Narrowing of the foreskin (phimosis): Causes, symptoms and treatment

Phimosis—the medical term for a tight foreskin—occurs when the foreskin cannot be pulled back over the glans, or can only be done so with pain. In newborns and infants, a tight foreskin is completely normal. Only as the child develops does the foreskin gradually separate from the glans. However, if the tightness persists beyond early childhood, a urological evaluation should be performed.

Causes of Phimosis

Phimosis can have various causes:

• Congenital tightness: In many boys, the foreskin is tight from birth and usually loosens on its own by the age of three
• Inflammation: Recurrent inflammation of the foreskin or glans can cause scarring, leading to secondary phimosis
• Scarring from injury: If the foreskin is retracted too early or with force, small tears form that scar and worsen the tightness

When should you see a urologist?

If you notice phimosis in your child, we recommend a visit to a urologist starting at age two, but no later than age three. By this age, the glans and foreskin are usually no longer fused together, and the foreskin should slide easily over the glans.

An appointment is also advisable if:

• The foreskin cannot be retracted in a child aged 5 or older
• Your child complains of pain when urinating
• There are recurring infections in the area of the foreskin

Complete and incomplete phimosis

There are two forms of phimosis:

• Complete phimosis: The foreskin cannot be pulled back over the glans even when flaccid
• Incomplete phimosis: Retraction is possible when flaccid, but not during an erection

Both forms can cause symptoms—ranging from inflammation and pain to problems with urination.

Treatment Options

Important: Never force the foreskin back! Doing so can lead to serious injuries, such as constriction of the glans (paraphimosis). It can also worsen the narrowing due to scarring.

Depending on the severity and age, various treatment options are available:

• Conservative therapy: Cortisone-containing ointments can make the foreskin softer and more elastic
• Gentle stretching exercises: In combination with ointment therapy, under medical supervision
• Surgical procedures: If conservative measures are insufficient, various surgical options are available—ranging from a partial widening of the foreskin to complete circumcision

Schedule an appointment at UROMED so we can discuss the best treatment option for you or your child together.