Tight Foreskin: Understanding Phimosis Causes and Symptoms

May 09,2024 |
dad son and doctor

Whether you're expecting a newborn boy, parenting a toddler, or experiencing some discomfort as an uncircumcised male, it's important to educate yourself on the unique conditions of male genitalia. This is especially important as an uncircumcised male. Although there are several benefits of an uncircumcised penis, there are also a few risks, especially regarding phimosis and paraphimosis. Phimosis and paraphimosis are two conditions that affect the foreskin of the penis, each presenting distinct challenges and potential complications. Here, we'll discuss the intricacies of phimosis and paraphimosis, including insights into their causes, symptoms, and appropriate treatment options.

What is Phimosis?

Phimosis is a condition that leads to the inability to retract the foreskin over the head of the penis. It can affect both children and adults who haven't been circumcised but doesn't always result in issues or complications. The only time that phimosis is problematic is when it begins to cause symptoms.

Two different types of phimosis can occur: physiologic phimosis and pathologic phimosis. Physiologic phimosis is when children are born with tight foreskin. This remains during the first few years of life and typically resolves on its own as the child grows. Pathologic phimosis is when the foreskin is too tight due to fungal or bacterial infection, skin conditions, scarring from injury, or inflammation.

What is Paraphimosis?

A condition called paraphimosis occurs when the foreskin becomes trapped behind the glans penis (the head) after being retracted and stays in place there. The foreskin gets stuck behind the head and will not go back to its original position. Immediate treatment is needed to address this condition, as the foreskin could restrict blood flow to the penis and cause more serious complications. In addition to the foreskin not pulling back over the head, there is often a degree of pain or discomfort, swelling or inflammation, and redness associated with this condition.

Symptoms of Phimosis

The most notable symptom of pathologic phimosis is a foreskin that becomes too tight to be pulled back. This can occur in older children or adults due to trauma, illness, or skin conditions. Phimosis can also have the following symptoms:

  • Swelling
  • Inflammation
  • Redness
  • Discoloration
  • Soreness
  • Unpleasant odor
  • A white ring around the opening of the foreskin
  • Hematuria
  • Pain during urination
  • Weak urine stream
  • Painful erections
  • Pain during sexual activity
  • Recurrent urinary tract infections

Many babies are born with phimosis, and your pediatrician may mention it during those first few visits. As a parent, you will notice that the foreskin cannot be retracted or seems to be "stuck" in place. You may also notice a slight ballooning of the foreskin during urination. Regardless, it's important to avoid forcibly pulling back the foreskin of a baby or young boy because it could lead to further damage and severe discomfort. It's also nearly impossible to ask babies and toddlers about their pain or discomfort, so if you suspect it's becoming a problem, it's important to see your pediatrician.

What Causes Phimosis?

As mentioned, physiologic phimosis is normal in babies and toddlers. However, it can also be caused by an underlying condition or infection if it occurs later in life. This is called pathologic phimosis but still results in difficulty pulling the foreskin back. Some of the most common instances that lead to pathologic phimosis include:

  • Skin Conditions — There are a few skin conditions that may affect the end of the penis and increase the risk of phimosis. Common conditions include eczema, psoriasis, penile lichen sclerosus, lichen planus, and balanitis xerotic obliterans.
  • Medical Conditions — Individuals with diabetes are more likely to experience something called balanitis, which is an infection of the head of the penis. This can increase the risk of pathologic phimosis over time.
  • Injury and Infection — Phimosis may occur after an injury to the genitals. It can also be caused by certain sexually transmitted infections (STIs).
  • Scar Tissue — Fungal or bacterial infections can lead to scars that cause the foreskin to tighten or become less stretchy. This can make retraction of the foreskin difficult or even painful. To help reduce the risk of infection, it's important to prioritize hygiene and keep the penis clean.

Can Physiologic Phimosis Be Prevented?

You technically cannot prevent physiologic phimosis. It's present in almost every newborn before circumcision. Therefore, a slight degree of phimosis is normal until children get older. At this point, the foreskin should begin to retract on its own or if you gently pull it back during cleanings. Your pediatrician may also suggest stretching exercises to help.

Circumcision will remove the foreskin and is the only way to prevent phimosis completely. Your doctor may recommend circumcision for this reason, but it's important to weigh your options and make the decision on your own.

Circumcision is irreversible and comes with its risks. Some families may choose to circumcise their newborn due to social, religious, or cultural reasons. Others prefer to leave the choice up to their children, as adult circumcision is still possible. It's a personal choice that should be discussed with your family and pediatrician.

Can Pathologic Phimosis Be Prevented

You can take some precautions to prevent pathologic phimosis, but there's still no 100% guarantee. The only way to ensure you or your child doesn't experience it is through circumcision. Still, proper hygiene and care can reduce your risk. If you or your child experiences any skin conditions, getting treatment can help reduce the risk of it spreading to the genitals and causing scarring. It's also important to clean underneath the foreskin to remove smegma, a collection of dead skin cells.

When to Contact a Doctor

Phimosis is completely normal in uncircumcised newborns, babies, and young boys. Oftentimes, the foreskin doesn't retract anytime before the age of five fully, but it may not be possible until a child is ten or older. It's usually not a problem unless your child begins to develop symptoms and experience discomfort. If you notice any bleeding around the head of the penis and foreskin, discharge, or an unpleasant odor, contact your doctor. You should also schedule an appointment if the foreskin is tight to a point that causes discomfort or visible swelling.

Do not try to forcibly pull back the foreskin of a young boy or baby, as this could cause damage that may result in issues later in life. You should also avoid any deodorants, perfumed soaps, and talcum powder, which can lead to irritation.

How to Diagnose Phimosis

It's usually fairly simple to diagnose phimosis in both children and adults. This will include a physical exam where the doctor examines the penis and tests the flexibility of the foreskin. You may also need to undergo a urinalysis to check for any infections. If you've been sexually active, your doctor may also recommend STI testing. Individuals who are at risk for diabetes may also have their blood sugar levels checked to catch any potential undiagnosed issues.

Phimosis Treatment Options

Treatment of phimosis will depend on severity and your personal preferences. Your doctor may suggest gentle manual retraction each day to help increase elasticity, or you may need surgery to remove the foreskin. The most common treatments include:

Steroid Creams and Gels

Children who have phimosis are oftentimes given a topical steroid ointment to help soften the foreskin and allow it to retract. It must be applied twice daily for several weeks with manual stretching. Once the foreskin is retracted without issue, the ointment can be discontinued and replaced with manual stretching during warm baths.


When infections are present, you'll need to utilize antibiotics to kill unhealthy bacteria. Your doctor will prescribe the appropriate type and give you instructions on how to take them or administer them to your child.

Circumcision Surgery

Surgical treatment may be recommended when other treatments aren't working. While it's rare for physiologic phimosis, your doctor may suggest circumcision in individuals who experience paraphimosis, a lack of blood flow to the penis, or recurrent UTIs. Circumcision may be performed at any age, so talk to your doctor if you want to take this route.

Circumcision is a serious decision at any age of life, but it does have some benefits. Of course, there are other ways to treat phimosis and reduce the risk of any serious complications. Regardless, it's important to discuss your options with your healthcare provider. If you experience other conditions, Byram Healthcare offers a wide selection of high-quality urologic supplies that can be discreetly delivered to your door. Visit our educational support page or our urology roduct selection guide to learn more.