It is the narrowing of the foreskin that makes it difficult or impossible for a complete and easier uncovering of the glans; the foreskin is thus the skin covering the glans. Phimosis can occur only in erection (mild cases) or it can also be present in flaccid penis.
The causes can be:
- Congenitals: the foreskin, which is normally abundant and tight in children, also remains tight during pubertal development rather than widening;
- Acquired: are the causes which intervene after the normal pubertal development; they are generally linked to the infectious factors, infections of the glans and foreskin (balanoposthitis) which post healing result into the processes of cicatricial retraction of the foreskin until the phimosis.
The inability to retract the foreskin in whole or in part is variable depending on the severity of the disorder:
- Mild grade Phimosis: the glans is seen with difficulty only in erection, it can be annoying during the intercourse when the foreskin is retracted downwards, however, the condition does not lead to hygiene problems;
- Medium grade Phimosis: it can even be verified in the flaccid penis, the glans is seen only in part, in such cases, besides facing problems in the sexual phase, there may be problems of hygiene, cleaning of the glans becomes difficult and may invite infectious complications that may worsen the phimosis;
- Severe grade Phimosis: the glans cannot to be seen, the hygiene factor gets compromised, there are frequent infectious complications and in more advanced cases, it gets difficult even to urinate.
The diagnosis of phimosis is very simple and is often done by the patient himself. On examining, the foreskin looks tight and therefore the diagnosis becomes easy to conduct. In milder forms where phimosis manifests itself only during erection, the outcome of the examination gets a little doubtful, in such cases the interview with the patient clarifies the situation.
The treatment of phimosis includes:
- Medical treatment
- Surgical treatments
The medical treatments are reserved to those cases wherein the phimosis is either supported by infection or inflammation, while it is not indicated in cases of congenital phimosis. Medical treatments for the same include-
- Anti-infective treatments targeted to the causative agent of balanoposthitis, generally bacterial or fungal, which depending on the situation can be dosed exclusively localy: aureomycin, gentamycin ointments etc. or antifungal ointments; in the more severe cases, however, it may be necessary to employ a systemic treatment comprising of antibiotics or oral antifungals such as;
- Anti-inflammatory treatments: these are primarily corticosteroids based on local treatments; these drugs can be employed in the infectious phase in combination with the drugs mentioned above, and in the subsequent post-infectious inflammatory phase to prevent a stabilized cicatricial retraction; where a phimosis might be supported by recent inflammatory factors and thus becomes reversible, these treatments can be lead to unprecedented benefits and treat the forms of phimosis that may initially hint towards surgical interventions for an untrained eye; in such cases, it gets possible to avoid surgery.
The surgical treatments of Phimosis include Circumcision and Partial Postectomy.
- Circumcision: is one of the most commoly used operations. It is done under local anesthesia and performed at the base of the penis circumferentially. The procedure includes the removal of the entire foreskin; after surgery, the glans remains completely uncovered; the treatment has the advantage to be decisive in almost all cases but has the disadvantage of leaving the glans completely uncovered;
- Partial Postectomy: is, as its name implies, the operation of partial removal of the foreskin; this surgery is recommended when there is a formation of narrow preputial ring while the rest of the foreskin remains spacious, in the treatment, only the narrow part of the foreskin gets removed. The advantage of surgery is that a part of the foreskin remains retained and thus the glans remain partially covered; however, it has the disadvantage of the reoccurrence of phimosis.
After surgery the stitches are absorbable and do not require removal, the wound heals in about two weeks, normal sexual activity takes around 3-4 weeks to resume, although at the beginning of the recovery the scar still remains fresh and can give some discomfort, however, the use of the ointments consisting of anti-inflammatory substances can help to accelerate recovery. The glans that remains uncovered in whole or in part becomes extremely sensitive because it comes in direct contact with the external environment; this sensitivity is however completely transitional because it rapidly forms a keratinized (corneum) coating, like the one found on the lips, which helps reduce the sensitivity.
Phimosis is a benign disease that can become a source of problems, especially when it hinders the normal course of the life of the subject, it is easily detected in just one examination; it is easily treated; the treatment is not only surgical in nature but in its early inflammatory forms, it can be treated very well with medical treatment also; surgery, when needed is decisive; in addition to the complete removal of the foreskin performed in the circumcision surgery, one can perform partial removal as well (Partial Postectomy).