What is Phimosis?

Phimosis is a condition where the foreskin (prepuce) is too tight to be retracted over the glans penis. There are two types:

Physiological phimosis: normal in most male children under 3 to 5 years, resolves with age.

Pathological phimosis: persistent tight foreskin causing symptoms, or developing due to scarring, infection, or lichen sclerosus.

What is Paraphimosis?

Paraphimosis is a condition where a retracted foreskin becomes trapped behind the glans and cannot return to its normal position, causing swelling, pain, and progressive constriction. Paraphimosis with significant swelling is a medical emergency requiring urgent care to prevent tissue damage.

Symptoms

Phimosis:

  • Inability to retract the foreskin
  • Difficulty with cleaning
  • Recurrent infections (balanitis)
  • Painful erections in adults
  • Ballooning of foreskin during urination
  • Weak urinary stream

Paraphimosis:

  • Trapped, retracted foreskin
  • Swelling and pain of the glans and foreskin
  • Progressive discolouration if untreated
  • Difficulty urinating in severe cases

When to Seek Care

Non-urgent phimosis consultation:

  • Persistent tight foreskin beyond childhood
  • Recurrent infections
  • Symptoms affecting hygiene, urination, or sexual activity

Urgent (paraphimosis):

  • Retracted foreskin that cannot be returned
  • Swelling and pain of the glans

Do not delay in paraphimosis; time-sensitive tissue viability.

Treatment Options

Conservative Management (Selected Phimosis)

  • Topical steroid ointment applied for 4 to 8 weeks
  • Gentle gradual stretching under guidance
  • Effective in a significant proportion of pathological phimosis, especially in children

Circumcision (Surgical Treatment)

For phimosis not responding to conservative measures, recurrent infections, or by patient choice.

  • Performed as day-care procedure under local, regional, or general anaesthesia depending on age
  • Duration: 20 to 45 minutes
  • Recovery: return to normal activities within 1 to 2 weeks

Emergency Reduction (Paraphimosis)

Manual reduction of the trapped foreskin, often after topical measures to reduce swelling. If manual reduction fails, dorsal slit or emergency circumcision may be required.

Recovery After Circumcision

  • Wound care with dressings
  • Sitz baths from day 2
  • Loose clothing
  • Return to school/office in 3 to 7 days
  • Return to sexual activity (adults): 4 to 6 weeks
  • Follow-up at 1 week and 3 weeks