Tight foreskin (phimosis)
What should I do if I have a tight foreskin?
If you are unable to retract your foreskin fully, especially if it becomes red or painful, you should contact your GP. If a tight foreskin has been retracted and cannot be brought forward again, you should seek urgent treatment in your local hospital.
In adults, tightness of the foreskin may cause no symptoms for most of the time. Problems usually become more obvious (and troublesome) when you get an erection and attempt sexual intercourse.
What could have caused my tight foreskin?
In children, a tight foreskin is usually congenital but, in adults, it is often due to a scarring disease known as balanitis xerotica obliterans (BXO, sometimes called lichen sclerosus). We do not know the cause of BXO.
What treatments are available for this problem?
Stretching of a diseased foreskin is best avoided. There is no scientific evidence that it produces a cure and it can actually precipitate further tearing and scarring. This may worsen a phimosis which then requires surgical treatment later in life. Forcible retraction of the foreskin in children should be avoided.
Steroid creams may soften your foreskin if the scarring is mild; stopping the cream, however, may result in a return of the condition.
Antibiotics may be needed if swabs show any evidence of infection
Using a condom during sexual intercourse may make the penis more comfortable
Circumcision is the mainstay of treatment if the foreskin is scarred by balanitis xerotica obliterans. This is one of medicine's oldest operations and has often been depicted in ancient and religious art (pictured above right; by Signorelli).
Preputioplasty is effective In children with congenital tightening of the foreskin. Several incisions are made into the tip of the foreskin to expose the head of the penis. The foreskin then needs to be retracted regularly until it has healed completely. Preputioplasty has a very limited role in adults and is not effective in those with a very tight foreskin due to active lichen sclerosus.
Frenuloplasty is the best option if the tightness is due to a short penile frenulum, rather than a tight foreskin. However, a short frenulum may also be associated with a some scarring of the foreskin, so full circumcision is still needed in some patients.
Partial removal of the foreskin is not recommended. Scarring may return in the foreskin remnant and the cosmetic results, particularly during erection, are often unacceptable.