Phimosis can create doubts in many people, especially boys. The condition is common in their childhood, but most of the time it tends to disappear as the child grows. However, if the condition is still present in adolescence, it may be necessary to resort to surgery.
Phimosis is a condition characterized by the inability to retract the foreskin (the skin around the head of the penis) and expose the glans, that is, the head of the penis.
Usually boys are born with phimosis, which is natural. The foreskin, the skin that covers the glans, is glued to it early in life, but over time it takes off and the head of the penis can be exposed.
Only 10% of boys reach 3 years of age with phimosis and this number decreases even further until 5 years of age. However, after 5 years of age, the presence of phimosis can be detrimental to the health of the penis.
The main problem caused by phimosis is the difficulty of cleaning.
Phimosis at older ages can be treated with ointments or surgery. Forcing the foreskin so that the glans is exposed can cause injuries to it, making the healing process even tighter.
In the International Classification of Diseases number 10 (ICD-10), phimosis can be found through the code N47.
What are the types of phimosis?
There are 4 different types of phimosis. Are they:
Physiological phimosis is the name of the type of phimosis that every boy is born with. The foreskin does not allow the glans to be exposed early in the child’s life. However, it is common that in the course of the following years the phimosis disappears.
Secondary phimosis happens when the physiological has passed, but something causes the foreskin to prevent the glans from being exposed again. This usually happens after trauma, injury or infection.
Phimosis is usually divided into grades ranging from 1 to 5. The less glans can be exposed, the higher the grade. Paraphimosis is a special condition and occurs when grade 1 phimosis exists. Although, in general, the highest grades are more dangerous, paraphimosis is more harmful than grade two, for example.
This is because in this case there is a possibility that it blocks the blood flow to the head of the penis.
Paraphimosis happens when the glans is completely exposed, but getting it back into the foreskin can be difficult because it is too tight. This tightening can constrict the bloodstream.
There is a so-called female phimosis. Rarer than the male, it happens when the small lips of the vagina are closed, blocking the vaginal orifice.
Phimosis has 5 degrees. Are they:
In this degree, the glans is completely covered and it is not possible to expose it. The skin of the foreskin has only a small opening through which the urine can escape and it is frequent that there is an accumulation of urine inside the skin before it can pass, forming a small bladder. This facilitates infections and hinders hygiene.
At grade four, opening the foreskin is easier and it may be possible to see a small piece of the glans inside, but it is still completely covered by the skin. The problems caused by this are the same as those resulting from grade 5.
In this degree of phimosis, the foreskin allows a small part of the glans to be exposed. This slightly reduces the chances of infection as the urine does not accumulate inside the foreskin before leaving, but it still makes it difficult or impossible to clean the area.
In grade 2, the glans may be mostly exposed, but not yet completely. The foreskin ring – the part of the skin that does not expand, keeping the foreskin closed. It looks like a rubber ring around the penis – it does not allow the skin to go to the end of the glans and hygiene here can also be impaired.
It often also manifests as paraphimosis. In grade 1, the preputial ring is able to pass through the crown of the glans (the back of it is wider than the rest), but has difficulties in returning to the front due to the tightness.
The cleaning of this type of phimosis is easier than the others, however there is a different risk here. Tightening of the foreskin can constrict blood vessels. If it is strong enough, this squeeze is able to block the flow of blood and lead to necrosis.
Physiological phimosis is natural. The foreskin serves to cover and protect the penis from friction, the sun, impacts and dehydration, in addition to facilitating sexual life.
When the baby is born, there is usually an adhesion of the foreskin to the glans. This adherence is necessary for preputial protection in the first years of life, which is especially important since the penile region is very sensitive.
However, as time goes on, it needs to allow the glans to be exposed.
Moisture is important for the head of the penis, but if there is no hygiene, the risk of infections is high. Likewise, the movement of the foreskin facilitates penetration during sex.
