Why can't I pull my foreskin back? - Tight Foreskin or Phimosis

Phimosis is a phenomenon in which the foreskin around the tip of the penis cannot be retracted (drawn back). A tight foreskin is typical in uncircumcised infant males, but it normally goes away by the age of three.

As the foreskin is still attached to the glans penis of uncircumcised infant males, it will not retract. For the first two to six years, this is quite typical. Around the age of two, the foreskin should begin to separate from the glans on its own. It's never a good idea to try to pull your child's foreskin back before it's ready, as this can be painful and cause damage to the foreskin.

According to one study, the foreskin separates from the glans in 4% of infants, 20% at 6 months, 50% at a year, 90% at 3 years, and 99% in adult males. Some people, however, develop tight foreskin later in life as a result of scarring due to recurring infection.

How does tight foreskin occur?

Due to the presence of secretions from the foreskin, the foreskin normally separates from the glans and becomes a vestigial structure that covers and protects the glans after birth. The glans will separate the two and keep them that way.

Phimosis is a condition that can happen to anyone. It's unclear why some get it while others don't. If the foreskin is forcibly retracted before it is ready, this problem can develop. This can cause skin irritation and scarring, making it more difficult to retract the foreskin later.

Later in life, inflammation or an infection to the foreskin or penile head (glans) may cause phimosis. Inflammation of the glans penis is also known as balanitis. Poor hygiene practice may lead to recurrent infection which results in scarring causing tight foreskin.

When does phimosis becomes a problem?

Individuals with a tight foreskin are more prone to infection (balanitis), with roughly 36% of them having repeated infections. Unless it creates symptoms like redness, discomfort, or swelling, phimosis is usually not a problem.

Phimosis can also interfere with urination. While passing urine, some people may experience ballooning of the foreskin as well as pain or discomfort. Long-term partial obstruction of the urine passage can also harm the kidneys and renal system.

A doctor should be consulted if you have recurrent infections of the glans or foreskin. An infection can manifest itself in a variety of ways, including:

• colour changes in the glans or foreskin

• the appearance of rash or patches

• pain

• itchiness

• swelling

Is frenulum breve the same as phimosis?

Frenulum is a ring of tissue that runs underneath the penis. A frenulum breve is when the frenulum becomes too tight or too short. Upon erection, pushing the foreskin back can cause a lot of tension on the frenulum, causing the penis to bend downward. This can result in tears to the frenulum during strenuous activities like sexual intercourse, leading to extreme discomfort and bleeding.

Repeated tears can cause scarring, as well as tightening of the frenulum, which eventually will lead to further tears in the future.

Phimosis is often confused with frenulum breve. Their main difference is that phimosis is when a band of scar tissue form on the foreskin while frenulum breve is when your frenulum is too short. Having frenulum breve however can result in phimosis due to recurring tears causing scarring leading to tight foreskin, preventing you from pulling the foreskin back.

Click HERE to know more about FRENULUM BREVE

What are the causes of phimosis?

The majority of cases of phimosis are congenital, however there is also acquired or "pathological" phimosis. This type of phimosis can be caused by a variety of reasons, including:

• Balanitis (inflammation of the foreskin)

• Balanoposthitis (inflammation of both the glans and foreskin)

• Excessive pulling back of the foreskin (e.g.: too frequent masturbation)

• Frequent urinary catheterisation

• Poor practice of genital hygiene

• Diabetes – causing an individual to be prone towards infection like balanitis

• The frenulum is too short (frenulum breve)

In adults, phimosis may be associated with sexually transmitted diseases (STDs), such as:

• Syphilis

• Gonorrhea and Chlamydia

• Recurrent Genital Herpes

• HPV Warts

How to treat phimosis?

A physical exam and a review of your symptoms are usually sufficient to determine whether you have phimosis or an underlying illness like balanitis.

A swab of the foreskin to be tested in a lab is usually the first step in treating balanitis or another type of infection. This is to help determine the source or cause of the infection which will aid in determining the suitable methods of management.

Treatment of phimosis can either be surgical or non-surgical. These include:

Non-surgical

The use of steroid creams, which have anti-inflammatory and immunosuppressive properties, helps to reduce scar tissue formation and collagen fibre deposition.

Steroid creams cause foreskin thinning due to loss of tissue matrix and reorganisation of the collagen and elastin fibres inside the foreskin. Besides that, steroids inhibit the synthesis of collagen fibres and skin cells (epidermis) growth.

Using steroids, on the other hand, does not guarantee a long-term benefit for the treatment of phimosis in all individuals. Daily, gentle retractions or stretching of the foreskin for 15 seconds may also be helpful in treating phimosis in certain people.

Antibiotic or antifungal ointments may also be useful in cases where bacterial or fungal infections are suspected.

Surgical

In more serious situations, a surgical approach may be needed. For example, if the individual has severe or persistent balanitis or balanoposthitis causing the foreskin to be painfully tight.

Some of the operative methods for treating phimosis include circumcision, prepuce plasty (remodelling of the foreskin via surgery to widen it and enable the foreskin to be pulled back) and foreskin dilation using balloon or artery forceps.

Alternatively, surgery may also be done to release the adhesions coming from the scar tissues in areas where the foreskin is stuck to the glans. This will preserve the foreskin as compared to circumcision whereby the foreskin is surgically removed. However, there is a risk of the problem to recur.

What will happen if phimosis is left untreated?

This condition usually resolves by itself in more than 90% of cases without the need for any forms of intervention, either surgical or non-surgical.

Once it becomes persistent or causing symptoms, it can develop into a serious and painful condition. It is, however, curable, not life-threatening, and the results are usually excellent. The goal is to seek medical help as soon as symptoms appear.

Some of the complications associated with phimosis are:

• Painful urination

• Prolonged obstruction towards the urinary tract causing renal problems

• Pain and discomfort during sexual activities

• Paraphimosis (foreskin unable to return to its original position after being retracted)

• Penile malignancy

Can phimosis be prevented?

Good cleanliness is essential for avoiding the consequences of phimosis. Every day, gently wipe the penis and under the foreskin with warm water to maintain hygiene. This will effectively keep the skin flexible and prevent infection.

Those who have uncircumcised penis are recommended to pull back the foreskin and wash underneath using warm water. Avoiding the use of talc or deodorant on the area, as well as using a light or non-fragranced soap, will lessen the chance of irritation.

Circumcised men should also clean their penis regularly with warm water and mild, non-perfumed soap.