General Practice 2022

Phimosis: what é, how to identify, types and treatment

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Phimosis: what é, how to identify, types and treatment
Phimosis: what é, how to identify, types and treatment
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Phimosis is an excess of skin, scientifically called foreskin, that covers the head of the penis, like a fibrous ring that causes difficulty or inability to expose the glans.

This condition is common in male babies and tends to disappear in most cases up to 1 year of age, to a lesser extent up to 5 years or only at puberty, without the need for specific treatment. However, when the skin doesn't sag enough over time, you may need to use a specific ointment or have surgery.

In addition, other conditions can cause phimosis in adulthood such as infections or skin problems, for example, which can cause pain, discomfort in sexual intercourse or urinary infections.In these cases, it is important to consult a urologist to start the most appropriate treatment, which is usually done through surgery.

How to identify

The only way to identify and confirm the presence of phimosis is to try to manually retract the skin covering the glans penis. When it is not possible to see the glans completely, this represents phimosis, which can be classified into 5 different degrees:

  • Grade 1: the foreskin can be fully pulled, but the base of the glans is still covered by skin and it may be more difficult to bring the skin forward;
  • Grade 2: the foreskin can be pulled, but the skin does not pass the widest part of the glans;
  • Grade 3: the glans can only be pulled up to the urinary orifice;
  • Grade 4: the accumulation of skin is so great that the retraction of the foreskin is very reduced, not being possible to expose the glans;
  • Grade 5: most severe form of phimosis in which the skin of the foreskin cannot be pulled and the glans cannot be exposed.

Although the degree of phimosis is not very important to decide the best treatment, which depends especially on the age of the boy, this classification can be useful to identify phimosis and to follow the treatment progress. Generally, the first check for the presence of phimosis is performed in the newborn baby, and the physical examination is performed by the pediatrician.

In the case of secondary phimosis, which can appear in adolescence or adulthood, the man himself can observe if there is any difficulty in skin retraction or symptoms such as redness, pain, swelling or bleeding in the head of the penis or in the foreskin, or symptoms of a urinary tract infection such as pain or burning when urinating. In these cases, a consultation with a urologist is recommended as soon as possible to carry out laboratory tests such as a blood count, urinalysis or bacterial culture exam, for example.

Types of phimosis

Phimosis can be classified into some types according to its cause and characteristics, the main ones being:

1. Physiological or primary phimosis

Physiological or primary phimosis is the most common type of phimosis and can be present from birth in baby boys and occurs by a normal adhesion between the inner layers of the foreskin and glans, which is the head of the penis, making complete retraction of the foreskin more difficult.

2. Pathological or secondary phimosis

This type of phimosis can arise at any stage of life as a result of inflammation, repeated infection or local trauma, for example. One of the main causes of pathological phimosis is poor hygiene on the penis that causes accumulation of sweat, dirt, bacteria or other microorganisms, causing infection that can lead to an inflammation called balanitis or balanoposthitis.

Furthermore, some skin conditions such as eczema, psoriasis or lichen planus, which make the skin of the penis patchy, itchy and irritated, can cause secondary phimosis.

In some cases of phimosis, the skin is so tight that even urine can be trapped inside the skin, increasing the risk of urinary tract infection. Phimosis can cause complications such as difficulty in cleaning the region, increased risk of urinary tract infection, pain in sexual intercourse, greater propensity to have a sexually transmitted infection, HPV or penile cancer, in addition to greatly increasing the risk of developing paraphimosis, which is when the foreskin gets stuck and does not cover the glans again.

How the treatment is done

Treatment of childhood phimosis should always be guided by a pediatrician and specific treatment is not always necessary, since phimosis can be naturally resolved up to 2 or 3 years of age. However, if phimosis persists after this stage, treatment with ointments containing corticosteroids and foreskin retraction exercises or surgery may be necessary after 2 years of age.

The treatment of secondary phimosis should be done under the guidance of a urologist who may indicate surgery or prescribe antibacterial ointments with clindamycin or mupirocin or antifungals such as nystatin, clotrimazole or terbinafine, depending on the type of microorganism causing the phimosis. Understand when phimosis surgery is indicated.

In addition, if secondary phimosis occurs from sexually transmitted infections, the urologist should treat the infection with oral antibiotics or antivirals.

Learn more about treating phimosis.

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