Phimosis

What phimosis is

Phimosis is the medical term for a foreskin that cannot be comfortably retracted back over the head of the penis. It can be present from childhood (physiological) or develop later in life (acquired).¹

In adults, phimosis commonly develops because of scarring, recurrent inflammation of the foreskin or glans (balanitis), or a condition called lichen sclerosus (balanitis xerotica obliterans, BXO) which causes progressive scarring.¹

Common symptoms

• Difficulty retracting the foreskin, either at rest or during erection.
• Discomfort or pain with erection or intercourse.
• Splitting, tearing, or bleeding of the foreskin.
• Recurrent infections of the foreskin or glans.
• Difficulty urinating, or a ballooning foreskin during urination.
• Difficulty cleaning under the foreskin, which can contribute to irritation.

A related but separate problem is paraphimosis, where a retracted foreskin becomes stuck behind the glans and cannot be brought back forwards. This can cause swelling and restricted blood flow and is a medical emergency requiring urgent attention.

Assessment

Assessment at Urology NSW includes a history of symptoms and any previous infections or skin conditions, and an examination of the foreskin and glans. Where lichen sclerosus is suspected, a small tissue sample (biopsy) may be taken to confirm the diagnosis, as appearance alone is not always reliable.¹

Management options

Treatment depends on the underlying cause, severity, and the impact on daily life and sexual function.

Conservative treatment

• Topical corticosteroid cream - a several-week course of a potent topical steroid, combined with gentle stretching, can improve flexibility of the foreskin in many men and is a reasonable first step for milder phimosis without significant scarring.^{1, 2}
• Hygiene and skin care - gentle cleaning and avoidance of irritants can reduce recurrent inflammation.
• Treatment of any infection - antifungal or antibacterial therapy where indicated.

Surgical options

• Circumcision - removal of the foreskin. This is usually the definitive treatment when topical treatment has not worked, when there is significant scarring, or when lichen sclerosus is present.¹
• Preputioplasty - a foreskin-preserving procedure that widens the tight ring. It is suitable for selected patients and may not be appropriate where scarring is extensive.

Both procedures are usually performed as day surgery. Risks include bleeding, infection, altered sensation, and scarring, which are discussed in detail during the consent process.

When to seek care

It is reasonable to seek assessment if you have:

• Ongoing pain or splitting of the foreskin.
• Recurrent infections.
• Difficulty urinating or with sexual activity.
• A sudden inability to bring a retracted foreskin back forwards (paraphimosis) - this needs urgent assessment, usually through an emergency department.

How to access care

• Contact Urology NSW to arrange a consultation.
• Request a second opinion if you have already been assessed elsewhere.
• Call the rooms on 02 8382 6980.