Foreskin Tightening: Causes, Symptoms & Treatment

Foreskin stenosis (phimosis) is an abnormality of the outer ring of the foreskin covering the glans of the penis seen in many boys and a few men. In the vast majority of cases, this mostly harmless abnormality is of a merely temporary nature. Usually, no medical intervention is required for foreskin tightening.

What is foreskin stenosis?

Foreskin stenosis is a condition in which the movable foreskin (prepuce) cannot be moved to expose the glans. Foreskin stenosis occurs in two basic forms: Either the foreskin cannot be pulled over the glans at all or only partially. In both cases, the attempt to pull the foreskin over the glans is regularly associated with feelings of tension or pain. Foreskin constriction must be distinguished from the very common foreskin adhesion (physiological phimosis), which is often confused with it and in which the inner foreskin leaf sticks to the glans as a result of developmental processes. Physiologic phimosis usually resolves before the age of six.

Causes

Narrowing of the foreskin can have congenital causes, but it can also be acquired. Inflammation or tearing can cause scarring, which leads to shrunken tissue on the foreskin in boys and men who originally had a normal foreskin opening. The shrinkage then causes an acquired narrowing of the foreskin. Diabetics are particularly susceptible to this form of foreskin constriction. Furthermore, certain skin diseases can be responsible for the occurrence of foreskin constriction. However, foreskin stenosis can also result from babies or young children having their foreskin pulled back too early or by force.

Symptoms, complaints, and signs

Those who suffer from foreskin constriction can only retract it with pain or not at all. However, a so-called foreskin adhesion (physiological phimosis) exists in every child. Only when the foreskin still cannot be retracted between the ages of three and five is it said to be pathological phimosis. In addition, symptoms such as scarring, inflammation or pain may also occur. Another symptom of a narrowed foreskin is that it can tear or feel tight during an erection. In addition, the foreskin inflates during urination and urine is difficult to void. Very often, the foreskin and glans are inflamed and white deposits are also visible on the glans due to the difficulty of intimate hygiene. If the foreskin is forcibly pulled back, paraphimosis may occur. In this case, the foreskin becomes trapped behind the so-called glans rim and it is not possible to return it to its original position. Typical symptoms are then severe pain and edema in the glans. However, foreskin tightening can also be asymptomatic, but is then often the cause of problems during sexual intercourse, urination or urinary tract infections.

Diagnosis and course

Foreskin stenosis is generally spoken of only from the point at which foreskin adhesion is no longer an option for the lack of ability to retract the foreskin due to age, i.e. after the 6th birthday. The vast majority of cases of foreskin tightening do not represent a serious physical problem and do not require treatment. However, in cases of foreskin constriction, a foreskin that is too tight can cut off the blood supply behind the glans after it is retracted (paraphimosis). This can result in tissue death and, in extreme cases, even loss of the glans if treatment is not given. Treatment is also indicated if inflammation develops more frequently under the foreskin, which is too tight, or if urine backs up under the foreskin, causing discomfort when urinating because of the foreskin constriction.

Complications

Untreated foreskin stenosis can lead to various complications as it progresses. If no treatment is given despite pronounced phimosis, this can lead to chronic inflammation of the glans and foreskin. This in turn increases the risk of developing penile carcinoma. If the narrowed foreskin leads to problems with urination, this can cause urinary tract infections.In the worst case, phimosis promotes acute urinary retention, in which the affected boys and men can no longer empty their bladder spontaneously. Another possible complication of foreskin narrowing is pharaphimosis. This secondary condition occurs when the foreskin can no longer be pushed back and thus impairs blood circulation in the penis. In the worst case, this can lead to tissue necrosis in the glans. If phimosis is detected early, treatment is usually risk-free. Problems can occur if the child is allergic to the cortisone ointment prescribed to stretch the foreskin. If the foreskin is stretched too quickly, there is also a risk that the skin will tear. Surgical treatment can lead to infection and, in rare cases, injury. Side effects to the anesthetics cannot be ruled out.

When should you go to the doctor?

