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Phimosis

Our specialist surgeons are trained in the medical and surgical management of phimosis in adult males

What is Phimosis?

Phimosis is a condition in which the foreskin cannot be fully retracted over the head (glans) of the penis. While this is normal in children, phimosis in adult males is usually acquired and may cause discomfort, hygiene problems, infections, or difficulty with sexual activity or urination.

Common Causes of Phimosis in Adult Males

Adult phimosis most often develops due to chronic inflammation or scarring of the foreskin. Common causes include:

  • Recurrent balanitis or balanoposthitis
    (inflammation of the glans and foreskin, often related to infection or poor hygiene)

  • Chronic skin conditions
    such as lichen sclerosus (balanitis xerotica obliterans)

  • Poor genital hygiene

  • Repeated trauma or forced retraction

  • Age-related loss of skin elasticity

Non-Surgical (Conservative) Management

Conservative treatment may be appropriate in mild or early cases and usually aims to reduce inflammation and improve foreskin elasticity.

Options include:

  • Topical corticosteroid creams
    (commonly used for inflammatory causes such as balanitis)

  • Improved genital hygiene

  • Treatment of underlying infections
    (antifungal or antibacterial therapy when indicated)

  • Gentle foreskin stretching exercises
    under medical guidance

➡️ These treatments may be effective initially, but phimosis can recur or persist despite adequate conservative management.

When is Surgery Recommended?

Surgery is usually indicated when conservative measures have failed, particularly in cases of:

  • Recurrent or chronic inflammation

  • Scarring or fibrotic foreskin

  • Painful erections or sexual dysfunction

  • Recurrent infections

  • Urinary obstruction or ballooning of the foreskin

Surgical treatment provides a definitive and long-term solution.

Surgical Treatment Options

1. Circumcision

  • Circumcision is the complete removal of the foreskin

  • Eliminates phimosis permanently

  • Reduces risk of recurrent infections

  • Commonly performed, safe, and effective

Considerations:

  • Permanent removal of the foreskin

  • Longer healing time compared with limited procedures

2. Foreskin-Preserving Surgical Alternatives

For patients who wish to retain the foreskin, foreskin-preserving procedures may be suitable in selected cases, and include the Heineke-Mikulicz Preputioplasty (HMP) resulting in a surgical widening of the tight foreskin ring. It involves a longitudinal incision followed by transverse closure.  It preserves the foreskin. It has the following benefits over circumcision:

  • Shorter recovery time compared with circumcision

  • Maintains normal appearance and sensation

Best suited for:

  • Localised tight foreskin without extensive scarring

  • Patients motivated to preserve the foreskin

Key Messages

  • Adult phimosis is usually acquired and often related to inflammation or scarring.

  • Conservative treatment may be tried initially but is not always successful.

  • Surgery is the standard treatment when non-surgical options fail.

  • Both circumcision and foreskin-preserving procedures such as HMP are effective options.

  • Choice of procedure depends on severity, underlying cause, and patient preference.

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