Narrowing of the foreskin (phimosis) is an abnormality of the outer ring of the foreskin covering the glans of the penis found in many boys and a few men. In the vast majority of cases, this mostly harmless anomaly is only temporary. As a rule, no medical intervention is required for a narrowing of the foreskin.
What is foreskin constriction?
Tight foreskin is a condition in which the movable foreskin (prepuce) cannot move to expose the glans. For fatal familial insomnia (ffi), please visit nonprofitdictionary.com.
The narrowing of the foreskin occurs in two basic forms: Either the foreskin cannot be pulled over the glans at all or only partially. In both cases, the attempt to pull the foreskin over the glans is regularly associated with feelings of tension or pain.
A distinction must be made between the narrowing of the foreskin and the very common adhesion of the foreskin (physiological phimosis), which is often confused with it and in which the inner layer of the foreskin sticks to the glans as a result of developmental processes. Physiological phimosis usually resolves before the child reaches the age of six.
Causes
Tightening of the foreskin can be congenital, but it can also be acquired. Inflammation or tears can lead to scarring, which leads to shrinking tissue on the foreskin in boys and men with an originally normal foreskin opening.
The contraction then causes an acquired narrowing of the foreskin. Diabetics are particularly susceptible to this form of narrowing of the foreskin. Furthermore, certain skin diseases can be responsible for the occurrence of tight foreskin. However, a narrowing of the foreskin can also be caused by premature or violent retraction of the foreskin in babies or small children.
Symptoms, Ailments & Signs
Anyone who suffers from a narrowing of the foreskin can only pull it back with pain or not at all. However, a so-called foreskin adhesion (physiological phimosis) exists in every child. Only when the foreskin still cannot be pulled back between the ages of three and five does one speak of pathological phimosis. In addition, symptoms such as scars, inflammation or pain can also occur.
Another symptom of a tight foreskin is that it can tear or feel tight during an erection. In addition, the foreskin swells up when you urinate, making it difficult to empty the urine. Very often, the foreskin and glans are inflamed and white deposits are visible on the glans, which are caused by the difficult intimate hygiene. If the foreskin is forcibly pulled back, paraphimosis can occur.
In this case, the foreskin is pinched behind the so-called glans crown and it is not possible to bring it back to its original position. Typical symptoms are severe pain and edema in the glans. A narrowing of the foreskin can also be asymptomatic, but is then often the cause of problems with sexual intercourse, urination or urinary tract infections.
Diagnosis & History
A narrowing of the foreskin is generally only spoken of from the point in time at which adhesion of the foreskin is no longer an option for the inability to pull back the foreskin due to age, i.e. after the 6th birthday.
The vast majority of cases of tight foreskin are not a serious physical problem and do not require treatment. In the case of a narrowing of the foreskin, however, if the foreskin is too tight after it has been pulled back, it can cut off the blood supply behind the glans (paraphimosis). This can lead to the death of tissue and, if treatment is not carried out, in extreme cases even to the loss of the glans.
Treatment is also indicated if increased inflammation develops under the foreskin that is too tight or urine builds up under the foreskin due to the constriction of the foreskin, so that there are problems with urinating due to the constriction of the foreskin.
Complications
An untreated narrowing of the foreskin can lead to various complications in the further course. If there is no treatment despite pronounced phimosis, this can lead to chronic inflammation of the glans and foreskin. This in turn increases the risk of developing penile carcinoma. When the tight foreskin causes problems with urination, it can cause urinary tract infections.
In the worst case, phimosis favors acute urinary retention, in which the affected boys and men are no longer able to empty their bladders spontaneously. Another possible complication of narrowing of the foreskin is pharaphimosis. This secondary disease occurs when the foreskin can no longer be pushed back and thus impairs blood circulation in the penis. In the worst case, this can lead to tissue necrosis in the glans.
If phimosis is detected early, treatment is usually risk-free. Problems can arise if the child is allergic to the cortisone cream prescribed to stretch the foreskin. If the foreskin is stretched too quickly, there is also a risk that the skin will tear. Surgical treatment can lead to infections and, in rare cases, to injuries. Side effects to the anesthetics cannot be ruled out.
When should you go to the doctor?
The narrowing of the foreskin can naturally only occur in boys or men. They therefore belong to a risk group and should seek medical help in the event of irregularities. Problems with going to the toilet, pain in the area of the external male sex or skin changes on the penis should be checked by a doctor. If you feel unwell, feel ill or feel irritated, it is also advisable to clarify the cause.
