Phimosis - Symptoms, Causes, and Treatment

What are the Types of Phimosis?

There are primarily two types of phimosis: Physiological Phimosis and Pathological Phimosis

Physiological Phimosis

Physiological phimosis, sometimes referred to as primary phimosis, is a type of phimosis that occurs naturally at birth. Most cases of phimosis resolve on their own as a newborn reaches adolescence. In some cases, though, it can persist into adulthood as well. Non-surgical treatment methods such as steroid creams are generally considered to be highly effective in treating physiological phimosis. However, if the condition seems to persist thereafter, your urologist may recommend circumcision surgery.

Pathological Phimosis

Pathological phimosis, also known as secondary phimosis, is a type of phimosis that occurs due to external factors such as scarring, infection, or inflammation of the penis caused by an injury. Pathological phimosis can occur irrespective of age and usually requires surgical treatment.  Some of the common phimosis causes in adults include:

• Poor hygiene
• Balanitis
• Posthitis
• Balanoposthitis
• Skin conditions
• Swollen Penis
• Formation of scar tissue
• Injuries

Causes of Phimosis

Phimosis can occur due to a multitude of reasons. Some of the most common phimosis causes are given below:

• Balanitis: Balanitis is a penile condition that is characterized by pain and inflammation of the penis glans (head of the penis). Most cases of balanitis can be treated with antibiotics or topical creams. However, severe or recurrent cases may require circumcision. Symptoms of balanitis include redness, itchiness, and swelling, which can cause phimosis.
• Foreskin Infection: Medically referred to as posthitis, this is a condition that is characterized by inflammation of the foreskin. Causes of posthitis generally include poor hygiene, bacterial infections, fungal infections, allergies, and sexually transmitted infections. Symptoms include pain, discoloration, and swelling that can cause phimosis. Similar to balanitis, most cases can be treated with antibiotics and antifungal creams. However, recurrent cases may require circumcision.
• Balanoposthitis: Balanoposthitis is a condition that occurs when the penis glans and foreskin becomes inflamed simultaneously. Symptoms of balanoposthitis are similar to balanitis and posthitis and can lead to phimosis as well.
• Sexually Transmitted Infection: Certain STIs such as herpes, gonorrhea, and syphilis can lead to balanitis. This can further lead to phimosis. 
• Lichen Sclerosus: This is a condition that causes white patches to develop on the foreskin and glans. Lichen Sclerosus can lead to the formation of scar tissue on the foreskin and cause foreskin tightness. 

While corticosteroid ointments may help you relieve some symptoms, circumcision is generally considered to be an effective treatment.

Symptoms of Phimosis

Some of the most common phimosis symptoms are given below:

• Swelling and tenderness in the penis
• Pain when urinating
• Weak urine stream
• Ballooning during urination
• Frequent UTI 
• Bleeding or thick discharge from under the foreskin
• Painful erection
• Pain during intercourse

Diagnosis

Diagnosis of phimosis is a simple preoperative procedure that your urologist will likely perform prior to surgery. The aim behind these diagnostic tests is to assess your overall health and take precautions if required. For phimosis, diagnosis generally begins with a simple physical examination. Your urologist will try to gently retract the skin that covers the head of the penis manually. If the foreskin is not retractable or the penile glans are not completely visible, it indicates phimosis. Your urologist may also ask you about your surgical and medical history and if you take any preexisting medications. It is advisable to answer these questions to the best of your ability. To check for any infection, your urologist may also perform additional tests such as: 

• Blood tests: A blood test is one of the most common tests that your urologist may perform to monitor your overall health and check for signs of any infection that may have caused your phimosis. 
• Urinalysis: A urinalysis, also known as a urine test, is a test that is performed to examine the visual, chemical, and microscopic aspects of your urine. A urinalysis test is generally performed to check for signs of Urinary Tract Infection (UTI). 
• Urethral Discharge Culture: A urethral discharge culture is a test that your urologist may perform to identify infections in your urethra or genital tract. Urethral discharge culture is also effective in detecting Sexually Transmitted Infections (STIs), such as gonorrhea and chlamydia.

Surgical Treatment for Phimosis

Circumcision is generally considered to be a safe and effective treatment for phimosis. Circumcision is a surgical procedure that involves the removal of the foreskin. Before moving on to how a circumcision surgery is performed, let us discuss the diagnostic tests that your urologist may perform to better understand your condition. 

