Concerns About Phimosis: When to Seek Medical Attention? - Family Medicine

Dr. Xiao Yongxun reply Family Medicine

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Dear Mr.
Lin:
1.
The skin covering the shaft of the penis folds over the glans and is referred to as the prepuce or foreskin.
Normally, the foreskin should be retractable to expose the glans; however, some individuals have a foreskin opening that is too small, preventing the glans from being exposed.
This condition is known as phimosis.
Individuals with phimosis or excessive foreskin who do not maintain proper hygiene may accumulate smegma beneath the foreskin.
2.
The accumulation of smegma can lead to two potential outcomes: (1) Infection and inflammation: If a local bacterial infection occurs, it can lead to purulent inflammation known as balanoposthitis.
(2) Cancer risk: Smegma may expose the glans to carcinogenic substances and viruses over time, increasing the risk of penile cancer.
Therefore, it is essential to regularly retract and clean the foreskin as a basic hygiene practice; individuals with phimosis are advised to undergo surgical circumcision.
3.
The initial response of males to sexual stimulation is an erection, which is proportional to the level of stimulation.
When sexually stimulated, the parasympathetic nervous system is activated, causing dilation of the penile arteries, while venous return is obstructed, resulting in engorgement and rigidity of the penis.
The foreskin retracts, exposing the glans, which is known as the erectile reflex.
Ejaculation, the male sexual climax, is a reflex triggered by sympathetic nervous system activation.
During this time, high pressure in the urethra (due to the engorgement of the corpora cavernosa) causes contraction of the bladder sphincter, preventing urination during ejaculation and ensuring that semen does not reflux into the bladder.
The entire ejaculation process typically lasts about 1 to 2 minutes, after which the erection subsides, entering the refractory period.
4.
Phimosis refers to a condition where the opening of the foreskin is too small to retract normally.
It can make cleaning the foreskin and glans difficult, leading to local inflammation and cancer.
5.
Paraphimosis occurs when the foreskin of an individual with phimosis is forcibly retracted and becomes trapped behind the glans, leading to local swelling and an inability to return the foreskin to its original position.
This can cause severe pain and urinary retention.
6.
Redundant prepuce refers to an excess of foreskin tissue that completely covers the glans, but the opening is not too small; thus, it is different from phimosis.
Redundant prepuce can also lead to infections due to difficulty in maintaining local hygiene.
The formation of smegma may be associated with the development of cancer.
7.
Based on your description, these are normal responses and findings; theoretically, there is no need for concern.
Cleaning smegma is necessary; however, since you are still quite young and may have had little or no sexual experience, the washing process may cause an erection, leading to the foreskin retracting and getting stuck in the glans, which can cause panic.
In reality, if you relax, the penis will naturally hang down, the swelling will subside, and the foreskin can be pushed back.
Additionally, after cleaning away smegma, the glans should appear pink; unless one is older or frequently experiences engorgement from sexual activity, the glans may appear deep red or purple.
8.
If you have further questions, please discuss them with your family physician or visit a urology clinic at a regional hospital.

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Reply Date: 2020/05/28