When boys are born, their foreskin will often be tight, but it will loosen over time and it will be possible to pull it easily over the head of the penis. From the age of 2 until the age of 6, the foreskin should start to separate naturally. Phimosis occurs when the foreskin remains unusually tight and cannot be pulled back.
Phimosis isn’t a problem until it starts to cause symptoms such as redness, soreness, or swelling. If you notice this in your son, you should talk him to the GP.
Phimosis can also develop later in life after puberty and can be caused by infections, STIs, or skin conditions such as eczema, psoriasis, lichen planus, and more commonly by lichen sclerosus.
Not being able to pull back the foreskin means that it is difficult to clean the head of the penis and therefore causes hygiene issues. It might cause pain when urinating or when the penis is erect. If you develop phimosis as an adult, it may still be possible to have sex, although it is often uncomfortable.
Try not to force the foreskin back yourself, as this can lead to painful fissures or splitting on the inside of the foreskin. For those adults struggling with phimosis, make sure to use a condom and lubricants during sex, to make yourself more comfortable but see a doctor to have it examined and treated.
It’s also very important that you practice good hygiene on yourself or your son by washing the penis with warm water each day in the bath or shower.
The initial treatment will often mean applying steroid cream to the penis. However, if that does not work, surgery is the next option option.
Depending on the severity of the phimosis, for children, the surgery will normally be a small cut in the foreskin, which should be enough to loosen up the foreskin so that it can be pulled back. However, in adults there is usually too much scarring and so a circumcision may be needed.
In adults, if there is active lichen sclerosus then the recommendation is to have a circumcision if topical agents fail to resolve it. This will prevent issues later including interference with sexual intercourse as well as reducing the risk of pre malignant disease and transformation into cancer of the penis. It’s not an issue to be dismissed.
As always, if you’re worried about a tight foreskin on you or your son, go and see the GP right away. It’s always better to seek medical advice than to ignore the problem.
