Phimosis: Symptoms, Care, and Treatment Options

Phimosis issue

Hello, doctor.
I'm about to enter my senior year of high school.
When I was younger, I didn't have a good understanding of health, and I thought it was normal for the penis to be covered, so I didn't pay much attention to it.
It wasn't until middle school that my parents told me to wash my penis by pulling back the foreskin to clean it properly.
However, during middle school, I couldn't fully retract it, and it was painful.
Now, I can see the head of the penis, but when I try to pull it back, the glans is very sensitive and painful to touch, and I can't pull it back far.
There are some white substances around it.
I would like to ask the doctor, if the foreskin cannot be fully retracted or can only be pulled back a little, should I wash the glans directly with water, or should I apply some ointment and wait until I can retract it more comfortably before observing? (Sorry for the lengthy message, and thank you for taking the time to read it.)

Qiu Xiansheng, 10~19 year old female. Ask Date: 2022/07/10

Dr. Fu Shizhang reply Urology

It is recommended to first try applying topical ointment; if there is still no improvement, a circumcision procedure may be necessary.

Reply Date: 2022/07/10

More Info

Phimosis is a condition where the foreskin of the penis cannot be fully retracted over the glans (the head of the penis). This condition can be quite common in young boys, but it can persist into adolescence and adulthood. Understanding phimosis is crucial for proper care and treatment, especially if it causes discomfort or hygiene issues.

Symptoms of Phimosis
The symptoms you described are typical of phimosis. They include:
1. Inability to Retract the Foreskin: As you mentioned, you can see the glans but cannot fully retract the foreskin without pain.

2. Pain or Discomfort: Sensitivity of the glans and pain when attempting to pull back the foreskin are common symptoms.

3. Hygiene Issues: Difficulty in cleaning under the foreskin can lead to the accumulation of smegma, which is the white substance you noted. This can increase the risk of infections.

4. Inflammation or Infection: If the foreskin is not retracted, it can lead to inflammation (balanitis) or infections.

Care and Hygiene
For proper hygiene, it is essential to clean the area, but you should do so gently to avoid causing pain or injury. Here are some recommendations:
- Gentle Washing: Use warm water to clean the area. Avoid using soaps or harsh chemicals, as these can irritate the sensitive skin of the glans and foreskin. Simply rinsing with water is often sufficient.

- Avoid Forceful Retraction: Do not force the foreskin back if it causes pain. This can lead to tearing or scarring, which may worsen the condition.

- Observation: Monitor the area for any signs of infection, such as redness, swelling, or discharge. If you notice any of these symptoms, it is important to consult a healthcare provider.

Treatment Options
If phimosis is causing significant discomfort or hygiene issues, there are several treatment options available:
1. Topical Steroids: Your doctor may prescribe a topical steroid cream to help loosen the foreskin and reduce inflammation. This treatment can be effective in many cases and may allow for easier retraction over time.

2. Gentle Stretching Exercises: Under the guidance of a healthcare provider, you may be advised to perform gentle stretching exercises to gradually increase the elasticity of the foreskin.

3. Circumcision: In cases where phimosis is severe and does not respond to conservative treatments, circumcision (surgical removal of the foreskin) may be recommended. This is a more permanent solution and is usually considered when other treatments have failed.

4. Preputioplasty: This is a less invasive surgical option that involves making small incisions in the foreskin to widen it without removing it entirely.

When to See a Doctor
It is essential to consult a healthcare provider if:
- You experience severe pain or discomfort.

- There are signs of infection (redness, swelling, discharge).

- You have difficulty urinating.

- You are concerned about hygiene or the appearance of the area.

In summary, phimosis can be managed effectively with proper care and treatment. Gentle washing with water is recommended, and if you have persistent issues, a consultation with a healthcare provider is essential for further evaluation and management. They can provide guidance tailored to your specific situation and help you find the best approach to address your concerns.

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