Phimosis: Understanding Causes, Symptoms & Treatment

Phimosis is the inability to retract the foreskin over the glans penis. It is not "having no foreskin"—that is circumcision or congenital absence (aposthia). Phimosis can be physiological (normal in infants) or pathological.

Causes

• Physiological: Normal in newborns/children; foreskin adhered to glans. Resolves spontaneously in most by adolescence.
• Pathological (Acquired):
• Balanoposthitis (recurrent inflammation/infection) → scarring (BXO — balanitis xerotica obliterans).
• Forceful retraction → tears → fibrosis.
• Chronic irritation (poor hygiene, diabetes).
• Lichen sclerosus (BXO) — white, sclerotic plaque at prepuce tip.

Symptoms

• Ballooning of foreskin during urination
• Pain/difficulty with retraction or erection
• Recurrent balanitis (redness, discharge, odor)
• UTIs (stasis)
• Sexual dysfunction/pain

Treatment

• Conservative: Topical corticosteroids (0.05% betamethasone, 0.1% mometasone) × 4–8 weeks + gentle daily stretching. Success ~80–90%.
• Preputioplasty: Dorsal slit or circumferential incision preserving foreskin.
• Circumcision: Definitive; indicated for BXO, failed conservative, patient preference.

Hygiene

Gentle cleaning under foreskin (if retractable) with water only—no soap. Dry thoroughly. Circumcised: normal bathing.

See a urologist for evaluation. Avoid forced retraction—it causes scarring.