What is a foreskin constriction?
If the foreskin is constricted, the slightly stretchable opening of the foreskin (prepuce) is not sufficient to allow it to be pulled back over the glans. The medical term for this phenomenon is phimosis, derived from the ancient Greek word phimos for constriction. Phimosis can be congenital or acquired later.
Primary, congenital phimosis can basically be completely normal up to a certain age. This is because in more than 90 percent of newborn boys, the foreskin is stuck to the glans and cannot be moved. This is a natural arrangement so that the sensitive skin of the baby’s glans has as little contact as possible with feces and urine. By the age of around seven years, this foreskin adhesion or physiological phimosis has loosened in around half of all boys. But please note: Never try to remove the foreskin from a baby or young boy if it is still attached to the glans. If the foreskin has still not loosened by the end of puberty, then there is a constriction and it is a primary phimosis. Treatment of primary phimosis is only important if it leads to symptoms such as inflammation or problems urinating or is still present after puberty.
Secondary phimosis, acquired in the course of life, affects adults. Various possible causes have changed the foreskin and narrowed it so that it can no longer be pushed back acutely. Secondary phimosis is rare, but should be taken seriously. If left untreated, it can cause inflammation and is considered a risk factor for penile cancer.
Foreskin constriction: it should be treated
There is also the so-called paraphimosis. The foreskin is constricted, but when it is pushed back over the glans, it sticks to the corona due to the lack of width of the foreskin. This constricts the glans, resulting in paraphimosis, formerly known as a “Spanish collar”. This risk can also occur during an erection. The constriction not only causes pain, but also impedes blood flow to the glans. To prevent permanent tissue damage, you should visit us as soon as possible so that we can release the strangulation.
Foreskin constriction: Causes and risk factors
Primary phimosis is a developmental condition caused by the frequent and harmless adhesion of the glans to the foreskin in the first few years of life. With increasing age, however, the foreskin becomes somewhat stronger, which makes it easier to move. It is not known why in some boys the foreskin cannot be retracted later and primary phimosis manifests itself.
The causes of secondary phimosis, on the other hand, are known. These are usually tiny scars that lead to a narrowing of the foreskin. These scars are usually caused by inflammation of the glans or foreskin. These include skin diseases such as lichen sclerosus, which is associated with inflammation and hardening of the skin. Diabetics in particular have an increased risk of phimosis because they are prone to skin infections.
Tears in the delicate foreskin, such as those that can occur in babies and children when the foreskin is forcibly pushed back while still attached to the glans, can also lead to scarring. The tissue hardens and contracts, which automatically narrows the foreskin opening.
Another reason why the prepuce cannot be pushed back: The elastic foreskin frenulum (frenulum praeputii) is shortened – it starts below the urethral opening at the glans and connects it to the base of the foreskin. Shortening of the frenulum often occurs together with phimosis.
Symptoms Foreskin constriction: pain, problems urinating
The main symptom is that the foreskin cannot be pushed back behind the glans without difficulty. In children, as already emphasized, this is normal and usually does not require treatment, unless there are additional symptoms such as inflammation and problems urinating.
However, secondary phimosis can also occur:
- Difficult intimate hygiene: Because the foreskin cannot be pushed back, the man cannot clean the penis and foreskin properly.
- Deposits under the foreskin: This poor intimate hygiene leads to deposits forming under the foreskin, which in turn promotes inflammation and has even been linked to penile cancer.
- Painful erection: The narrowing of the foreskin slows down the erection considerably.
Phimosis: Diagnosis with us
In children, we will also check for a possible narrowing of the foreskin, physiological phimosis, as part of the preventive examinations. We test whether the foreskin can be pulled back or is still stuck to the glans, depending on age. Only if the constriction causes problems, such as reduced urine flow or inflammation, will we recommend treatment.
We will also perform this test on adults with suspected secondary phimosis and take a detailed medical history. Possible questions are:
- Since when can the foreskin no longer be retracted?
- Has she ever been able to withdraw without any problems?
- Do you have problems when the penis is erect, such as painful pulling on the glans?
- Do you often have urinary tract infections?
- Have you ever had a penis injury?
If the glans or foreskin show signs of inflammation, further examinations may be necessary. In addition, it is often useful to clarify with a blood test whether the person concerned may have undiagnosed diabetes.
Foreskin constriction: Prevention, early detection, prognosis
Prevention of phimosis is only possible for the secondary, acquired form, not for the primary, congenital form. What can prevent secondary phimosis:
- Please never try to push back the foreskin by force. This can lead to both micro and major injuries. During healing, scars form which can constrict the foreskin.
- Protect yourself from injuries and violence in the genital area.
- If you notice any changes to the penis, such as inflammation of the foreskin or glans, please do not hesitate to come to us so that the change can be treated as early as possible and the risk of scarring minimized.
- Treatment of urinary tract infections. The inflammation can also indirectly lead to changes in the foreskin.
Progression and prognosis of foreskin constriction
Primary phimosis has a strong tendency to heal itself, so the foreskin constriction grows out on its own. The medical advice for this congenital form of foreskin constriction is therefore to wait and see. Treatment is only necessary if problems arise, such as inflammation, discomfort and changes in urination.
Secondary phimosis should be treated, otherwise it increases the risk of urinary tract infections. Difficult intimate hygiene can also promote inflammation and even penile cancer.
When treated professionally, foreskin constriction can be safely corrected, and relapses and other complications are extremely rare. Afterwards, it is usually possible to perform intimate hygiene without any problems, experience a normal erection without pain and empty the bladder undisturbed.
Treatment of phimosis with ointment or surgery
There are two options for treating phimosis, either with an ointment or with surgery.