Phimosis
Clemens Gödel is a freelancer for the medical team.
More about the experts All content is checked by medical journalists.Phimosis is a narrowing of the foreskin of the penis. It prevents or makes it more difficult for the foreskin to pull back. This can be normal well into preschool age. However, if the foreskin doesn't loosen as it grows, it later tightens, or causes problems, treatment may be needed. A narrowing of the foreskin can be treated with cortisone ointment or circumcision. Here you can read everything you need to know about symptoms, diagnosis and treatment of phimosis!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. N47
Phimosis: description
Phimosis is the narrowing or trunk-like extension of the foreskin (prepuce). As a result, this can only be pushed back behind the glans penis with pain and with the risk of injury or even not at all. The narrowing of the foreskin is usually congenital, so it mainly occurs in children. Phimosis in adults, on the other hand, is rare. Acquired phimosis can also occur as a result of local inflammation or injury.
Depending on the extent, two main forms of phimosis can be distinguished:
- Absolute (complete) phimosis: The foreskin cannot be pushed back in either a flaccid or a stiff (erect) penis.
- Incomplete (relative) phimosis: The foreskin cannot be pulled back only when the penis is stiff.
A shortening of the foreskin ligament (frenulum breve) must be distinguished from the foreskin constriction, which in the simplest case can be treated by severing the connective tissue band at the bottom of the penis.
Paraphimosis
An absolute emergency is the so-called paraphimosis. You can read more about this in the article Paraphimosis!
Phimosis in children is normal
In newborns and infants, it is perfectly normal for the foreskin not to move. The reason is that the inner foreskin layer (inner foreskin sheet) is glued to the glans. This protects the very sensitive skin of the glans from contact with urine and feces. Over time, this adhesion usually loosens: Through recurring (involuntary) erections and a strengthening (keratinization) of the foreskin, the dissolving process of the foreskin is driven by the glans below.
From the age of three, the foreskin is mobile in 80 percent of boys and should at least be movable from the age of five at the latest. In many five-year-olds, however, the foreskin is not yet fully retractable. Among the six to seven year old boys five to seven percent are affected by a narrowing of the foreskin, among the 16 to 18 year old boys around one percent show a phimosis. Adults, on the other hand, are less affected.
Long-term phimosis increases the risk of inflammation and urinary tract infections, which can justify starting therapy.
Phimosis: symptoms
The main symptom of phimosis is that the foreskin cannot or can hardly be pushed back over the glans. In mild cases, this does not result in any complaints. But it can also cause pain and itching. In addition, phimosis promotes inflammation and infections in the foreskin area.
With a pronounced narrowing of the foreskin, urination is also more difficult: the urine stream is very thin and weakened. The direction of the urine stream can also deviate to the side. In addition, the tight foreskin can inflate like a balloon when urinating due to the backlog of urine.
In adults, phimosis can also hinder erection and ejaculation. Foreskin tightening sex can therefore be painful.
Phimosis: causes and risk factors
A distinction is made between primary and secondary phimosis.
Infant phimoses are almost always primary, that is, congenital. The foreskin constriction then already exists from birth and does not recede as it normally does in the course of growth. The reasons for this are not known.
Acquired (secondary) phimosis develops in the course of life, mainly through scarring as a result of local inflammation and injuries. In probably 80 percent of the cases, the secondary foreskin narrowing is due to the so-called lichen sclerosus (also called balanitis xerotica obliterans). Lichen sclerosus is an inflammatory skin disease that causes the skin - in this case, the foreskin - to harden. The cause of this disease are probably immune cells, the activity of which is directed against the body's own tissue (autoimmune reaction). It is not known why lichen sclerosus develops. Many factors are likely to be responsible, including genetic ones.
Infections and other inflammatory processes of the foreskin can also lead to scarring and thus to phimosis. These are common reasons for foreskin tightening in old age.
