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Tight Foreskin (Phimosis)
In adults, tightness of the foreskin may cause no symptoms for most of the time. Problems usually become more obvious (and troublesome) when you get an erection and attempt sexual intercourse.
What are the facts about tight Foreskins?
In most children, the foreskin cannot normally be retracted completely before the age of 5. In some, full separation may not take place until the age of 10;
Injury or infection of the foreskin may contribute to tightening;
Ballooning of the foreskin (blowing up when passing urine, pictured) does occur with a tight foreskin but may also occur in children with a normal foreskin;
Tightness of the foreskin may interfere with the normal passage of urine and can, in severe cases, cause acute retention of urine; and Tight foreskins may encourage tumours of the penis to develop but tumours never arise in patients who have been circumcised in childhood .
What could have caused my tight foreskin?
Stretching of a diseased foreskin is best avoided. There is no scientific evidence that it produces a cure and it can actually precipitate further tearing and scarring. This may worsen a phimosis which then requires surgical treatment later in life. Forcible retraction of the foreskin in children should be avoided.
Steroid creams may soften your foreskin if the scarring is mild; stopping the cream, however, may result in a return of the condition.
Antibiotics may be needed if swabs show any evidence of infection
Using a condom during sexual intercourse may make the penis more comfortable
Circumcision is the mainstay of treatment if the foreskin is scarred by balanitis xerotica obliterans. This is one of medicine's oldest operations and has often been depicted in ancient and religious art (pictured above right; by Signorelli).
Download a leaflet about circumcision Click here
Preputioplasty is effective In children with congenital tightening of the foreskin. Several incisions are made into the tip of the foreskin to expose the head of the penis. The foreskin then needs to be retracted regularly until it has healed completely. Preputioplasty has a very limited role in adults and is not effective in those with a very tight foreskin due to active lichen sclerosus.
Frenuloplasty is the best option if the tightness is due to a short penile frenulum, rather than a tight foreskin. However, a short frenulum may also be associated with a some scarring of the foreskin, so full circumcision is still needed in some patients.
Download a leaflet about Frenulplasty Click here
Partial removal of the foreskin is not recommended. Scarring may return in the foreskin remnant and the cosmetic results, particularly during erection, are often unacceptable.
Can other diseases affect the foreskin?
Yes; conditions that may affect the foreskin include:
• Viral infections (genital warts, genital herpes simplex)
Bacterial infections (syphilis, chancroid)
Infestations (scabies, pediculosis)
Skin disorders (lichen planus, psoriasis, contact dermatitis, fixed drug eruptions)
Balanitis (plasma cell infiltration, Reiter's disease)
Precancerous conditions (giant genital warts, Bowen's disease, Erythroplasia, Bowenoid papulosis)
Penile cancer (squamous carcinoma
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