Phimosis

  1. What is: tightness of the foreskin that does not allow the glans to be uncovered. (Read more)
  2. Causes: lack of dilatation and growth of the skin of the foreskin from birth (congenital) / result of inflammation of the foreskin (acquired). (Read more)
  3. Severity:  Tight or Non-tight. (Read more)
  4. Symptoms: Inability to fully uncover the glans without the foreskin tightening. (Read more)
  5. Complications: risk of paraphimosis and other disabling complications of the penis(Read more)
  6. Consequences: hygiene, health, sexual and psychological issues. (Read more)
  7. Solutions: ointments (for juvenile phimosis), circumcision or Phimostop(Read more)

Phimosis: what is

Phimosis is a tightening of the foreskin that prevents a man from uncovering the glans. This condition, which comes in different degrees of severity, makes it difficult and very painful to uncover the glans completely and independently, does not allow a man to have an enjoyable sex life and can have unpleasant complications. In cases of phimosis, forcing the foreskin to uncover the glans can cause lacerations of the skin and subsequent scars that can aggravate the condition. Or it can even lead to a case of paraphimosis with the “strangulation” of the glans. There are no certain data but the statistics state that between 2 and 4% of the male population has faced or faces this anatomical handicap. There can be several causes: let’s see what they are.

Phimosis: causes

Phimosis Congenital

This type of phimosis can be present in childhood or noticed in adolescence.
Let’s start by saying that proper cleansing of the penis is important from the first years of life.
At birth, male babies mostly have an abundance of preputial skin that hides the glans. Over time, this skin adapts to the growth of the penis.
However, paediatricians recommend checking that there are no tenacious adhesions between the inner part of the foreskin and the glans, which prevent it from being uncovered.
But let’s get back to phimosis in children / teenagers.
In infants, from the first years of life, there is a tightening of the foreskin. This shrinkage is physiological and is normally overcome with growth.
In some cases, however, it may happen that the foreskin does not widen together with the penis. This happens to about 1% of the male population and, over the years, creates increasing difficulty in uncovering the glans.
This is known as congenital phimosis. If mild (not tight), it may only be noticed in adolescence, with the first spontaneous erections or during sexual activity. The tightening of the foreskin is so slight that it allows for normal cleansing of the penis, but, during the erection phase, it prevents the total uncovering of the glans.
If tight, on the other hand, adequate cleansing of the glans is also prevented and, on average, it is diagnosed before adolescence.
Some medical scientific authors state that the condition of phimosis in childhood is overdiagnosed because the doctor does not distinguish between the natural non-retractability of the developing foreskin and a genuine pathological situation. In this instance, before recommending an operation it would be advisable to wait to confirm the diagnosis, since, today, this condition can be resolved by adulthood without surgery.

Acquired Phimosis (adult phimosis)

Acquired phimosis, on the other hand, occurs in adulthood and is the disabling result of inflammation of the foreskin (balanoposthitis) caused by a microbial agent (bacteria and / or fungi). After solving the infectious problem through medical therapy, however, there often remains a tightening and scarring of the foreskin which is precisely called phimosis.
In even simpler terms, here’s what happens: you have inflammation of the penis; the inflammation is treated with appropriate medical therapy; the treatment takes effect but we witness the formation of a “noose”, a circle of harder skin around the foreskin. The “noose” that is formed is the phimotic ring, a set of epidermal cells which are now rigid. The scar resulting from the infection of the wounds on the foreskin creates this ring, which, over time, can stiffen more and more, making it almost impossible to uncover the glans.

Severity levels

Grade Definition
Non-tight phimosis Grade 1 Pulls back completely but remains tight at the base
Non-tight phimosis Grade 2 Pulls back but not beyond the glans
Tight phimosis Grade 3 Pulls back partially
Tight phimosis Grade 4 Pulls back slightly
Tight phimosis Grado 5 Does not pull back at all

In the medical field, a specific scale is used to define the severity levels of phimosis: the Kikiros scale. In this scale, 5 grades are identified to distinguish between the different pathological levels.

