When does a tight foreskin require treatment?

While phimosis, another name for a tight foreskin, often resolves itself naturally during childhood, it can sometimes cause pain or recurrent infections. In this informative guide, highly respected consultant paediatric surgeon Mr Brian MacCormack gives expert insight on when a tight foreskin requires treatment and the importance of self-retraction techniques.

What is phimosis?

Phimosis simply means a tight foreskin. For many boys throughout early childhood this is entirely normal - a physiological phimosis.

How does phimosis affect a child’s quality of life?

For most boys, a tight foreskin causes little in the way of symptoms. Ballooning of the foreskin during passage of urine is very common and actually part of the normal way the foreskin stretches and loosens up from the head of the penis.

Some boys can have recurrent pain and infections, whilst older boys can complain of painful erections. In some boys the foreskin becomes very scarred and abnormal - a condition called BXO (balanitis xerotica obliterans).

How is phimosis treated?

Most cases of physiological phimosis will resolve spontaneously as the boy gets older. For boys whose symptoms are more troublesome a six week course of steroid ointment can be helpful.

For the most part, the key is good self-retraction technique every time a boy tries to pass urine. It is important to note that if BXO is suspected the usual treatment would be a circumcision.

What’s involved in phimosis surgery?

In cases of BXO, a circumcision is the treatment of choice. In children this usually involves a general anaesthetic and careful removal of the foreskin, stopping any bleeding, and closing the two edges of the skin with dissolving stitches.

In carefully selected, motivated, older boys without BXO an alternative procedure called a preputioplasty can be very successful. In a preputioplasty the foreskin is widened rather than removed.

What’s involved in phimosis surgery recovery?

Antibacterial ointment is applied to the area twice daily for one week. Regular simple pain relief will be required for five to seven days and most boys should be back to normal within a week or two. Following a preputioplasty, it is critical that self-retraction of the foreskin starts forty-eight hours after the procedure.

Mr Brian MacCormack is one of Northern Ireland’s leading consultant paediatric surgeons. If you are concerned about your child’s foreskin problems and wish to book a consultation with Mr MacCormack, you can do by visiting his Top Doctor’s profile.