Restrictions or a loss of libido, disturbances in the sexual act or states of strong emotional stress are signs of a disease. A doctor is needed so that an individual treatment plan can be developed after the diagnosis has been made. Excessive feelings of shame or withdrawal from social life also indicate irregularities. Relationship problems, an increased potential for conflict and a refusal of physical closeness are often indications of existing disorders.
If the foreskin cannot be pushed back completely without symptoms, a doctor should always be consulted. During the growth process of the child, this process should be checked regularly by a pediatrician. Adolescents should be adequately enlightened and informed by their legal guardians about the functional activities of the male sex. In order to avoid complications or subsequent disorders, it is advisable to consult a doctor immediately after noticing impairments.
Treatment & Therapy
The narrowing of the foreskin usually disappears as a result of natural stretching processes: 20% of seven-year-olds still suffer from narrowing of the foreskin, compared to just under 2% of 18-year-olds. As a result of the narrowing of the foreskin, considerable psychological irritation associated with fears can occur in the boy concerned, but these can usually be easily overcome by means of a sensitively conducted informational discussion.
In cases where medical treatment of the narrowing of the foreskin is required, the focus is on normalizing the relationship between the size of the glans and the flexibility of the foreskin opening. Treatment with cortisone-containing ointments may be sufficient if the narrowing of the foreskin is not very pronounced.
However, an operative procedure is often unavoidable in order to eliminate the symptoms associated with the narrowing of the foreskin when urinating or when having an erection. There are several variants of the surgical procedure known as “circumcision”, which lasts only a few minutes and is mostly carried out on an outpatient basis. Usually only the front part of the foreskin is removed. Removal of the entire foreskin is less common.
The “Plastic Bell” method is increasingly used in small children for narrowing of the foreskin, in which the foreskin dies and falls off without an operation by constricting it with a plastic bell.
Prevention
Congenital narrowing of the foreskin cannot be prevented. In order to prevent an acquired narrowing of the foreskin, one should in any case refrain from following erroneous folk medicine traditions and forcibly stretching the foreskin of small children by pulling it back. It is also absolutely necessary to see a doctor early on in the event of frequent inflammation of the glans, foreskin or urinary tract in order to avoid scarring that could lead to narrowing of the foreskin.
Aftercare
A narrowing of the foreskin is often not treated medically. This is particularly the case with affected boys under the age of ten if they are otherwise symptom-free. In such cases, however, regular follow-up checks are necessary. The examinations take place at intervals of about six to twelve months at the pediatrician. This uses a palpation examination to determine whether there are changes in the foreskin or whether there are urinary tract infections or inflammation.
In some cases, narrowing of the foreskin is treated surgically by performing a full or partial circumcision. After such an operation, several follow-up examinations are necessary. These are usually performed by a urologist. On the day after the circumcision, the bandage applied during the operation is changed to prevent infections from developing. It is also checked whether bleeding has occurred.
A further examination is necessary about a week after the procedure in order to identify any complications in good time. It takes about two to four weeks for the surgical wound to heal. As a rule, self-dissolving sutures are used. Therefore, it is not necessary to have them removed by a doctor. If no complications occur, no regular check-ups are necessary within the first few weeks after the operation. The affected person should treat the surgical wound daily with an ointment.
You can do that yourself
You should never try to pull back the foreskin with force, as this can be very painful. In addition, this leads to small injuries that can scar and narrow the affected foreskin opening even more. There is also a risk that the foreskin will get caught behind the patient’s glans and can no longer be pushed back on its own.
The foreskin forms a ring that increasingly cuts off the blood supply to the glans, also known as the “Spanish collar”. This is an emergency that needs to be treated by a doctor as soon as possible. The narrowing of the foreskin requires particularly thorough genital hygiene and care. However, it is sufficient to clean only the outer penis with a mild soap. Even in the first years of life, it is not necessary to push back the foreskin completely to clean the penis. It is sufficient to carefully wash the penis from the outside.
Under no circumstances should you try to clean the space between the foreskin and the glans with objects such as cotton swabs, as this can damage the already sensitive skin and cause severe pain. Cleaning under the foreskin only makes sense if the existing adhesions between the foreskin and the glans have loosened.
