Phimosis describes a condition in which the foreskin is too tight to be pulled back over the head or glans of the penis. It is a condition of the penis that occurs in some adults and children who aren’t circumcised. If you have phimosis, your foreskin can’t be pulled back (retracted). It may look like your penis has rings around the tip.
Having phimosis isn’t necessarily a problem. It only becomes a problem when it causes symptoms. This could be when phimosis is severe and leaves an opening the size of pinhole.
Types of Phimosis-
There are two types of phimosis: physiologic and pathologic.
The physiologic type is associated with childhood and usually resolves as you age.
The pathologic type is associated with a condition called balanitis xerotica obliterans (BXO). They are white inflammatory patches that can affect both males and females. In males, the affected areas usually involve the foreskin and penile glans, termed specifically balanitis xerotica obliterans.
What causes phimosis-
If you or your child has pathologic phimosis, there are various reasons it might develop, including:
- Poor hygiene: This could actually be a cause and a result of phimosis. It might be irritating and painful to try to clean thoroughly, but not cleaning could lead to infection.
- Skin conditions such as eczema, psoriasis, lichen planus and lichen sclerosis. When it affects your penis, lichen sclerosis is known as penile lichen sclerosis or balanitis xerotic obliterans (BXO).
- Preputial adhesions or scar tissue that keeps the foreskin attached to the tip (glans) of your penis.
- Infections, including sexually transmitted infections (STIs).
Phimosis does not always lead to symptoms. When it does, however, these may include redness, soreness, or swelling. A tight foreskin may interfere with the normal passage of urine. In severe cases, this can prevent the person from emptying their bladder fully. Phimosis can lead to inflammation of the penis, called balanitis, or inflammation of both the glans and the foreskin, called balanoposthitis. These conditions both tend to be caused by poor hygiene.
Someone with phimosis may have the following symptoms:
- Redness or discoloration, which may occur when infected/irritated.
- Swelling (inflammation), which may occur when infected/irritated.
- Pain while urinating (dysuria)
- Pain with erections or with sexual activity
A doctor will take a full history from the person, asking about any previous penis infection or injuries they might have had. They may also inquire about the impact of any symptoms on sexual activity. A physical examination will include them looking at the penis and foreskin.
The doctor may order urine tests to check for urine infections or take a swab from the foreskin area to check for bacteria or pus discharge.
How Phimosis affects your sexual wellbeing-
India is one of the fastest-growing countries and but still, sex is considered taboo by many. One such common problem faced by a lot of men in India is phimosis which is mainly due to uncircumcised penises. When you are unable to pull your foreskin to the back and see your glance, it is called phimosis. Not treating phimosis can lead to para-phimosis as well.
Patients should not forcefully pull the foreskin as it can also lead to small injuries, causing scarring which can make it even harder to pull the foreskin back. This is known as acquired or pathological phimosis. There is also a high chance that the foreskin may get stuck and form a tight ring around the penis, leading to paraphimosis. Paraphimosis leads to impaired blood flow to the penis, thus causing difficulty in achieving an erection hard enough to penetrate inside the vagina. Paraphimosis is an emergency condition and requires immediate treatment by a doctor.
Not being able to pull back the foreskin means that it is difficult to clean the head of the penis and therefore causes hygiene issues. It might cause pain when urinating or when the penis is erect. If you develop phimosis as an adult, it may still be possible to have sex, although it is often uncomfortable.
Unable to have satisfactory sex can lead to many unwanted differences between you and your partner. Sex is a natural need of physical assurance to the body and mind of a person but due to tight foreskin issues a person remains sexually unsatisfied, which leads to distrust in a relationship. Even with the fear of pain while or during sexual activity there can be psychological erectile dysfunction.
Sex helps to release anti stress hormones that keeps your mind calm and positive but due to phimosis, there is unsaid psychological pressure in your mind that leads to psychological sexual dysfunction like lack of libido, psychological erectile dysfunction and premature ejaculation etc.
Due to lack of good healthy physical intimacy; couples tends to apart from each other; losing the mutual emotional connection in the relationship. This can even lead to extra marital relationship for on partner who is just the one not suffering from phimosis. This in long term can lead to divorce.
If you try to force yourself to sexual activity despite of having tight foreskin, there can be injury big enough to cause a good amount of bleeding; and can even rush you to the hospital. If there is no bleed chances are the foreskin can get tight at the base of the penis lead to very less or no blood flow to the penis. This is also one of the emergencies when you are suffering from phimosis.
Howsoever even if you try having sex with foreskin issues with help of lubricants and condoms, there are chances that you might feel a lot of pain. This pain can make sex very uncomfortable, even make you stop the whole experience due to pain and develop fear, refraining yourself from another encounter of sexual intimacy.
Treatment of phimosis-
Treatment options for phimosis depend on the symptoms that occur. Most cases of balanitis are easily treated with good hygiene, creams, and ointments.
People are advised to clean the penis daily with lukewarm water and to dry it gently to improve hygiene. They should avoid using soap, bubble bath or shampoo on their genitals, and dry under the foreskin after urinating.
A doctor may recommend using a steroid cream or ointment to help with the irritation. If balanoposthitis has been caused by a fungal or bacterial infection, an antifungal cream or a course of antibiotics may be needed.
Doctors may suggest circumcision, in which all or part of the foreskin is removed, though the procedure carries the risk of bleeding and infection.
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