Phimosis (Tight Foreskin)

Phimosis means that the foreskin is too tight to be pulled back over the head of the penis. In babies and young boys this is normal, because the foreskin is naturally attached and loosens by itself, usually by about 5 to 7 years and sometimes not until the teens.

It counts as a medical problem when it is caused by scarring, called pathological phimosis, or when a tight foreskin in an older boy or a man causes symptoms. Treatment ranges from a steroid cream to circumcision.

Symptome

• A foreskin that cannot be retracted
• Ballooning of the foreskin while passing urine
• A thin or spraying urine stream
• Repeated redness, soreness or discharge under the foreskin
• A white, hard scarred ring at the tip
• Pain or splitting of the skin with erection or intercourse
• Repeated urinary infections in boys

Ursachen und Risikofaktoren

Physiological phimosis is simply normal development. Pathological phimosis is most often caused by lichen sclerosus, also called balanitis xerotica obliterans, a chronic inflammatory skin condition that leaves a white scarred ring. Other causes are repeated infections, especially in men with diabetes, poor hygiene and forceful retraction of a child's foreskin, which tears the skin and heals with scarring. In adult men, a foreskin that becomes tight for the first time is a reason to test for diabetes.

Wie es diagnostiziert wird

• Clinical examination: Looking at the foreskin is enough in nearly all cases. A scarred white ring is distinguished from a healthy but narrow foreskin.
• Urine and blood sugar tests: For adults with a new tight foreskin or repeated infections.
• Histology: Removed skin is examined when lichen sclerosus is suspected. In adults this also excludes rare pre-cancerous change.

Behandlungsmöglichkeiten

• Watchful waiting: For healthy boys without symptoms. Gentle washing, and never forcing the foreskin back.
• Steroid cream: A moderately potent or potent steroid applied to the tight ring twice a day for 4 to 8 weeks with gentle stretching. It works in a large majority of boys without scarring.
• Preputioplasty: A small operation that widens the foreskin and keeps it, for selected cases without lichen sclerosus.
• Circumcision: Removal of the foreskin. It is the definitive treatment for scarred phimosis and lichen sclerosus. In children it is done under general anaesthesia, in adults often under local.
• Treatment of lichen sclerosus: Potent steroid ointment and follow-up, because the condition can also narrow the urinary opening.

Wenn es dringend ist

If the foreskin has been pulled back and is stuck behind the head of the penis, with swelling and pain, this is paraphimosis. It cuts off circulation and needs an emergency department immediately. Inability to pass urine also needs urgent care.

Reisen nach Türkiye zur Behandlung

This is a minor, common problem that any urologist or paediatric surgeon near you can treat, and steroid cream needs no travel at all. Adults who are already visiting for other care can have a circumcision done as a day case and fly after a few days, with healing over 3 to 4 weeks and no intercourse for about 4 to 6 weeks. Taking a child abroad solely for this operation is hard to justify.

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