Rajiv, 28 years old, is a gulf immigrant and is recently married. He came to my clinic last week. He wasn’t really comfortable talking to me, but up on confronting he said his sex is painful. On the physical examination of his genitals, I observed that his foreskin do not retract over the head of the penis. This problem is pretty common and is generally called ‘Phimosis – tighter foreskin.’
Phimosis can be really bothersome but unusually serious. It may have an extremely negative effect on both you and your partner’s sex life. Mostly, boys will have retractable foreskin by the time they turn 10 years and 95 % boys before they turn 18 years. Since penis is thrust during sex, phimosis can cause redness, swelling and tenderness, which makes sex very painful.
What’s more of a concern than phimosis is it’s possible that during sex you may cause paraphimosis. Friction or sheer force of your partner your foreskin may retract, but will stuck and never return to its original position. It is an emergency medical condition and one should consult with a urologist or andrologist immediately.
Causes of Phimosis
Phimosis is either physiological or pathological.
- Physiologic phimosis is present from birth (congenital condition), in which children are born with a tight foreskin. The foreskin retraction occurs naturally during late childhood and early adolescence.
- Pathologic phimosis occurs in adults, due to infection, inflammation, or scarring and is usually found in uncircumcised adult men.
- Pain during sex
- Inability to retract foreskin which can affect sex life
- Inflammation of penis head
How to manage Phimosis
Option 1 – Self Treatment – Stretch the Foreskin
Tight foreskin is not a big concern and many men can simply try stretching the foreskin. Although it is not clinically backed, it is safe and easy. Try to stretch the foreskin gently. Even mild force can damage it. Use any lubricant to ease stretching and try this daily for 5 to 10 minutes, when the penis is flaccid. Be as gentle as you can.
No luck? Okay, move on to next option.
Option 2 – Try topical steroids & antibiotics
Topical steroids like betamethasone, cortisone and mometasone furoate can help in foreskin retraction. Apply the steroid creams to the external and internal part of the foreskin’s tip. Do it twice or thrice a day. However, consult with a doctor and use prescription steroid creams.
Topical steroids work in case of physiologic phimosis. For pathologic phimosis, you need proper treatment from GP or Andrologist. Oral antibiotics may help reducing inflammation and pain.
If these neither of these options work,
Option 3 – Surgery
It is the best option to treat phimosis, which is rather due to short frenulum for the foreskin or too tight foreskin. If short frenulum associates with scarring in the foreskin, a full circumcision is required in a few patients.
Circumcision is the mainstream treatment when foreskin is infected and scarred. Sometimes your doctor may perform partial circumcision or dorsal split. However, avoid partial removal of foreskin, because during erection, you may develop scarring from the remnants of foreskin tissues.
Circumcision is the tradition treatment for phimosis. Yet, keep it as the final resort and consider only after your doctor recommends it.