Phimosis is a condition where the foreskin is too tight to be pulled back over the head of the penis (glans).
Phimosis is normal in babies and toddlers, but in older children it may be the result of a skin condition that has caused scarring. It isn't usually a problem unless it causes symptoms.
Immediate treatment is needed in cases where phimosis causes problems such as difficulty urinating.
Most uncircumcised baby boys have a foreskin that won't pull back (retract) because it's still attached to the glans.
This is perfectly normal for about the first two to six years. By around the age of two, the foreskin should start to separate naturally from the glans.
The foreskin of some boys can take longer to separate, but this doesn't mean there's a problem – it will just detach at a later stage.
Never try to force your child's foreskin back before it's ready, because it may be painful and damage the foreskin.
When phimosis is a problem
Phimosis isn't usually a problem unless it's associated with symptoms such as redness, soreness or swelling.
If your child's glans is sore and inflamed they may have balanitis. There may also be a thick discharge underneath the foreskin. If both the glans and foreskin are inflamed it's known as balanoposthitis.
Take your child to see your GP if they have these type of symptoms. They will be able to recommend appropriate treatment.
Most cases of balanitis can be easily managed using a combination of good hygiene, creams or ointments, and avoiding substances that irritate the penis.
Balanoposthitis can also sometimes be treated by following simple hygiene measures, such as keeping the penis clean by regularly washing it with water and a mild soap or moisturiser. If it's caused by a fungal or bacterial infection, an anti-fungal cream or a course ofantibiotics may be needed.
In adults, phimosis can occasionally be associated with sexually transmitted infections (STIs). It can also be caused by a number of different skin conditions including:
psoriasis– a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales
lichen planus– a non-infectious itchy rash that can affect many areas of the body
lichen sclerosus– a scarring condition of the foreskin (and sometimes glans) that's probably caused by urinary irritation in susceptible men and boys
Topical steroids (a cream, gel or ointment that contains corticosteroids) are sometimes prescribed to treat a tight foreskin. They help soften the skin of the foreskin, making it easier to retract.
When surgery may be needed
Surgery may be needed in cases where a child or adult has severe or persistent balanitis or balanoposthitis that causes their foreskin to be painfully tight.
Circumcision (surgically removing the foreskin) may be considered if other treatments have failed, but it carries risks such as bleeding and infection. Therefore, it's not recommended as a first line treatment but is sometimes the best and only option.
Alternatively, surgery to release the adhesions (areas where the foreskin is stuck to the glans) may be possible. This will preserve the foreskin but may not always prevent the problem recurring.
Paraphimosis is where the foreskin can't be returned to its original position after being retracted.
It causes the glans to become painful and swollen and requires emergency medical treatment to avoid serious complications, such as increased pain, swelling and restricted blood flow to the penis.
It may be possible to reduce the pain and inflammation by applying a local anaesthetic gel to the penis, and pressing on the glans while pushing the foreskin forward. In difficult cases, a small slit may need to be made in the foreskin to relieve the pressure.
In severe cases of paraphimosis, circumcision may be recommended. In very severe cases, a lack of blood flow to the penis can cause tissue death (gangrene) and surgical removal of the penis may be necessary.