One of the most common questions I receive from intact men concerns the fear that they have phimosis. Interestingly, most of them don’t have anything to worry about – they have a tight foreskin NOT phimosis; but they worry the need for circumcision may be present. (Either way, circumcision should NEVER be the first treatment that comes to mind!) To allay your fears, here are some quick tips to determine if you have actual phimosis or just a tight foreskin.

Phimosis comes from the Greek phimos meaning “muzzle”. The word phimosis is pronounced with a long “i” that sounds like “eye”: fi – mohs – iss.

The use of the word “phimosis” is problematic because it is simultaneously used to describe the normal neonatal foreskin – physiological phimosis – as well as a condition that may need medical intervention – pathological phimosis. Using the same term to describe a normal condition and a medical diagnosis resembles the same problem with using the term smegma for the normal lubrication of the foreskin as well as a bacterial overgrowth, which is not smegma at all.

Phimosis in a newborn boy is normal. The foreskin is designed to cover the glans completely and is attached to the glans by the synechia, similar to how a fingernail is attached to the finger. Again, the foreskin being completely attached to the glans penis is NORMAL physiological phimosis in infants and older boys. (NEVER retract the foreskin of babies or children!)

Pathological phimosis occurs when a male’s foreskin has already completed the natural separation process, but the foreskin does not retract over the glans AND begins to form a whitish band around the edge of the mucocutaneous junctional zone. This is different from having a tight foreskin – and yes, I know this is getting confusing.

True phimosis is actually rare because it has several symptoms that present early on and can be treated. Aside from the excessive foreskin tightness, other symptoms include the foreskin blocking the urinary meatus — lips — and interfering with the normal flow of urine or ejaculation fluid.

The most common reason for developing phimosis as a teen or adult is due to scarring on the internal foreskin or the glans, and this is likely caused by forced retraction before the foreskin was naturally separated from the glans.

Symptoms of true phimosis:

• Foreskin does not retract at all when penis is erect.
• Pain if foreskin is attempted to be retracted.
• Difficulty urinating.
• Difficulty ejaculating (not to be confused with erectile dysfunction).
• Hardened, whitish ring like a rubberband around the edge of foreskin over the glans.

If left untreated, true pathological phimosis can lead to infections under the foreskin that can result in balanitis. In the most extreme cases of true phimosis, the foreskin can become papery-thin and gray/black or gangrenous from lack of circulation. Intact men with phimosis who are also diabetic are more likely to experience this extreme issue.

A tight foreskin is another matter entirely.

Symptoms of a tight foreskin:

• Foreskin retracts with effort when penis is erect.
• Foreskin gets “stuck” behind glans when retracted, but can be moved forward again.
• May or may not be painful when foreskin is moved.

A tight foreskin can be treated by manual stretching of the skin or a steroidal cream. Circumcision is not necessary for a tight foreskin.

An inability to retract the foreskin all the way back is NOT a sign of a tight foreskin. Your foreskin is unique to you, so the amount your foreskin moves is unique to you.

If your foreskin gets stuck behind the glans and cannot be moved forward, that is paraphimosis and can lead to balanitis and cutting off the circulation to the entire glans. See a foreskin-friendly doctor immediately or go to the Emergency Room.

If you have any questions, please contact me for a Skype session, and I will try to help.

Take care,

trish