When there are diaper rashes and scars in the area of the foreskin, the phimosis may tighten or be prevented from undoing.
This is because when the skin heals it contracts and loses elasticity. If this happens with the foreskin ring, which is the narrowest part of the foreskin, the skin may be unable to stretch enough to expose the glans.
It is not known with certainty what causes phimosis in babies or what causes it to not come undone by itself in the first years. However, doctors believe that this happens due to a number of factors, which may be congenital (it has been this way since birth) or due to diaper rash caused by poorly performed penile hygiene.
Infections, as well as in adults, can also be a cause for phimosis in babies.
Untreated phimosis in childhood usually follows the person through adolescence and adulthood. However, it is possible that it will appear during adulthood even if it broke up during the first years of life. This is usually caused by infections of the glans or foreskin, or because of scarring from wounds that can occur in a variety of ways.
The risk factors for phimosis in children are not known. While only 10% of boys pass the age of 3 with phimosis, only a part of them need treatment for this and it is not possible to know in advance which ones they will be. There is no hereditary relationship, so it is not because the father has phimosis that the son will also have it.
However, some factors increase the risk of developing secondary phimosis, both in children and adults. Are they:
Infections, which may or may not be caused by sexually transmitted diseases, are capable of injuring the skin of the foreskin, which heals with less flexible and contracted tissue. This reduces the space that exists for the passage of the glans.
When the reduction is large enough, the glans may be unable to expose partially or totally.
Other infections that can cause phimosis are urinary tract and foreskin infections.
People with diabetes are more likely to develop infections due to circulatory and healing problems that exist as a result of the disease.
Lack of hygiene
The lack of hygiene facilitates the proliferation of bacteria in the glans, causing scarring and phimosis in the same way as infections. Despite causing the condition through infections, the lack of hygiene enters as a risk factor of its own as it is one of the main causes of penile infections.
Wounds in the penis region, which can be caused by trauma or friction, bring scar tissue to the region. If this tissue affects the foreskin it can prevent the glans from being exposed.
These wounds may also appear after excessive or aggressive handling of the foreskin. Massages and exercises that can be recommended on the internet, if done incorrectly, can cause injuries and should only be done when recommended by doctors.
Balanoposthitis is an inflammation of the glans or foreskin, not necessarily caused by an infection, but they can also lead to this. This inflammation can be caused by skin diseases, the use of aggressive soaps, poor hygiene, infections or even uncontrolled diabetes.
It is important to go to the urologist to deal with these inflammations, as the swelling can make it more difficult to transport blood to the organ.
What are the symptoms of phimosis?
Phimosis can cause several uncomfortable and even dangerous symptoms for the patient. Between them:
Pain when urinating
Depending on how tight the foreskin ring is, it can constrict the urethra and hinder the passage of urine, causing pain.
Phimosis can cause sensitivity in the glans for several reasons: Lack of exposure and custom to contact, trauma due to the tension of the foreskin that did not detach from the glans, infections and inflammations.
When there is inflammation of the glans or the skin of the foreskin, there may be swelling.
Due to the difficulty of cleaning, infections can occur more easily in the glans and foreskin in people with phimosis.
Pain during sex
The tension exerted on the skin of the foreskin can cause pain during sex, especially if the lubrication is not adequate. As the glans produces its own lubrication that is below the foreskin, it is easier to lack penile lubrication during sex, which leads to pain.
Accumulation of secretions
The glans produces secretions that help keep it moist and protected, as well as lubricating itself for sex. Due to the problems to sanitize it, these secretions can accumulate and cause several problems such as bad smell and infections.
Cutting blood flow
When the preputial ring is too tight, especially in cases of paraphimosis, there may be constriction of the blood vessels that take blood to the glans, reducing or even cutting off circulation. This can lead to necrosis and there are cases of patients who have had to amputate part of the penis because of this.
