By phimosis the foreskin of a boy or man is so narrow in the end that it can not be dropped down. There are mainly two types of phimosis. In one type, the foreskin is elastic so that it can be stretched wider at least to some extent. In the other type there are scars or indications around the tip that makes it totally rigid.
Sometimes the phimosis is partial, so that the foreskin can be pulled down, but not pushed back again. When the foreskin is trapped in a retracted position, it is called paraphimosis. This condition should be considered as an emergency, since the tight foreskin can cut off the blood supply to the penile head.
A boy usually has a narrow foreseenkin in his earliest years and the foreskin also is fixed to the penal head. Gradually the tip widens and the foreskin gets loose so that it can be pulled down. Usually it is possible to withdraw it when the boy is 4-7 years old, and the diagnosis phimosis is there usually not done at a very young boy. Phimosis also usually gets away by itself before or during puberty.
If the opening in the foreskin tip is very narrow, the foreskin will often get inflated by urine during voiding, an occurrence called ballooning. Phimosis can cause inflammation in the foreskin and at the penile head, caused by gathering of smegma and substances from the urine, and consequent growth of bacteria, but it does not occur in every case. The narrow foreskin can make sex and ejaculation cumbersome.
In some boys the foreskin just does not widen, so it remains very narrow, and then you usually get the elastic type of phimosis. Other boys or men get infections or inflammations in the foreskin that produce scars and constrictions that make it difficult to pull it down, so you get the rigid type of phimosis. The infections are usually due to bad hygiene.
The best way of preventing phimosis due to infections and scarring is daily to pull back very gently the foreskin as far as it gets without resistance, wash it well with some mild soap, and then flush it well. The parents should do this on young boys, while older boys, teens and adults should do this by themselves. One should never try to force the foreseen down, however. Some doctors warn against using any kind of soap and recommend pure water.
There are great cultural differences regarding treatment of phimosis between the regions of the World. At some places traditional treatment for phimosis has been circumcision. It has however been shown that phimosis can be cured in most instances without surgery, especially the elastic type:
In boys before puberty, the simplest treatment is daily flushing with clean water under the foreskin to take away impurities, while waiting for the condition to resolve by itself. Complications or special susceptibility for infection, like in diabetic boys, can make more specific treatment necessary at an early age. Some boys may also feel it to be more comfortable after treatment.
Salves with corticosteroids can also be used 4-6 weeks to make the foreskin softer and combine it with gentle daily attempts to pull the foreskin back. After some weeks the foreskin can usually be rolled back normally in 70% of the cases. On the market you can also find salves based on herbal extracts for the same use.
A simple traditional and often successful treatment directed at the condition is each day to stretch the tip of the penis mechanically, and also gently pull it back as long as it gets without resistance, usually with the fingers. The method should preferably be done together with flushing and good washing around the tip. Older boys can learn to perform this method themselves.
By the inelastic type of phimosis some kind of surgery will sometimes be necessary, but in many communities surgery is regarded as the last option due to several factors: It is difficult to obtain a real good result functionally and aesthetically by surgery, regardless of method. There is a risk for complications as infections, bleedings and scarring, and there is a risk connected to anesthesia.
Circumcision will solve the initial problem, but a full circumcision will alter the penal in a way that the boy or man not always will be pleased with, even when the procedure is fully successful, and this operation also gives the greatest risk for all complications. In addition to the complications mentioned, the exposed penile head will be subjected to mechanical irritation, as a response grow thicker, and can thebyy loose sensitivity. Circumcision will leave a ring of scar just below the penile head that may not look good and feel uncomfortable. Also the reduced amount of skin on the penis can make erections more difficult.
Often one can cut off an inelastic ring at the tip, and occasionally also use the other methods some time afterwards. Some surgeons do a more complicated reshaping of the foreskin to widen it (preputial plasty), and in many countries in Europe this is the recommended method when surgery is necessary.
When consulting a doctor for treatment of phimosis, one should discuss the methods available to find that which fits best the interest for the patient, which often will be a young boy, and not automatically accept a suggestion for circumcision. If the doctor is rigidly inclined towards circumcision, a second opinion should be consulted.