Circumcision Surgery

There are primarily 3 methods of performing a circumcision surgery. While all 3 methods are considered safe and effective, they vary in the overall procedure and equipment.

Stapler Circumcision

A stapler circumcision is a minimally invasive urological procedure that your urologist may recommend to treat phimosis. In a stapler circumcision, the surgeon uses a stapler device, an advanced and disposable surgical device, to remove the foreskin. This stapler device fits snugly over the penis glans and, once fired, removes the foreskin in a quick motion. A stapler device is also fitted with a silicone ring that wraps itself around the incision wound as soon as the foreskin is cut. This silicone ring helps prevent excessive bleeding and promotes better healing. Once the incision wound has healed (which generally takes around 10-14 days), the silicone ring will fall off on its own.

Laser Circumcision

Laser circumcision is another alternative that your urologist may suggest to treat phimosis. A laser circumcision is an advanced and minimally invasive urological procedure that uses a medical laser to remove the foreskin. In this procedure, the laser is moved along a predetermined incision line. Due to its extremely precise nature, laser circumcision does not carry the risk of any excessive bleeding or infection either. Laser circumcision is generally performed on an outpatient basis and has proven to provide patients with quicker recovery and better postoperative quality of life.

Open Circumcision

Sometimes referred to as the dorsal slit technique, open circumcision is a conventional method of circumcision. In this procedure, the surgeon uses a scalpel or surgical scissors to cut and remove the foreskin carefully. Compared to laser or stapler circumcision, open circumcision is more invasive and requires more recovery time. Due to its invasive nature, it also carries a significant risk of complications and infection as well. However, actual cases of any serious complications are very rare. 

How to Prepare Yourself Before Phimosis Surgery?

Prior to surgery, your urologist will likely instruct you to follow some simple tips and guidelines to ensure a smooth and complications-free circumcision operation, such as:

• Avoid eating or drinking anything for at least 6 hours leading up to the surgery. This typically applies to patients undergoing the procedure under general anesthesia.

• Leave any jewelry, ornaments, or contact lenses at home. You do not need them in the hospital, and they may interfere with the procedure.

• Make sure to thoroughly clean and shave the pubic area.

• Wear loose, comfortable clothes. It is also advised to bring an extra pair of snug, comfortable briefs to wear after the procedure. Continue to wear these at home until the swelling and soreness has eased.

• Avoid consuming any alcohol or smoking for at least 48 hours leading up to the surgery. These can not only slow down your recovery process but may also result in anesthesia-related complications.

• While not necessary, take at least a few days off from work. Most patients can return to their daily routine in just 2-3 days after surgery, but each patient has different healing capabilities, and your recovery time after phimosis surgery may take slightly longer to complete.

• Due to anesthetic after-effects, you won’t be able to drive yourself home after the surgery. It is advisable to plan ahead and have someone drive you home or at least accompany you in a cab.

Recovery After Phimosis Procedure

On average, recovery after phimosis surgery can take anywhere from 7-10 days. Most patients are able to return to their daily activities and life just 2-3 days after surgery. However, the healing ability of each patient is different. Depending on your overall health, method of surgery, and quality of postoperative care, recovery time may vary. To ensure a smooth recovery and minimize the chances of any postoperative complications, your urologist may also instruct you to follow some simple guidelines such as: 

• Keep the surgical site clean and dry. 
• Refrain from smoking or drinking alcohol for at least 48 hours after phimosis surgery.
• Stay hydrated. Make sure to drink at least 3-4 liters of water every day.
• Avoid swimming pools, public lavatories, or public baths. 
• Refrain from sexual intercourse or masturbation until your doctor thinks it's safe to do so. 
• Avoid any strenuous exercise or activities that may exert excessive pressure on your groin region.

Non-Surgical Phimosis Treatment

Before going forward with surgery, your healthcare provider may recommend some non-surgical alternatives to circumcision that may help you reduce phimosis symptoms and provide effective phimosis treatment without surgery. 