The diagnosis can be made by the general practitioner or urologist . Physical examination is enough for the diagnosis. The doctor will analyze the skin, try to expose the glans and if it cannot be completely exposed, will give the diagnosis of phimosis, in addition to its degree and the type of the disease.
The differentiation between the degrees of phimosis is not as relevant as the patient’s age. If he is less than 5 years old, observation is made. From that age, treatment with ointments can be done and surgery can be considered if there is no improvement with the application of the ointment.
Yes , phimosis can be cured. In most cases of physiological phimosis, it resolves itself. In cases of secondary phimosis, the cause can be treated and ointments can be used so that the skin allows the glans to pass. If necessary, circumcision can be used, a surgery that removes the foreskin, resolving phimosis.
There are two types of treatment that can be used to cure phimosis. They are as follows:
There are specific ointments for the treatment of phimosis. They are used to make the skin more malleable, facilitating the passage of the glans through the foreskin. Exercises can be used in conjunction with the ointment to increase the chances of the treatment working.
After applying the ointment (which should not be used on the glans, but on the brake and the pre-facial ring, depending on what needs treatment) the skin should be pulled slightly, without causing pain. With each application of the ointment, the exercises must be done.
It is important to follow the medical recommendations for exercise, since if they are done in the wrong way, they can make the situation worse due to micro-wounds that, when healing, leave the foreskin even more closed.
This treatment can take a few days, weeks or even an entire year, depending on the degree to which the phimosis is. In addition, ointments do not always work. In such cases, surgery may be recommended.
Postectomy is surgery to remove the foreskin. It is performed in the hospital by the pediatric surgeon when in children and by the urologist in adults.
It is a simple surgery. The patient is usually discharged on the same day. It is recommended for children with phimosis between 7 and 10 years old, since at that age recovery is easy and the child has not yet entered adolescence, which can make healing difficult.
With general or local anesthesia, a cut is made in the foreskin to open and detach it from the glans. Then, another cut is made to remove the excess skin. Stitches are placed to accelerate healing, which is completed in a few days.
Although it is more common in children, it can be done in adults without problems.
Advantages of circumcision
It is important to remember that, in spite of reducing the risk of contracting these sexually transmitted diseases, this reduction is extremely small and negligible, since it is only due to the fact that there is nowhere for the viruses to stay if they fail to enter the urethra at first. The best method of preventing STDs is condoms .
Risks of circumcision
The hospital performance of this surgery rarely causes problems, but like any surgical procedure, there are risks related to anesthesia, in addition to infections and bleeding.
Disadvantages of circumcision
Among the disadvantages of circumcision is the possibility of reduced sensitivity. In the first days after removing the foreskin, the glans may become more sensitive than normal due to friction with clothing.
However, this same friction, over time, causes the skin on the head of the penis to thicken, making it less sensitive.
Circumcision in babies
Circumcision is a Jewish custom and is performed as a religious ritual, performed on the eighth day of the child’s life, symbolizing the covenant of God and the people of Israel.
The procedure is also customary in the United States. Approximately one-third of boys born in the United States undergo surgery shortly after birth. It is defended as a cultural and health practice.
However, there is medical literature that states that the experience is painful and traumatic when performed without anesthesia, which is the situation in most of these cases.
About 87% of babies show behavioral changes after surgery and some do not cry because they go into shock. There are movements that aim to reduce and end unnecessary circumcision.
The only type of medicine for phimosis is ointment, which serves to make the skin more flexible, allowing the passage of the glans.
- Postec .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Living with phimosis is an option in some cases. Especially in grade 2, where there are fewer complications and there is more glans exposed, surgery is optional.
There may be greater risks of infection and inflammation due to hygienic difficulties, but keeping the penis clean in these cases is not impossible, just a little less practical.
Grade 1, 3, 4 and 5 phimosis, however, can cause serious problems if ignored and the treatment that aims to cure it is recommended by doctors.
