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Phimosis- tight foreskin in adults

Patients would say “I think I have tight foreskin” 

In adults, tightness of the foreskin might cause no symptoms for most of the time. Problems usually become more obvious (and troublesome) when you get an erection and attempt sexual intercourse.

If you are unable to pull back your foreskin fully, especially if it becomes red or painful, you should contact your GP or Dr Khan. If a tight foreskin has been retracted and cannot be brought forward again (Known as Paraphimosis) you should seek urgent treatments at your local hospital.

In children, a tight foreskin is usually congenital, but in adults, it is often due to a scarring disease known as balanitis xerotica obliterans (BXO, sometimes called lichen sclerosis). We do not know the cause of BXO. 

Stretching of a diseased foreskin is best avoided. There is no scientific evidence that produces a cure and it can actually precipitate further tearing and scarring. This might worsen a phimosis which will then requires surgical treatment later in life. Forcible retraction of the foreskin in children should be avoided.

Steroid creams might soften your foreskin, if the scare is mild; stopping the cream, however, this might result to return of the condition.

Antibiotics might be needed if swabs show any evidence of infection

Using a condom during sexual intercourse might make the penis more comfortable


Circumcision is the mainstay of treatment if the foreskin is scarred by balanitis xerotica obliterans.

Prepuceplasty is effective in children with congenital tightening of the foreskin. Several incisions are made into the tip of the foreskin to expose the head of the penis. The foreskin then needs to be retracted regularly until it has healed completely. Prepuceplasty is totally ineffective in most adults; it may be effective in some selective adults without BXO phimosis. 

Frenuloplasty is the best option if the tightness is due to a short penile frenulum, rather than a tight foreskin. However, a short frenulum may also be associated with scarring of the foreskin, so full circumcision is still needed in some patients. 

Partial removal of the foreskin is not recommended. Scare might return on the foreskin remnant, while the cosmetic results are often unacceptable, particularly during erection.

This information is taken from The British Association of Urological Surgeons website 

Source: http://www.baus.org.uk/patients/conditions/13/tight_foreskin_phimosis

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