Antibiotics

Infections or skin conditions are some of the most common reasons behind phimosis in adults. In such cases, your urologist may prescribe you some antibiotics for phimosis treatment. Some medications that your urologist may prescribe are given below:

• Amoxicillin: Amoxicillin is used to treat certain infections caused by bacteria. Amoxicillin comes as a capsule, tablet, chewable tablet, and liquid that you can take by mouth. Depending on the type of infection you have, it is taken every 12 hours or every 8 hours with or without food. However, consult your urologist before taking any medications or antibiotics.Follow the directions on your prescription label carefully, and ask your urologist to explain any part you do not understand. Take amoxicillin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

• Doxycycline: Doxycycline is another antibiotic that your urologist may prescribe if you have a more severe case of phimosis that is caused by infections such as chlamydia or gonorrhea. Doxycycline is a tetracycline antibiotic that inhibits bacterial growth and is thought to have anti-inflammatory effects. Doxycycline is generally taken with a full glass of water.It is also advised to drink plenty of liquids while you are taking this medicine. Take doxycycline exactly in the quantity and direction prescribed by your doctor. Do not take this medicine in larger or smaller amounts or for longer than recommended.

 

• Metronidazole: Metronidazole is an antibiotic that is generally prescribed to treat a wide variety of infections. It works by stopping the growth of certain bacteria and parasites. In most cases, metronidazole 400 mg twice daily for one week is recommended for effective phimosis treatment.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.

Creams and Ointments

Creams and ointments are one of the most commonly recommended methods of treating mild cases of phimosis. There are several steroid-based and non-steroid-based creams and ointments to treat mild cases of phimosis. These ointments help loosen the foreskin and when paired with some foreskin stretching exercises, it may help you retract the foreskin fully. Some phimosis creams and ointments that your urologist may prescribe are given below:

• Betnovate-N: Betnovate-N is one of the most commonly prescribed ointments for tight foreskin treatment. Betnovate-N is an ointment that contains a steroid named betamethasone valerate.Betnovate majorly helps relieve eczema, psoriasis, and lichen planus, which are some common causes of tight foreskin. Apply this ointment at least twice or thrice daily for about 4-6 weeks.
• Temovate: Temovate is another steroid-based cream that contains propionate 0.05% as an active ingredient. Similar to betnovate-N, temovate acts against skin conditions such as eczema and psoriasis. You should use Temovate twice a day for at least 2 weeks.However, prolonged use may have some side effects. Before use, it is advised to consult with your urologist first.
• Canesten: Canesten is a topical cream that your urologist may prescribe if the primary cause of your foreskin tightness is a fungal infection. Canesten mainly contains clotrimazole and helps reduce inflammation and soreness caused by tight foreskin.
• Elocon: Elocon contains a mild steroid named mometasone furoate 0.01% and has an anti-inflammatory effect on the tight foreskin. Elocon can help you get significant relief from swelling, redness, and itching caused by a tight foreskin. However, it is not recommended for children under the age of 2 years.
• Ilotycin: Ilotycin is a cream that contains erythromycin as the main component, an effective antibiotic against bacterial infections. Ilotycin can be used as an effective treatment for tight foreskin caused by excessive bacterial growth.

Home Remedies

Home remedies that you can perform to manage phimosis symptoms include:

• Use coconut oil to gently stretch the foreskin: Coconut oil is widely considered to be one of the best home remedies for phimosis. Coconut oil has natural antifungal properties and can help you perform foreskin stretching exercises more easily.However, you need to be very gentle and not stretch or pull quickly or with force. Additionally, speak with your doctor first and always wash the oil off properly after each use.
• Apply Castor Oil: Castor oil is a vegetable oil that is derived from castor beans. Castor oil is rich in essential fatty acids that moisturize the skin and can help you relieve some phimosis symptoms. Lubricating the penis with castor oil can help you prevent pain and scarring.However, be sure not to let the oil stay on the penis for long and wash it off with lukewarm water after use. This can further help you get rid of any dirt and dead cells that may have accumulated in the area under the penis.
• Foreskin stretching exercises: Mild to moderate cases of phimosis can be managed by simple foreskin stretching exercises recommended by your urologist.Gently and slowly pulling the top of your foreskin using just 2 fingers may ease some of the symptoms you are facing. It is highly advised to be careful while performing these exercises and avoid any forceful stretching.
• Maintain good penile hygiene: For mild cases of phimosis, maintaining proper hygiene of the penis can prove to be quite effective.Use mild soap and thoroughly clean the penis regularly with lukewarm water. Also, make sure to keep the area under the foreskin clean. You can use cotton swabs for this purpose. Maintaining good penile hygiene is a great way to avoid excess buildup of any bacteria or smegma.
• Retracting exercises: Retracting the foreskin over the penis glans regularly may also encourage better stretching of the foreskin.It is advised to use lubricants such as coconut oil or water while performing such exercises for easier retraction. It is important to use extra caution during such exercises and avoid forcefully stretching the foreskin.

