What is phimosis?

Phimosis is the inability to retract the foreskin over the head of the penis. Simply put, phimosis is a “tight foreskin”. While phimosis is prevalent in around 96% of men and AMAB newborns, the foreskin usually separates from the glans with age. Teenagers and adults with phimosis may have different degrees of tightness, and different treatments may be required based upon the severity of the condition. Ben Challacombe, a consultant urologist based in London, says that phimosis “can be common in families, but it’s usually idiopathic, meaning it just occurs for no reason.”

For some individuals with phimosis, they may find that the condition doesn’t cause any issues, while others may find issues when they urinate or have sex. For some, it can be an embarrassing issue that causes intimacy issues and low self-esteem surrounding body image.

Phimosis signs and symptoms

Beyond the obvious sign of being unable to retract your foreskin, you may notice issues when passing urine, such as the foreskin ballooning, or you may have a weak stream of urine. You might find that it is painful when you get an erection, due to the tightness of the foreskin. Another common symptom is having a white ring around the opening of your foreskin, which is a sign of scar tissue caused by the condition.

What it feels like to have phimosis

Individuals can experience phimosis in different ways. It can be quite a singular experience depending on the extent of the condition on the individual. For some, attempting to retract the foreskin can cause bleeding and discomfort, while others may be able to achieve partial retraction. This considered, it can sometimes have an impact on an individual's sex life.

Greg from Hackney in London chose to have an adult circumcision in order to address his phimosis. He first realised that he might have phimosis when watching pornography and realising that his penis was different to the ones that he was seeing on-screen. “I always knew something was different, and as I got older I felt really body conscious whenever I was naked or in a sexual situation,” he recalls. “I couldn’t really enjoy sexual encounters before my circumcision. I was scared that someone might ask questions, and there was also the fear of pain or discomfort if my sexual partner was a bit rough or inexperienced when it comes to a tight foreskin.”

“I chose to have a circumcision because my urologist explained that while steroid creams may offer some relief, they weren’t a guaranteed fix in the way that a circumcision would be,” Greg continues. “I’d lived with the condition long enough and didn’t want to wait any longer. I wanted to get it sorted as soon as possible and to know that it would be 100 percent effective, so circumcision was the best course of action for me, and I’m so glad I did it.”

Jack from Leeds in West Yorkshire, thinks he may have phimosis, but hasn’t yet sought medical advice for a diagnosis. Whilst having some discomfort during sexual activity, he doesn’t find that the condition has had much of an impact on his everyday life. “I’m not too bothered about it to be honest, but I probably should have got it checked out earlier but I’ve always found it so embarrassing and terrified of the procedure.” He says. “I ended up having a tear during sex which was one of the worst experiences of my life, but I guess it did get a bit better once that had healed, but I know I should have gone to a GP about the issue.”

Phimosis diagnosis

If you think you may have phimosis, contact your GP and they will be able to explore whether this is the correct diagnosis for you. They will likely refer you to a urologist, a specialist doctor who help to treat problems linked to the female urinary system and the male genitourinary tract. They can also diagnose and treat issues with the kidneys, male reproductive system and the prostate.

The urologist will be able to explain the options that are available to you once they have evaluated the severity of your phimosis.

Phimosis treatments

“Mild cases of phimosis can be treated with steroid based creams and retracting of the foreskin,” says urologist Ben Challacombe, but don’t ignore it. “If left untreated, the condition can worsen and the only option may be a circumcision.”

The process (which will likely be demonstrated by your urologist) of using a steroid based creams involves pulling back to the foreskin and applying the steroid cream to soften the skin, and then repeating the process 3-4 times per day until the foreskin is able to fully retract over the glans. It’s important that individuals should stop when they feel any discomfort in order to avoid pain and damage to the foreskin.

Despite being considered an effective form of treatment, if results aren’t achieved after 3-4 weeks of using the steroid cream, individuals should seek further assistance from a medical professional to explore alternate treatment options.

Phimosis surgery

If topical creams and stretching exercises prove to be an ineffective treatment for phimosis, surgery may be an option.

Preputioplasty is a surgery, which is done within one day and under local aesthetic, that involves making an incision down the foreskin which is closed with dissolvable stitches and serves as a “release” for the tight foreskin. This form of treatment may be preferable for people who wish to retain the appearance of a foreskin, but again is subject to the advice of a urologist who will determine whether a preputioplasty will be an effective course of treatment.

Circumcision may be considered as a “last resort” treatment. “Phimosis is the most common cause of adult circumcision,” Challacombe says. It’s 100% effective in treating the condition, and studies have found that circumcision can also significantly reduce the risk of contracting HIV and other sexually transmitted diseases.

Circumcisions performed by the NHS are usually conducted under general anaesthetic with patients being discharged the same day as the surgery. It takes around 10 days to recover from the event but sex should be avoided for between 3-4 weeks post surgery. There’s understandably some discomfort that comes with having a circumcision, but painkillers like paracetamol and ibuprofen can help to ease the pain. Other hacks include wearing loose-fitting clothing for the few days after the surgery, and applying Vaseline to the penis will stop it sticking to underwear and clothing.

Further resources and help

There are lots of great resources available online if you think you might have phimosis. The NHS website contains lots of information about the condition, as well as useful information on circumcision and [other treatment options.] (https://www.nhs.uk/conditions/topical-steroids/)

The British Association of Urological Surgeons is a useful website for more in-depth information on phimosis, and answers many questions on the condition.

This is not a diagnostic tool - if you are experiencing symptoms of phimosis, book an appointment with your GP.