Phimosis: what it is, types, degrees and solution

Phimosis is an abnormality of the skin covering the penis. In a penis with phimosis, the foreskin over the glans penis cannot be partially or completely retracted to reveal the glans, usually because the foreskin is too narrow in the glans area.

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• Phimosis is a very common medical problem in boys and the most common solution is circumcision.
• There are several types of phimosis depending on the severity of the problem, which we explain in this article.

Recovery after phimosis surgery is usually completed within 15 days, although there are cases in which it may take longer.

There are two main types of phimosis:

Physiological phimosis

Phimosis is present from birth and is common in a large number of babies. Over time, the foreskin should become more elastic and widen until the glans is completely uncovered. If the problem has not disappeared by the age of 10, it will be necessary to see a doctor.

Pathological phimosis

This type of phimosis can occur at any age. It is usually caused by some kind of injury or infection of the penis and involves more complications than physiological phimosis. It should be seen by a doctor as soon as it is detected.

The main symptom is having problems when trying to retract the foreskin to fully reveal the glans penis. Pain may occur when urinating or during erections or sexual intercourse.

An important point to consider is not to confuse phimosis with having a short frenulum. The frenulum is the tissue that joins the back of the head of the glans penis to the inside of the foreskin. 

If the frenulum is too short, it will not be possible to fully uncover the glans penis, but this does not mean that you have phimosis.

The most common complications arising from phimosis after infancy are the following:

• Infections as a result of not being able to carry out correct hygiene
• Pain during sexual intercourse.
• Problems when urinating, from mild difficulty to severe obstruction.
• Paraphimosis: inflammation of the glans penis due to overexertion when trying to retract the foreskin.

It is possible to live with phimosis without surgery, but complications are more likely to occur. Surgery is always the most recommended option, as it is a minor, uncomplicated surgery that greatly improves the patient's quality of life.

Depending on the degree of tightness of the foreskin, a distinction can be made between various degrees of phimosis:

• Grade 1: punctiform, the glans is not visible, as the foreskin cannot be retracted at all, it is completely closed.
• Grade 2: punctiform, only the urinary meatus is visible, as the foreskin can be minimally retracted,
• Grade 3: the foreskin can be retracted to the middle of the glans penis.
• Grade 4: the foreskin can be retracted only to half of the glans penis.
• Grade 5: the foreskin may retract completely, but causes pain and a phimotic ring is observed.

Whatever the degree of phimosis, circumcision can always be performed to eliminate the problem.

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For young children, corticosteroid treatment is often used. By applying a cream, the skin of the foreskin gradually separates from the glans penis. This treatment usually lasts about 4 weeks. If after this time the problem has not disappeared, it will be necessary to see a doctor again.

The solution to phimosis after infancy is circumcision. Circumcision is a surgical operation in which the foreskin is cut. It is minor surgery and the operation is performed under local anaesthesia.

The result is that the glans is permanently uncovered. The wound and stitches are placed just below the glans. The procedure takes about half an hour and rarely presents complications.

Once the surgery has been performed, it is necessary to take care of the operated area, as there will be stitches to close the cut.

You must go to the health centre the days after the surgery. There, the healthcare staff will carry out the appropriate treatment, cleaning the area, changing the gauze and applying some type of iodine-based antiseptic. 

The following days, the treatments can continue to be carried out at the health centre or can be done at home.

It is very common for involuntary erections to occur after the operation. This is something to be very careful with, as the erection may cause a stitch to pop out, in which case you should go to a medical centre immediately.

After the surgery, the doctor will probably prescribe antibiotics to prevent infection of the wound. It is also important to wash the area regularly with warm water and mild soap to prevent infection.

A very important point is not to have sexual intercourse until at least 4-5 weeks after the operation, as the wound may not be fully healed.

Complete healing after circumcision usually occurs about 6 weeks after the operation. After this time, the patient can resume his or her life without any restrictions.

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