Are you experiencing problems with your foreskin? If your penis feels overly restricted or you struggle to retract your foreskin you might be alarmed, but it's a pretty common concern that is linked to a medical condition called phimosis.
So when does a tight foreskin, or phimosis, become a problem that needs further treatment or surgery? And what’s the difference between phimosis and paraphimosis?
GP and Queens Park Football Club doctor Sandesh Gulhane has performed surgery for phimosis many times. He explains everything you need to know about both conditions:
What is phimosis?
Put simply, phimosis is when the foreskin can’t be easily retracted over the head of the penis and it’s a very common condition.
‘It can be normal in babies and toddlers and in these instances the skin should not be forced back,’ Gulhane says. ‘Older children may have it as part of a skin condition, but unless it causes problems urinating or they experience repeated infections under the foreskin, nothing need be done about it.’
Symptoms of phimosis may include the following:
- Irritation or bleeding particularly during sexual intercourse or masturbation.
- Stinging or pain when passing urine.
- Inability to pass urine if the foreskin is particularly tight.
Phimosis treatment tips
Phimosis is where the foreskin is too tight to be pulled back over the head of the penis. ‘If the foreskin is tight but can be retracted, then this is not a phimosis,’ Gulhane explains.
Gulhane recommends the following at-home treatment tips:
✔️ In adults a tight foreskin can be treated by lying in a warm bath and gently pulling the foreskin back without pain.
✔️ Repeat this daily and the foreskin will gradually become looser.
✔️ If your foreskin is tight your GP may also prescribe you topical steroids which make the skin thinner, and therefore easier to retract.
When does phimosis become a problem?
Phimosis only becomes a serious problem if you notice back-flow when urinating, or if urine flows out sideways instead of in a straight stream, Gulhane says. If you experience repeated infections under the foreskin it may also be worth seeking treatment.
If you force the foreskin to retract, or it is forcibly retracted during sexual intercourse, it can be painful and may bleed. ‘This is not a big problem but will be scary!’ Gulhane adds. ‘You might feel down about pain during intercourse, or if it stops you from doing what you want. Don’t suffer in silence, go and see your GP.’
Make an appointment with your GP if you experience any of the following:
- A burning sensation, pain or difficulty with urination.
- White or cloudy discharge from the penis.
- Inflammation of the head of the penis, known as balanitis.
- Pain, irritation, or itching.
- Inability to pull your foreskin back once it has been retracted, known as paraphimosis.
What is paraphimosis?
Sexual issues only arise if paraphimosis occurs and you are unable to pull your foreskin back once it has been retracted. This is where the penis become erect while the foreskin is positioned over the head. Then, during intercourse the foreskin gets forcibly retracted and can not be pulled back over the head.
‘This can be scary and painful, and if left without treatment may result in the blood supply to the head of the penis being interrupted – meaning it can die,’ explains Gulhane.
‘This is an emergency as the blood flow can be compromised to the head of the penis,’ Gulhane explains. ‘Relaxing and becoming flaccid usually solves this. To become flaccid, try icing the penis and milking the blood back from the tip to the base.’
If this doesn’t work, you need to go to A&E where doctors will insert a needle to drain the blood. In rare cases they may perform surgery – usually a circumcision.
What happens during a circumcision?
Circumcision is a surgical procedure that involves partial or complete removal of the foreskin. Gulhane explains that planned circumcision surgery is always a better bet than surgery in case of an emergency, as it often has better results.
‘It may be painful but it will get better quickly,’ Gulhane explains, but he says the operation is safe and usually has no real complications.
Circumcision risks and recovery
Gulhane outlines the following risks and recovery associated with circumcision. If you have any concerns, speak to your GP.
- There may be bleeding and infection at the site of the circumcision.
- There may be irritation of the head of the penis.
- There is a small risk of inflammation of the opening of the penis and injury to the penis.
- There will be discomfort and swelling around the head of the penis for about four days.
- It should take 10 days for the wound to heal.
- You are advised to take a week off work to recover.
- You should avoid sexual intercourse for at least four weeks.