Phimosis

Phimosis (from Greek φίμωσις phimōsis 'muzzling') is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

Phimosis
An erect penis with a case of phimosis
Pronunciation
  • /fɪˈmsɪs/ or /fˈmsɪs/
SpecialtyUrology
SymptomsUnable to pull the foreskin back past the glans
ComplicationsBalanitis, penile cancer , urinary retention
Usual onsetNormal at birth
DurationTypically resolves by 18 years old
CausesNormal, balanitis, balanitis xerotica obliterans
Risk factorsDiaper rash, poor cleaning, diabetes
Differential diagnosisHair tourniquet, lymphedema of the penis
PreventionSteroid cream, stretching exercises, circumcision
Frequency1%–2% (in uncircumcised males 18 years or older)

In young boys, it is normal not to be able to pull back the foreskin at all. Over 90% of cases resolve by the age of seven, although full retraction is still prevented by preputial adhesions in over half at this age. Occasionally, phimosis may be caused by an underlying condition such as scarring due to balanitis or balanitis xerotica obliterans. This can typically be diagnosed by seeing scarring of the opening of the foreskin.

Typically, the condition resolves without treatment by the age of 18. Efforts to pull back the foreskin during the early years of a young male's life should not be attempted. For those in whom the condition does not improve further, time can be given or a steroid cream may be used to attempt to loosen the tight skin. If this method, combined with stretching exercises, is not effective, then other treatments such as circumcision may be recommended. A potential complication of phimosis is paraphimosis, where the tight foreskin becomes trapped behind the glans.

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