Phimosis is the inability to expose the glans, which is the terminal part of the penis, because the foreskin that covers it does not have sufficient opening. This condition is common in infants and tends to disappear, in most cases up to 1 year of age. Sometimes it takes longer to resolve naturally and may disappear closer to 5 years of age or only at puberty, without the need for specific treatment. However, as time passes and the foreskin continues not to allow the glans to be exposed, it may be necessary to use a specific ointment or have surgery.
There are 2 types of male phimosis:
- Physiological phimosis: it is the most common condition and is present since birth;
- Secondary phimosis: may occur at any stage of life, after an infection or local trauma, for example.
In some cases the foreskin is so tight, that even urine can get trapped inside the skin, increasing the risk of an urinary tract infection. Phimosis can cause various complications such as difficulty cleaning the region, increased risk of urinary tract infection, pain during intimate contact, increased risk of having an STD, HPV or penile cancer, and a greater possibility of developing paraphimosis, which is when the foreskin gets stuck behind the glans and can no longer get back to its flaccid position covering the glans.
How is phimosis diagnosed
The only way to confirm the presence of phimosis is to try to retract the skin that covers the penile glans manually. When it is not possible to see the glans completely, this can indicate phimosis, which can be classified in 5 different degrees. Although the degree is important, the best treatment is determined according to the boy's age. The first check for the presence of phimosis is done in the newborn baby, but it is part of all pediatric appointments until the age of five.
Generally when secondary phimosis appears in adolescence or adult life, men usually can observe themselves the difficulty in retracting the foreskin. If they see they have this problem we recommend they consult an urologist.
Phimosis detected in children is curable and doesn't always need specific treatment, and so it is important that the pediatrician evaluates the situation to determine the course of action because sometimes it resolves naturally around the age of 4 or 5. If phimosis persists after this age or secondary phimosis presents itself, specific treatment is necessary, which can be done with:
1. Phimosis ointments
You should apply corticosteroid-based ointments that have anti-inflammatory, analgesic and antibiotic properties making it easier for the skin to glide over the glans. The ointment prescribed by the doctor is normally applied twice a day for 1 month and may be enough to cure phimosis.
2. Phimosis Retraction Exercise
In boys over the age of 5 there are some exercises that can be done to try and reduce phimosis, however they must be done without forcing or causing any pain.
To do the exercise you should hold the penis with one hand and with the other apply the ointment and pull the skin back slowly, for 1 minute, 3 to 4 times a day. This exercise should not cause pain or discomfort, but should "loosen the skin little by little". If the exercise not done correctly, besides the pain, it may form scars, new adhesions, and a fibrosis ring, which is a characteristic of paraphimosis.
3. Phimosis surgery
When the treatment mentioned above is insufficient, you can do a surgery to treat phimosis which is called postectomy. This type of surgery can only be done after 2 years of age and may be done in two ways, the first being the complete removal of the foreskin and the second implies performing one or several small cuts on the foreskin, which is sufficient to allow it to withdraw from the glans. However, this type of surgery may not be very efficient and tends to promote a new adherence in the area. In addition to the removal of the skin, the doctor can also perform a cut that releases the frenulum from the penis. See what the necessary cautions should be after phimosis surgery.
Surgery isn't possible until some existing problems are resolved, such as problems with blood clotting, local infection, or in cases of penile abnormalities, such as hypospadias or embedded penis, because in these cases it may be necessary to use the foreskin for reconstruction of other tissues of the genital region. After these conditions are controlled, the surgery for phimosis can be performed.
Phimosis in women
Phimosis can also affect girls, and in this case it is called female phimosis, which happens when the adhesion occurs between the labia minora, completely covering the vaginal opening. The treatment for female phimosis consists in applying an ointment with estrogen that usually solves the problem definitively.