A tight foreskin
A tight foreskin or phimosis is where the foreskin cannot retract back over the glans or head of the penis. This is completely normal in infants and children and should not be forced back. The membrane fusing the foreskin to the glans will break down gradually throughout childhood and even after puberty to around 18 years of age is normal. Forced retraction during childhood may create scar tissue which can be the result of phimosis as an adult.
If a teenager cannot fully retract his foreskin, it may be that the membrane is still breaking down. There is no need for concern as his genitals are still developing and there is plenty of time for the foreskin to loosen as he moves through teenage years to adulthood. Also, for many teenage boys, manipulation and masturbation is all that is needed to loosen the foreskin.
Stretching a tight foreskin
For a man who has a tight foreskin, there are non-surgical ways to treat it. The majority of tight foreskins can be loosened within a month or so by persistent stretching twice daily. The following is a method of stretching and is explicit. Start by warming the foreskin and using a lubricant, pull the foreskin forward away from the body several times, then pull it back as far as it will go onto the glans (head of the penis) and hold it stretched in this position for several minutes. Do this several times a day.
When stretching begins to make the glans visible, grip the glans between thumb and fingers and roll the foreskin forward and hold it in this stretched position for as long as you can – say 5-10 minutes and repeat as often as you have the time and enthusiasm for. Later you will find there is room for two or more fingers to stretch the foreskin further. Make sure you are stretching the tight preputial ring at the tip.
The glans is often uncomfortably tender to touch when exposed for the first time. The more it is exposed, the less tender it will be. By holding it under water or under the shower water, it will make it less tender and reach a normal level of sensitivity.
Take care to avoid trapping the foreskin behind the glans (Paraphimosis) when it becomes loose enough to happen but tight enough to be difficult to bring forward again. If this happens, first aid for this condition is simple. The glans (head of the penis) must be squeezed very tightly between thumb and forefinger. This forces blood out of the glans and reduces the size, the foreskin can then be brought forward to its normal position. Seek medical advice early if you cannot get the foreskin back over the glans.
Frenulum Breve
It may become apparent that further retraction of the foreskin is held up by a short frenulum (banjo string – the tongue of skin in the mid-line underneath the glans). This is called Frenulum Breve and can be cured by a small operation under local anaesthetic called a frenuloplasty.
Steroid Creams
Steroid creams should be used next if no significant progress has been made after a month. Some creams are prescription only, but a chemist can advise which is appropriate. The cream should be massaged into the tight part of the foreskin inside and outside 2-3 times a day for at least a month combined with further stretching. As the foreskin widens, it may become apparent that the frenulum is restricting retraction (see Frenulum Breve above).
Foreskin Stretching Devices
There are also phimosis treatment foreskin stretching kits on the market including Novoglan www.novoglan.com which introduce other ways to treat a tight foreskin.
Preputioplasty (Dorsal Relieving Incision)
A preputioplasty can be considered after all above options have failed to loosen a tight foreskin. This is an operation in which a cut is made through the tight ring that is limiting foreskin retraction, in an up and down direction and then sewn up in an across direction. Once this has healed (2-3 weeks) the foreskin can usually be retracted fully and the only change in appearance is a notch that becomes visible in the skin as it is retracted. Make sure you agree with your surgeon how far you will allow him to cut through the foreskin.
Pathological Phimosis
Pathological phimosis is scarring and obstruction of the opening of the foreskin. This is rare and may be found in diabetes and in a localised skin condition called Lichen Sclerosus which is often referred to as Balanitis Xerotica Obliterans (BXO) when it affects the penis. In this condition, the skin is thickened, white and hard. This condition requires professional medical treatment and can often be treated conservatively without the need for surgery.
Although this information is evidence based from medical professionals, we are not medical professionals ourselves and if further treatment is required, we recommend seeking a foreskin friendly doctor.
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