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What is phimosis?

Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction.

Phimosis is divided into two forms: physiologic and pathologic. Current incidence of phimosis is about 1% in 7th grade boys.

Physiologic phimosis: Children are born with tight foreskin at birth and separation occurs naturally over time. Phimosis is normal for the uncircumcised infant/child and usually resolves around 5-7 years of age, however the child may be older.

Pathologic phimosis: Phimosis that occurs due to scarring, infection or inflammation. Forceful foreskin retraction can lead to bleeding, scarring, and psychological trauma for the child and parent. If there is ballooning of the foreskin during urination, difficulty with urination, or infection, then treatment may be warranted.

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Symptoms of phimosis

The main symptom of phimosis is the inability to retract the foreskin by the age of 3. The foreskin usually loosens over time, but this process can take longer in some boys. By around the age of 17, a boy should be able to easily retract his foreskin.

Another common symptom of phimosis is a swelling of the foreskin while urinating.

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Causes of this condition

Phimosis can occur naturally. It’s unclear why it occurs in some boys but not others. The condition can also occur if the foreskin is forcibly retracted before it’s ready. This can harm the skin and cause scarring, making it more difficult to retract the foreskin later on.

Inflammation or an infection of the foreskin or the head of the penis (glans) may cause phimosis in boys or men. Balanitis is an inflammation of the glans. It’s sometimes the result of poor hygiene or an infection of the foreskin.

One of the infections that can lead to balanitis is called lichen sclerosus. It’s a skin condition that may be triggered by an abnormal immune response or a hormone imbalance. Symptoms can include white spots or patches on the foreskin. The skin may become itchy and easily torn.

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Seeking help

If phimosis interferes with healthy erections or urination, or if there are other symptoms, you should see a doctor.

Recurrent infections of the glans or foreskin should also be evaluated by a doctor. Signs of an infection may include:

  • changes in the color of the glans or foreskin
  • the presence of spots or a rash
  • pain
  • itching
  • swelling

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