When patients are not circumcised, the foreskin covers the entire glans, or head, of the penis. Usually, when pulling back on the foreskin, it should retract quickly, showing the entirety of the glans. This should be the case for both children and adults when the penis is in its flaccid or erect state. Phimosis is a condition in which the foreskin is tight, or the skin wraps tightly around the penile shaft, almost like a rubber band has been placed around it. In addition to potentially causing balanitis, an infection under the foreskin, phimosis can also be caused by balanitis and the swelling that often accompanies these infections.
What Are the Types of Phimosis?
There are essentially two types of phimosis, both of which are treated similarly but have slightly different presentations. Partial phimosis occurs when the foreskin retracts when the penis is flaccid but does not retract when the penis is erect. Complete phimosis means that the foreskin cannot be pulled back either in the flaccid or erect state.
The Different Grades of Phimosis
There are also five grades of phimosis, which help the urologist understand the severity of the disease and the best way to treat it:
- Grade 1 is a foreskin that can be retracted fully, but there is a ring of tissue squeezing on the penile shaft, much like having a rubber band around the penis.
- Grade 2 allows for partial retraction and, as such, partial exposure of the glans of the penis.
- Grade 3 is a lower level of partial retraction at which only the urethral opening or meatus is visible.
- Grade 4 does not allow any retraction of the foreskin.
- Grade 5 is any grade of phimosis with co-occurring balanitis.
What Are the Consequences of Phimosis, and Why Should It Be Treated?
In their young years, phimosis can cause several concerns. As you can imagine, a tight foreskin can be rather uncomfortable in mild circumstances and painful in others. Some of the common symptoms include:
- Dark red or blue glans or head of the penis
- Difficulty or pain when urinating
- Slowed urinary stream
- Pain when pulling back the foreskin
- Bulging of the foreskin when urinating
- Infections under the foreskin
Adults with this condition often present to a urologist for diagnosis and treatment. Adults will typically experience the widest variety of symptoms beyond discomfort as they will frequently experience sexual dysfunction as well – phimosis may cause:
- Pain during intercourse
- A lower level of enjoyment and sensation
- Premature ejaculation
- Recurrent infections or balanitis
- Less than ideal cosmesis
What Is Paraphimosis
Paraphimosis occurs when the foreskin is pulled back but becomes stuck behind the glans or head of the penis. Depending on the severity, this condition can put enough pressure behind the glands of the penis to impede blood flow which can cause swelling, pain, and tissue death. This is an emergency that needs immediate surgical care to relieve the pressure. Do not delay in getting the child/patient to an emergency room.
Does Newborn Circumcision Help?
Newborn circumcision, while an elective procedure, is the definitive preventative measure for phimosis. By removing the foreskin, there is, of course, no opportunity for phimosis or tightness in that region to occur. How this factors into a parent’s decision to circumcise their child is based on their personal beliefs and desires. However, it’s essential for us as medical professionals to offer all the benefits and risks of newborn circumcision.
While mild cases can often be treated with home care under the supervision of a qualified urologist, phimosis can worsen over time. Adolescents and adults with phimosis looking for treatment should speak to their pediatric or adult urologist to understand more about older child and adult circumcision, which is quite different from newborn circumcision.
For this and other questions about circumcision, please speak to your pediatric urologic surgeon or contact The Newborn Circumcision Center for more information and an appointment with one of our team.