It is a condition where the foreskin is too tight to be pulled back over the head or glans of penis .

In the initial years of life, the foreskin is attached to the glans. It normally separates from glans during 2-6 years of age . Parents shouldn’t panic and apply undue force to pull it back as it may result in injury to prepuce, bleeding and scarring , leading to severe phimosis. If it doesn’t separate till 6 years of age, they should consult a Urologist who may prescribe a cream or suggest surgery.

One should pull back the skin gently and wash with warm water daily while bathing. Don’t use strong detergents or soaps because the skin here is very soft.

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Problems can arise if phimosis is ignored. It can result in deposition of Smegma, inflammation of glans ( Balanitis ) or foreskin ( Posthitis) or both ( Balanoposthitis) . In uncircumcised children , it can result in urinary infection . In adults, it can result in difficulty in penetrative sex . Attempt to enter vagina with penis with phimosis can result in tear of skin , pain and bleeding . I have seen many cases of nonconsummation of marriage because the boy felt pain when he tried to have sex, didn’t have courage to discuss with someone and started avoiding intimacy due to fear of pain .

It is present since birth or can arise due to many other problems like infection, eczema, lichen plants, lichen sclerosis. The skin can get tight after healing or due to the disease process as such.

MANY PATIENTS WITH DIABETES DEVELOP REPEATED INFECTION OF GLANS OR FORESKIN . REPEATED INFECTION CAN BE A PRESENTING SYMPTOM OF DIABETES . We routinely screen every patient with these infections for diabetes .

Sometimes, it is difficult to bring back the skin after it is pulled back. It forms a ring at the base of glans . It is called PARAPHIMOSIS . I have seen patients with massive swelling of prepuce or glans because they ignore it for many days till it becomes painful . It can be very dangerous . Slowly the ring can become tighter and swelling may increase, causing reduced blood supply to the penis distal to ring . If totally ignored, it may lead to gangrene and need penile amputation . If the patient comes in time, it needs to be reduced under local Anesthesia or surgical intervention may be needed after giving a nick on the ring, circumcision can be done

Treatment is by circumcision . Contrary to belief, it is a common surgery in a sexual health hospital. It is a day care procedure under LA . Patient can go back the same day and start his work after 2-5 days. Possible complications are bleeding and infection but we have never seen in our patients Sexually active adults can start sex after about one month of surgery or when the erections are totally painless . 

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