Tight foreskin (phimosis and paraphimosis)

About phimosis and paraphimosis

In older children, phimosis may be the result of a skin condition that has caused scarring. 

In adults, phimosis can occasionally be linked to sexually transmitted infections (STIs).

Immediate treatment is needed in cases where it causes problems such as difficulty urinating (peeing).

Paraphimosis is where the foreskin can't be returned to its original position after being retracted (pulled back).

Symptoms of phimosis and paraphimosis

Phimosis

Phimosis isn't usually a problem unless it causes symptoms.

These include: 

• redness
• soreness
• swelling
• problems peeing - if the opening blocks the flow of urine (pee) it may cause the foreskin to balloon during urination

If your child's glans is sore and inflamed, they may have balanitis. This is an inflammation of the head of the penis.

There may also be a thick discharge underneath the foreskin. If both the glans and foreskin are inflamed, it's known as balanoposthitis.

Paraphimosis

Paraphimosis causes the glans (end of the penis) to become painful and swollen. It blocks the flow of blood in the penis.

 It requires emergency medical treatment to avoid serious complications.

These complications include:

• increased pain
• swelling
• restricted blood flow to the penis

In severe cases of paraphimosis, circumcision may be recommended.

In very severe cases, a lack of blood flow to the penis can cause tissue death (gangrene) and you may need surgery to remove the penis.

If you have any of the symptoms of paraphimosis, contact your GP immediately or call GP out of hours service.

When to see your GP

Take your child to see your GP if they have symptoms of phimosis and balanitis.

Your GP will discuss treatment options with you.

Most cases of balanitis can be managed without surgery.

Management includes using a combination of:

• good hygiene
• creams or ointments
• avoiding substances that irritate the penis

Balanoposthitis can also sometimes be treated by simple hygiene measures, such as keeping the penis clean by regularly washing it with water and a mild soap or moisturiser.

If balanoposthitis is caused by a fungal or bacterial infection, an antifungal cream or a course of antibiotics may be needed.

Causes of phimosis

In adults, phimosis can sometimes happen because of sexually transmitted infections (STIs).

It can also be caused by skin conditions, including:

• eczema – a long-term condition that causes the skin to become itchy, red, dry and cracked
• psoriasis – a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales
• lichen planus – a non-infectious itchy rash that can affect many areas of the body
• lichen sclerosus – a scarring condition of the foreskin (and sometimes glans) that's probably caused by urinary irritation in susceptible men and boys

Phimosis can cause pain, skin splitting, or a lack of sensation during sex.

Using a condom and lubricants while having sex may make your penis more comfortable.

When surgery may be needed

Surgery may be needed if a child or adult has severe or persistent balanitis or balanoposthitis that causes their foreskin to be painfully tight.

Paraphimosis may also require surgical treatment.

The health professional looking after you or your child will talk to you about treatment options.

Penis hygiene

It's important to clean your penis regularly to avoid problems developing.

You should:

• gently wash your penis with warm water every day
• if you have a foreskin, gently pull it back and wash underneath - don't pull back the foreskin of a baby or young boy because it could be painful and cause harm
• use a mild or non-perfumed soap to reduce the risk of skin irritation
• avoid using talc and deodorants on your penis as they may cause irritation
• circumcised men should also regularly clean their penis with warm water and a mild soap

More useful links

• How to use your health services
• Tight foreskin (phimosis)