What is the Best Treatment for Phimosis?

Circumcision surgery is generally considered to be a safe and effective treatment for phimosis in adults. Non-surgical solutions, such as antibiotics and steroid creams, can be effective in treating mild to moderate cases of phimosis, where the tightness of the foreskin does not cause significant discomfort or difficulty with penile hygiene. In more severe cases, however, phimosis surgery may be the only effective solution. While the application of phimosis ointment may provide you with good initial results, they may not be long-lasting, and your phimosis may reoccur once you have stopped using your prescribed phimosis medication. In the case of phimosis surgery, though, the foreskin itself is removed, meaning the chances of phimosis recurrence are almost zero. Additionally, phimosis surgery can also provide you with various benefits such as:

• Easier Hygiene: With the removal of the foreskin, it becomes much easier to wash the penis. Maintaining good penile hygiene is an excellent way to relieve phimosis symptoms and prevent chances of any penile problems.
• Decreased Risk of UTI: UTI, or Urinary Tract Infection, is an infection that can occur in any part of the urinary tract. The risk of urinary tract infection in males is low, but these infections are more common in uncircumcised adults.
• Decreased Risk of STI: Circumcised men might have a lower risk of certain Sexually Transmitted Infections (STIs) such as HIV and Human Papillomavirus (HPV). However, the protection is considered modest, and safe sexual practices remain essential.
• Effective Phimosis Treatment: Phimosis surgery is widely considered to be a safe and effective treatment for phimosis. 
• Decreased Risk of Penile Cancer: Although cancer of the penis is rare, it is found to be even less common in circumcised adults.

What if Phimosis is Left Untreated?

If left untreated for a long period of time, phimosis could lead to severe complications such as recurrent balanitis, gangrene, penile cancer, and in some severe cases, loss of the penis. Some studies also suggest that individuals with phimosis are also at an increased risk of developing penile cancer.  If you are struggling with phimosis symptoms, it is advised to consult with your urologist as soon as possible.

Frequently Asked Questions

What is the average phimosis surgery cost in India?

The average cost of phimosis surgery in India can start from Rs. 26,000 and go as high as Rs. 35,000. However, depending on various factors such as consultation charges, operating fees, method of surgery, hospital charges, and preoperative tests and diagnostics, the exact phimosis surgery cost may vary. 

Is phimosis treatment covered by Insurance?

Yes, phimosis surgery is generally covered by most health insurance plans in India if it is deemed to be a medical necessity. If left untreated, phimosis can lead to a multitude of penis-related complications and diseases that not only affect your everyday life but also may require additional, more complex surgical procedures for treatment. Hence, phimosis treatment is considered to be a medical necessity by urologists.

How long does phimosis surgery take?

Circumcision surgery is performed on an outpatient basis and does not take more than 15-20 minutes to complete. However, depending on the method of surgery you opt for, the exact duration of your phimosis surgery is likely to vary.

Can I have sex with phimosis? 

Yes, you can have sex when you have phimosis, but it might not feel good. Phimosis sex may also cause pain, skin splitting or lack of sensation. If you are struggling with phimosis, it's important that you use a condom and lubrication in order to avoid this and make sexual intercourse more comfortable.

Is phimosis treatment necessary?

Phimosis is a common condition that does not necessarily require treatment. As long as your condition is asymptomatic, it can be left untreated. However, if phimosis starts exhibiting symptoms and starts affecting your daily life, it is advised to consult with your urologist and seek treatment. 

Conclusion

Phimosis in adults is a relatively common condition that can significantly affect your daily life and health. Phimosis is found in almost all newborns and, in most cases, resolves on its own as a child reaches adolescence. But in some cases, the condition can perist into adulthood and cause painful symptoms. But, due to its sensitive nature, patients often hesitate to talk about it. If left untreated, phimosis can lead to serious, painful complications such as gangrene or recurrent penis infections. So if you are struggling with phimosis, get in touch with us and consult with our highly experienced team of urologists today.