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Forum Name: Urology Topics

Question: Somewhat tight foreskin


 pogsdogs - Sat Aug 07, 2010 8:10 pm

Hello
I'm 17 years old and this has been happening for a while now. My foreskin is somewhat tight, depending on the situation I can generally retract the foreskin when erect, however not always. I have no problems fully retracting it when flaccid.

I was just wondering if it is safe to do what is talked about on the internet, stretching carefully? The only other problem is the head of my penis is also a bit sensitive, only when dry and if in the shower it's usually ok to touch.

Thanks!
 Dr.M.Aroon kamath - Mon Aug 09, 2010 1:29 pm

User avatar Hi,
Some individuals have a narrow prepuceal opening (phimosis).This can be congenital or acquired(pathological).

Among the aquired causes, posthitis(inflammation of the foreskin) with or without balanitis(inflammation of the glans penis) is a common cause and diabetes mellitus is a common risk factor.

The degree of narrowing may be variable. It could be tight enough to make it impossible to retract the foreskin at all and may even result in back pressure changes or precipitate an acute retention of urine. With very minimal degree of phimosis, it may become difficult to retract the foreskin only during penile erections(such as in your case). Forcible retraction may result in cracking of the skin at the prepucial opening. this will heal with circumferential fibrosis, and with repeated episodes, worsening the phimosis over time.

Another condition called as lichen sclerosus (balanitis xerotica obliterans) needs a special mention. This sporadically seen condition usually occurs in middle aged, uncircumcised individuals. Cause is unclear(autoimmunity, Human papilloma virus infection, chronic bacterial infection, atypical mycobacteria are some of the suggested etiological factors).

Begins as hypopigmented, minimally erythematous areas and later, reddish macules or papules apppear which coalese to form whitish or greyish firm plaques. The lichenification is progressive and It can involve the glans and prepuce extensively in severe cases. A fibrotic ring at the prepuceal opening is characteristic. This restricts retraction of the prepuce and may result in a paraphimosis in some cases. Stenosis of the external urethral meatus may occur causing voiding difficulties and back pressure changes. This lesion is a risk factor for squamous cell carcinoma.

In your case, the most likely scenario is one of a very minimal degree of congenital phimosis. However, it is better to consult your doctor to exclude other causes.Stretching "carefully" may not always work and may cause unintended trauma as well. Moreover, there is a potential risk of paraphimosis developing during masturbation or sexual intercourse.The permanent, reliable and safe solution is a circumcision.
Best wishes!
 Dr.M.jagesh kamath - Mon Aug 09, 2010 7:45 pm

User avatar Hello,Dr.Aroon has dealt in detail about phimosis.From the dermatologist's perspective I can add one useful information.Application of potent steroid creme to the foreskin has resulted in excellent cure rates in this condition.You would need a prescription for the same because you should treat the external applied potent steroids in the same line as internal steroid intake.Do get a consultation before trying this.Ok?Best wishes.
 Dr.M.Aroon kamath - Mon Aug 09, 2010 10:28 pm

User avatar Hi,
I thank Dr.Jagesh for his valuable comment. I certainly agree with Dr.Jagesh in that, topical steroids are gaining acceptance as the primary modality of treatment for childhood phimosis. This is certainly true in the pediatric age group wherein most cases are congenital(non-pathologic). Most studies on use of steroid cremes in treatment of phimosis are in small children and older children. The cause of phimosis in adults is in most cases, is balanitis. There have been some studies in adults which have shown benefits as well of topical steroid therapy.Certainly one may try this as a first-line measure after excluding balanitis xerotica obliterans and treating the underlying cause of balanitis. Some 'older' surgeons(like me), still prefer circumcision in adults chiefly due to
- lack of sufficient personal experience with this alternative,and
- relative paucity of evidence in the adults.

Certainly, i see no contraindication to trying topical steroid applications as an initial measure in adults if underlying causes are identified and corrected.
Best wishes!

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