Scars also often occur when attempts are made too early and too intensely to push back the foreskin. These so-called retraction attempts are responsible for around 20 percent of cases of secondary foreskin narrowing. Adults should therefore be very careful with their children and themselves when manipulating the foreskin!
Phimosis: examinations and diagnosis
The specialist in examining and treating phimosis is the urologist. It deals with the organs that are responsible for urine formation and drainage, as well as with the male genitals.
In an initial conversation with the patient or (in the case of children) with the parents, the urologist collects the medical history (anamnesis). Among other things, he asks the following questions:
- Did the foreskin ever pull back?
- Are you having problems urinating (such as foreskin bloat)?
- Are there more common urinary tract or penile infections?
- Have you ever had an operation on the penis?
- Is there a known injury to the penis?
- Does the penis become hard when aroused (erection)?
The conversation is followed by a physical examination. The glans, the foreskin and the foreskin band are particularly important. First, the doctor checks whether the foreskin cannot be pushed back because it is still stuck to the skin of the glans beneath it, or whether it is actually too tight. In the case of a foreskin constriction, the foreskin is examined with regard to the narrowest point, the shape, the condition and the retractability. This is very important for any therapy. Scarring can sometimes be identified by a white ring around the opening of the foreskin.
If the doctor notices a secretion or inflammation (balanitis = inflammation of the glans), he will take a smear. In this way, possible infections can be detected or excluded. Often, however, such an inflammation is caused by remaining urine and thus mostly a pure chemical irritation.
The doctor should then observe the urination to assess the strength and deviation of the urine stream. Any bloating of the foreskin that may be present can also show up while urinating.
Phimosis: treatment
Early treatment for phimosis in the first few years of life is only necessary if the foreskin constriction is causing symptoms. In many cases, one can first wait. The phimosis treatment is usually started in preschool age; in the case of repeated inflammations, even from the age of three. Therapy aims to normalize urination and enable sexual function. Good genital hygiene is also important in the case of phimosis.
Local cortisone ointments
Local application of cortisone ointments is a non-surgical treatment of the foreskin constriction and also of adhesions. It should be tried especially in cases of phimosis that is not clear or only marginal.
The ointment should be applied to the foreskin twice a day for up to eight weeks. After two weeks, careful attempts should be made to push back the foreskin. However, tears and injuries must be avoided!
Around three quarters of all patients show a clear improvement in phimosis through cortisone therapy. The problem, however, is that very often the foreskin tightening reappears afterwards.
The often feared side effects of cortisone therapy are not to be expected with topical ointment application.
Phimosis: surgery
In many cases, circumcision is offered by doctors. Read everything you need to know about phimosis surgery here!
Notes for parents!
Parents should only pull back the foreskin on their child if this is easily possible. But the foreskin should never be mobilized with force! If it is not possible to push it back, adults should not be concerned: the foreskin does not have to be pulled back before puberty!
If the foreskin is flexible, it can be pushed back for urination and bathing. Like the penis, it should be cleaned regularly, but not too intensively and not with soap. After cleaning, make sure that the foreskin slides back into its original position so that no paraphimosis remains.
Even if the foreskin is immobile, the penis should be washed regularly.
If parents notice a sore or reddened foreskin, they should explain to the child that it is important to shake out and dry the foreskin after washing and using the toilet.
Phimosis: disease course and prognosis
In children, phimosis can often “grow out”. For this reason, the therapy can often be waited without major risks.
However, untreated phimosis can impede the outflow of foreskin secretions and lead to inflammation, obstruction of the urethra, and injury. People who suffer from infections and inflammation of the glans penis and foreskin more often have an increased risk of developing penile cancer. This risk is lower in circumcised men. In addition, they have a lower risk of HIV infection because there are many HIV-sensitive immune cells in the foreskin. The risk of cervical carcinoma (cervical cancer) is also reduced in partners of circumcised men.
In most cases, the operation is a successful and safe treatment option for phimosis that does not cause any problems even in adulthood, not even of a sexual nature.
Tags: menshealth drugs Menstruation
