What is Phimosis?

Phimosis is a condition that is characterized by very tight foreskin that makes it difficult to pull it back over the head or glans of penis. Most babies have phimosis at the time of birth, which means that you cannot retract the foreskin over the glans or head of penis – at least for the first few years of the post-natal life.The detachment of foreskin from the glans of penis usually begins around the age of 2 years, but may be delayed up to 6 – 10 years or later in some cases.In adults, phimosis is uncommon and may be associated with an infection or disease and may present with a variety of symptoms.

What are some classic causes of phimosis?

Phimosis is almost always seen in uncircumcised males only. This condition usually affects younger males and is less common in adult men. According to clinical data, in about 50% toddlers, foreskin cam be manually retracted or pulled over the glans manually in 1-year old babies. In about 90% cases, foreskin can be easily retracted in babies over 3 years of age. In teenagers between 16 to 18 years, the prevalence of phimosis is less than 1%.Following risk factors are usually implicated in the pathogenesis of phimosis:

• Boys who have a recurring history of urinary tract infections
• History of repeated trauma, injury of infection of foreskin

In older men, rough handling of foreskin/ penis or history of recurring sexually transmitted infections can lead to phimosis.

Other risk factors include:

• Lichen sclerosus: This skin condition is characterized by thickening or scarring of foreskin.
• Lichen planus: A non-contagious, itchy skin rash that can affect any part of the body, can also lead to phimosis.
• Psoriasis: This skin condition is characterized by flakiness of skin that may present with patches of crusty rash
• Eczema: Cracking, dryness or itchiness of skin that may affect any part of the body. Males who have eczema often develop phimosis.

Classic symptoms of Phimosis:

Phimosis is not always symptomatic. In symptomatic cases, people often complain if theres swelling, redness and soreness. In extremely severe cases, a tight foreskin may interfere with the urination and may ultimately result in the incomplete evacuation of the bladder.In poorly managed severe cases of phimosis, affected males may develop balanitis (inflammation of penile shaft) or even balanoposthitis (inflammation of both foreskin and glans). The risk of developing both of these conditions is fairly high in people with poor hygiene.You should suspect balanitis if you are experiencing following symptoms:

• Painful urination
• Accumulation of thick pus like fluid
• Swelling and redness
• Itchiness, odor and soreness of penis

Phimosis can also make sexual intercourse painful and may even cause splitting of skin or poor sensation. Use of lubricants or wearing condoms may improve the sensation and overall outcome.

How to diagnose phimosis?

Phimosis is usually diagnosed on physical examination. Your doctor may ask you a variety of questions regarding your medical and past history to ascertain the cause. If your doctor is suspecting an infection to be the cause of phimosis, they may carry out a variety of tests to confirm. How to treat phimosis?Phimosis can be treated by medical or surgical techniques. If an infection is causing phimosis, appropriate antibiotics is all you need. In most complicated cases of phimosis, surgical intervention such as circumcision may be needed.References:

1. Flynn, A. N., King, M., Rieff, M., Krapf, J., & Goldstein, A. T. (2016). Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus. Obstetrical & Gynecological Survey, 71(4), 221-222.
2. Flynn, A. N., King, M., Rieff, M., Krapf, J., & Goldstein, A. T. (2015). Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sexual medicine, 3(4), 251-255.

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