Phimosisย occurs when the foreskin is tight and cannot be pulled back to expose the head of the penis (glans). Sometimes, it is retractable when the penis is flaccid but cannot retract when the penis is erect. Repeated minor trauma or infection, mainly due to diabetes, can lead to a loss of elastic fibres in the foreskin due to scarring. This may result inย Balanitis Xerotica Obliterans (BXO). A tight foreskin can become stuck behind the head of the penis, leading to paraphimosis.
Causes
1. Balanitis Xerotica Obliterans (BXO), also called Lichen sclerosus (Read more about BXO)
2. Lichen planus – a non-infectious skin condition which may affect the foreskin
3. Eczema– long-term skin problems
Cleaning the inside of the foreskin is essential for preventing infection. It is advisable to wash the foreskin with mild soap or warm salty water during your shower or bath. This will help keep the foreskin clean.
Assessing the Severity
Phimosis is categorised into six distinct grades, each indicating the degree of tightness and retraction capability of the foreskin:
- Grade 0:ย The foreskin can be pulled back fully without any resistance.
- Grade 1:The foreskin can retract, but it remains tight behind the head of the penis.
- Grade 2:ย The head of the penis is partially exposed, but the inner foreskin is too tight to allow complete retraction.
- Grade 3:ย Partial retraction is possible, and the urethral opening becomes slightly visible.
- Grade 4:ย Some retraction occurs, but the head of the penis remains covered by the foreskin.
- Grade 5:ย No retraction of the foreskin is possible.
Notably, grades 4 and 5 often necessitate surgical intervention for effective resolution.
Appearance of the Foreskin
The appearance of the phimosis provides further insights into the condition:
- Score 0: The foreskin appears normal.
- Score 1:ย Fissures or skin splitting at the tip of the foreskin may be present.
- Score 2:ย A white scar partially surrounds the foreskin.
- Score 3:ย Severe scarring from conditions like Lichen Sclerosis or Balanitis xerotica obliterans may lead to occasional bleeding.
Scores 2 and 3 could indicate the presence of BXO phimosis, a more severe form of phimosis.
Treatment Options for Phimosis
Treatment for phimosis depends on factors such as age and the severity of the condition. Here are some available options:
1. Steroid Cream or Ointment: Applying steroid-based creams or ointments can help alleviate tightness and promote gradual foreskin retraction.
2. Stretching Exercises: In the early stages, gentle stretching exercises may aid in loosening the foreskin.
It’s important to note that attempting to stretch a scarred foreskin could result in further tearing and scarring. Additionally, various phimosis creams might be utilised with limited success.
When Surgical Intervention May Be Necessary
For grades 4 and 5 phimosis, as well as cases involving complications like BXO, surgical solutions become crucial. Some options include:
– Circumcision: This standard procedure involves removing the foreskin entirely. It’s particularly recommended for adults with recurrent fungal infections, diabetes-related issues, or severe BXO phimosis. There are different methods of circumcision
– Alternative Surgical Procedures: Options like preputioplasty, frenuloplasty, and partial circumcision offer alternatives to full circumcision. These procedures can be discussed with urologists at specialized clinics.
Seeking Professional Advice
It’s important to remember that this information is a guide and not a substitute for professional medical advice. If you’re experiencing any problem , consider consulting a medical specialist. Video consultations are available for personalized guidance.
Conclusion
Understanding phimosis is crucial for effectively managing this condition. Whether through non-surgical methods or surgical interventions, seeking our urologist’s opinion and personalised solutions can solve the problem.