Phimosis means a narrowed foreskin. It is an often condition and it can be considered as a disease because it interferes with normal life of the affected male and it may be associated with some serious complications.
The foreskin is a skin layer that covers the glans of the penis. It has an outer and inner layer. Under normal condition, the foreskin can be moved and dragged towards the base of the penis, thus exposing the glans and the same happens during the erection. When the edge of the foreskin is too tight, it can not be dragged over the glans and this condition is called phimosis. Phimosis may be also associated with a short frenulum (tissue connecting the foreskin to the lower side of the penis), which also prevents the foreskin to properly move.
Phimosis is either congenital, or it can develop during a man’s life. Shortly after birth, it is present in nearly all boys, where it is associated with bonding of the inner foreskin layer to the glans. Later the phimosis disappears in healthy individuals. However, in many boys the phimosis persists and in that case it must be solved.
Phimosis can also develop during the patient’s life as is written above. In such case it is usually related to the inflammation of the glans and foreskin or a foreskin injury. Injured or repeatedly inflamed foreskin tends to scarring and narrowing. That can happen when a teenage boy with a mild phimosis tries to “heal” by frequent painful stretching of the foreskin over the glans in order to extend it. Such “self-medication” can have a short-term effect but after a longer period the damaged foreskin may scar and narrow even more.
The foreskin is narrow and can not be dragged over the glans. Such attempts are painful and so may be even the erection. This causes great troubles during sexual intercourse that can become really painful and unpleasant. Moreover, sexual intercourse may further injure the narrowed foreskin and worsen the symptoms. In history, even some monarchs have suffered from phimosis such as the King Louis XVI (Marie Antoinette's husband) and Tsar Peter (husband of Catherine the Great). Both were relieved only by a therapeutic surgical intervention (see treatment).
In addition, long-lasting phimosis causes accumulation of whitish matter called smegma under the foreskin. The smegma contains exfoliated epithelial cells, bacteria and skin oils and moisture. It is not aesthetical and it is assumed to have a relationship to development of the penile cancer.
Phimosis may get further complicated by a so-called paraphimosis when the narrow foreskin is pulled over the glans and can not be further retracted strangling the glans tissue.
The phimosis can be diagnosed by a penis examination, ideally by an urologist or pediatrician.
Congenital phimosis can not be avoided or prevented, it can only be treated. However, it is advisable not to try to heal the foreskin by repeated painful traction and rather seek an urologist advice.
Phimosis may be treated conservatively (i.e. non-surgically) or by a surgical intervention.
The non-surgical treatment involves the application of ointments usually containing corticosteroids. Corticosteroids do not have much positive effects on the skin, but in this case it is desired. The foreskin loosens and gradually expands.
Surgical method of choice is the circumcision. It is a classic method that has been carried out for centuries in the Jewish and Muslim culture. Simply said, the foreskin is surgically cut and the glans is exposed. The surgical intervention is relatively simple and it is usually performed only in local anesthesia. If there is also present the short frenulum, it is cut as well. After the surgery, the circumcised penis is sensitive and painful to touch but these sensations fade quite quickly. The implementation of circumcision should be considered pragmatically. If it is not necessary for medical reasons, it is a questionable procedure.
Note: Many scientists assume that circumcision reduces the risk of penile cancer but this is rather a disputed theme.