There are 2 types of phimosis: physiologic phimosis and pathologic phimosis.

Physiologic phimosis is completely normal and is often present from birth. In fact, most boys are born with a non-retractable foreskin, which usually becomes retractable by age 10. It typically doesn’t cause symptoms and will usually resolve by itself, so treatment is only needed if issues arise.

Pathologic phimosis is caused by infection, inflammation or scarring. While it can develop at any age, it’s more common in adults or adolescents. Pathologic phimosis can lead to pain, hygiene problems and a higher risk of infections, so specialist treatment is required.

At Welbeck, our consultants are experienced in the diagnosis and treatment of phimosis. At an initial consultation, your consultant will identify the type of phimosis you have and recommend appropriate treatment.

There are both surgical and non-surgical treatments available for phimosis. At Welbeck, our specialist urologists devise personalised treatment plans, taking into account your comfort, personal goals and medical needs.

Non-surgical treatments include:

• topical steroid creams to help soften and loosen the foreskin

• gentle stretching exercises, which may improve retraction over time

• good hygiene practices – regular cleaning can prevent infections that worsen the condition

If non-surgical methods have not been effective, or in cases of severe phimosis, surgery may be required in the form of circumcision to remove the foreskin. At Welbeck, adult circumcision is performed as a day-case procedure, which means you will be able to go home on the same day.

When should you seek medical advice for phimosis?

We advise that you seek specialist medical care with a Welbeck urologist if:

• your foreskin is painful or causes discomfort

• you experience recurrent infections

• you have difficulty urinating, including a weak stream or ballooning of the foreskin

• you have scarring or white patches on your foreskin

• you are experiencing symptoms of a urinary tract infection (UTI)

• the condition has lead to paraphimosis – this is where the retracted foreskin becomes trapped behind the head of the penis and cannot return to its normal position. This is a medical emergency and requires immediate attention

At Welbeck, our urologists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialities, our consultants are also able to refer within the Welbeck ecosystem if needed to ensure you receive the best possible treatment as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment. 

Can phimosis be left untreated?

If you have a tight foreskin, we recommend seeing a specialist for treatment as soon as possible. If phimosis is left untreated, it can lead to complications including:

• inflammation of the foreskin (posthitis), glans (balanitis) or both inflammation (balanoposthitis)
• UTIs (urinary tract infections)
• foreskin tears (adhesions)
• the foreskin becoming stuck behind the glans (paraphimosis)
• poor hygiene
• increased risk of developing penile cancer (in long-standing cases)

What risks are associated with phimosis treatment?

The topical corticosteroid creams that are usually prescribed in the treatment of phimosis very rarely have any side effects.

Complications of circumcision can include bleeding, infection, the foreskin being too short or long, and pain.

Can phimosis be prevented?

Phimosis cannot be prevented in newborns. In adults, you may be able to prevent phimosis by taking care to fully retract your foreskin every time you urinate and pulling your foreskin back to clean underneath it whenever you wash.

When should I seek urgent care for phimosis?

Go to your nearest A&E if you have phimosis and any of the following:

• pain
• skin that looks infected
• symptoms of an infection, such as a fever, chills or headache
• trouble urinating or pain while urinating