Non-tight Phimosis

Non-tight phimosis is the least severe form as it allows the glans to be partially uncovered. There is therefore a partial sliding of the foreskin.
In this case it is recommended to resolve the situation as soon as possible to avoid the possible onset of paraphimosis. Indeed, especially during sexual intercourse, if the foreskin were to slide down to the base of the glans, the narrowest part of the foreskin could then get stuck just under the glans. This would prevent the skin from moving back up properly and would create a constricting noose around the penis.
Paraphimosis requires urgent treatment aimed at preventing this situation from preventing the flow of blood from the glans.
Usually we refer to non-tight phimosis for the first two grades of the Kikiros scale.

Tight Phimosis

Tight phimosis is the most severe case and makes it impossible to uncover the glans even with a flaccid penis. This does not allow for proper hygiene of the penis, creates difficulties in urination and prevents normal sexual intercourse.
In this case the glans may remain partially or totally covered by the foreskin (last 3 grades of the Kikiros scale), causing an obvious anatomical handicap. This condition becomes a problem to be addressed urgently and with suitable medical care because it hinders some normal daily activities in men.

Symptoms

phimosis symptoms

The diagnosis of phimosis is often made by the patient himself who notices the tightening of the foreskin. Depending on the degree of phimosis, this narrowing can vary and clinical observation is therefore necessary. However, it is always recommended to see a doctor to have your case assessed.
Symptoms related (but not exclusive) to this condition can be: penile pain; pain during sexual intercourse; erectile dysfunction; urinary retention; dysuria; skin ulcers; urethral itching.

Complications

Phimosis is an anatomical handicap and cannot be defined as a disease or pathology. The complications deriving from this characteristic are therefore all those pathologies that are encouraged by phimosis.
There is therefore an increased risk of balanitis (inflammation or infection of the glans penis), posthitis (inflammation or infection of the foreskin) and balanoposthitis (inflammation or infection of the glans penis and inner membrane of the foreskin).
The onset of these pathologies may be due to the stagnation of smegma and urine in the penis, caused by phimosis and the impossibility of proper hygiene of this part of the body.
If not properly treated, the degeneration of these pathologies can lead to painful calcifications of the foreskin.

Consequences

The consequences of phimosis are as follows:

  • Hygienic, due to the difficulty in accessing the glans.

  • Functional, because it makes any sexual activity painful and sometimes hinders urination.

  • Psychological, because it interferes with normal relations by requiring the use of lubricants.

  • Health-related, due to repeated lesions subject to reinfection and new scarring, exposing the man to the risk of evolving into paraphimosis (′strangulation of the glans′).

Solutions

The treatment of phimosis depends on many factors: type, age of the man, state of health.

Congenital phimosis treatment (children / teenagers)

There are different schools of thought among paediatricians on the treatment of congenital phimosis at a young age.
In some cases it is advisable to practise exercises that allow the foreskin to recover its elasticity. However, these exercises must be carried out with great caution and care to avoid worsening the situation.
In other cases, suitable treatment with steroid ointments is recommended. The use of steroid creams in congenital phimosis at a young age can lead to the resolution of the case without trauma.
The important thing is to always follow the instructions of your doctor, without ever forcing the situation.
Especially for younger patients, the idea of avoiding circumcision, if not strictly necessary, now seems to be widespread among doctors. This hypothesis is also confirmed by the positions taken by the AAP (American Academy of Pediatrics).

Acquired phimosis treatment (adults)

For the treatment of acquired phimosis, in most cases, doctors tend to recommend circumcision.
Surgery is certainly a definitive solution but it does not take into account the psychological and human implications that the man must face before deciding to remove a part of his penis.
For these reasons it is important to propose alternative options before resorting to surgery and Phimostop is one of these alternatives.
Phimostop is the only medical device validated by the Ministry of Health for the treatment of phimosis without circumcision surgery.

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