Narrowing of the foreskin, by its nature, can occur exclusively in boys or men. Therefore, they belong to risk group and should seek medical help in case of irregularities. Disturbances when going to the toilet, pain in the area of the external male sex or skin changes on the penis should be checked by a doctor. If there is a feeling of malaise, sickness or internal irritability, clarification of the cause is also advisable. Restrictions or a loss of libido, disturbances during the sexual act or states of strong emotional stress are signs of a disease. A physician is needed so that an individualized treatment plan can be developed once a diagnosis has been made. Excessive feelings of shame or withdrawal from social life also indicate irregularities. Partnership problems, an increased potential for conflict, and a refusal of physical closeness are often indications of existing disorders. If the foreskin cannot be pushed back completely without causing discomfort, a doctor should always be consulted. During the child’s growth process, this process should be checked regularly by a pediatrician. Adolescents should be adequately educated and informed by their legal guardians about the functional activity of the male sex. To avoid complications or secondary disorders, it is recommended that a physician be consulted immediately after the perception of impairment.

Treatment and therapy

Foreskin constriction usually disappears as a result of natural stretching processes: If 20% of seven-year-olds still suffer from foreskin constriction, the figure for 18-year-olds is just under 2%. As a consequence of foreskin stenosis, considerable psychological irritations associated with anxiety can occur in the affected boy, but these can usually be easily eliminated by a sensitively conducted informational discussion. In cases in which medical treatment of foreskin constriction is necessary, the focus is on normalizing the relationship between the size of the glans and the extensibility of the foreskin opening. In cases of mild foreskin stenosis, treatments with ointments containing cortisone may be sufficient. Often, however, a surgical procedure is unavoidable to eliminate the discomfort associated with foreskin stenosis when urinating or having an erection. There are several variants of this surgical procedure, which takes only a few minutes and is usually performed on an outpatient basis and is called “circumcision” (Zirkumzision). Usually, only the front parts of the foreskin are removed. More rarely, removal of the entire foreskin is required. In very young children, the “Plastic Bell” method is increasingly used for foreskin stenosis, in which the foreskin dies and falls off without surgery by strangulation using a plastic bell.

Prevention

Congenital foreskin stenosis cannot be prevented. In order to prevent acquired foreskin constriction, in any case, it should be refrained from following erroneous folk medical traditions and stretching the foreskin of infants by forcibly stripping it back. It is also absolutely necessary to see a doctor early in cases of frequent inflammation of the glans, foreskin or urinary tract to avoid scarring that could lead to foreskin stenosis.

Aftercare

Often, foreskin stenosis is not treated medically. This is especially the case with affected boys under the age of ten, when they are otherwise symptom-free.In such cases, however, regular checkups are necessary in the course of follow-up care. The examinations take place at intervals of about six to twelve months at the pediatrician’s office. The pediatrician uses a palpation examination to determine whether there are any changes in the foreskin or whether there are any urinary tract infections or inflammations. In some cases, the narrowing of the foreskin is treated surgically by complete or partial circumcision. After such an operation, several follow-up examinations are necessary. These are usually performed by a urologist. On the day following the circumcision, the bandage applied during the operation is changed to prevent the development of infections. In addition, a check is made to see if any bleeding has occurred. Another examination is necessary about a week after the operation to detect possible complications in time. The healing of the surgical wound takes about two to four weeks. As a rule, self-dissolving sutures are used. Therefore, it is not necessary to have them removed by a doctor. Unless complications arise, regular check-ups are not necessary within the first few weeks after surgery. The affected person should treat the surgical wound daily with an ointment.

What you can do yourself

No attempt should ever be made to forcefully retract the affected person’s foreskin, as this can be very painful. In addition, this causes small injuries that can scar and narrow the affected foreskin opening even more. In addition, there is then the danger that the foreskin gets stuck behind the patient’s glans and can also no longer be pushed back on its own. The foreskin forms a ring that increasingly cuts off the required blood supply to the glans, this is also called “Spanish collar”. This is an emergency that must be treated by a doctor as soon as possible. Foreskin constriction requires especially thorough genital hygiene as well as care. However, it is sufficient to clean only the outer penis with a mild soap. Also in the first years of life it is not necessary to push back the foreskin completely for cleaning the penis. It is quite sufficient to wash the outside of the penis carefully. Under no circumstances should you try to clean the space between the foreskin and the glans with objects such as cotton swabs, because this can cause great damage to the already sensitive skin and cause severe pain. Cleaning under the foreskin is only useful if the existing adhesions between the foreskin and the glans have loosened.