If surgery is required, phimosis is no longer a problem. It is necessary to get used to the difference in sensitivity and the use of lubricants can be recommended during sex and even during masturbation, since the skin that helps in this regard is removed during circumcision.
If you have phimosis, remember to do penile hygiene with care . It is necessary to ensure that the penis is as clean as possible to avoid complications.
Other than that, there are no other consequences or difficulties.
Complete healing can be expected. While in most cases the phimosis resolves on its own, ointments can cause the foreskin to recede.
If necessary, surgical treatment is recommended to avoid complications of phimosis. After surgery, the patient can go on with life normally.
If ignored, phimosis can bring some serious complications. Are they:
It is possible for bacteria to multiply in the space between the glans and the foreskin, which cannot be cleaned very well because of phimosis. These infections can become very serious.
Necrosis is the process of tissue death. When an infection becomes very severe or if blood vessels in the glans are blocked (which can happen in the case of grade 1 phimosis), there is a risk that the glans tissue will die.
This is extremely serious, as it leads to the decay of the organ still in the body, which can cause other infections and lead to death. In such cases, the glans needs to be amputated.
While physiological phimosis cannot be prevented, secondary can. Prevention occurs as follows:
There is no secret. To avoid adult phimosis, hygiene is the key. Cleaning the penis, especially inside the foreskin, prevents infections. This causes the skin to remain flexible, not allowing the formation of phimosis.
Some sexually transmitted diseases can cause penile infections. The best way to avoid them is to use a condom during sexual activities.
Will I lose phimosis when I lose my virginity?
No , sex does not remove phimosis. There is even a chance to make it worse, since it can pull the foreskin if the lubrication is not enough. This can lead to pain and micro-wounds, which heal and can make the condition worse.
However, this is not common. The most frequent is that there is no consequence for sex with phimosis.
Does phimosis affect penis growth?
No . The main factor that defines penis size is genetics. Phimosis does not alter the size of the penis in any way.
Does the penis grow after surgery?
No, neither . Surgery removes the foreskin, but it does not influence the size of the penis and its lack will also not influence it.
What is the right age to have the surgery?
The age recommended by doctors to perform the surgery is between 7 and 10 years of age. At this age the child already understands that the procedure is being done to help him, at the same time that he has not yet entered adolescence, which will bring several changes to his body and sexual organ.
If I have just a little extra skin, do I need to have the surgery?
It is not necessary. If the extra skin does not hinder the cleansing of the region and neither does the sex, there is likely to be no surgical need. However, only your doctor can talk about your specific case.
Do massages help to reduce phimosis?
Massages do not help with phimosis and can even make the situation worse . Stress can cause small sores on the skin of the foreskin which, when healing, loses elasticity and impairs the exposure of the glans. Massages should be avoided.
There is a natural adhesion of the foreskin to the glans, and it disappears in the first years of life. This grip can be removed with massage, but it would be removed anyway. If you go out with a massage, it is not phimosis, and if it is phimosis, massage does not help and can be harmful.
Who doesn’t have phimosis can develop?
-Yeah . Infections, diaper rash, injuries and trauma can cause phimosis even in adults. The lack of hygiene facilitates all this and can lead to phimosis in anyone, so keeping the penis clean is essential for his health.
When is it necessary to have phimosis surgery?
When phimosis impairs the boy’s health, leading to urinary tract infections, for example, surgery may be necessary. If possible, the ideal is to wait for the boy to reach, at least, 7 years old. At this stage, it is already possible to assess the relevance of surgery more safely.
How long does it take to recover from phimosis surgery?
The process after surgery tends to be simple. In general, after 10 days the region is already recovered, without swelling and without pain. After that time, activities can be resumed gradually, but those that pose a risk of injury or trauma should be avoided, for example, sports.
You learned that phimosis is something natural in babies, but that it should go away on its own in the first years of life. When this does not happen, there are greater risks of penile infections. Share this text with your friends so that they also learn about phimosis!