Medical News Today: What causes a tight foreskin?

A tight foreskin naturally occurs in babies and young children, and it can occasionally persist into adulthood. Although a tight foreskin does not always lead to serious medical complications, it may cause symptoms such as redness, pain, and inflammation.

Symptoms like these can interfere with normal urination and a person’s sex life. Some research shows that 2 percent of men have nonretractable foreskins throughout their lives, despite being otherwise healthy.

Read on to learn more about the classifications of tightness in the foreskin, causes, and treatment options.

What are the types of a tight foreskin?

Sad looking man with tight foreskin caused by phimosis or paraphimosis.
A tight foreskin may be categorized as phimosis or paraphimosis.

The medical community categorizes a tight foreskin as:

Phimosis

When the foreskin is too tight to be pulled back over the head of the penis, this is termed phimosis.

It is normal for young boys (usually aged 2 to 6 years) to have a foreskin that will not retract. In these instances, there is no need to be concerned about phimosis unless it causes pain, swelling, or difficulty urinating.

Paraphimosis

In cases of paraphimosis, the foreskin does not pull forward once retracted. The tip of the penis, called the glans, becomes painful and swollen.

Paraphimosis is more serious than phimosis. Emergency medical treatment may be needed to reduce the pain and swelling, and to restore blood flow to the penis.


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Causes of phimosis

Phimosis can be either physiologic or pathologic.

Physiologic phimosis

This describes a foreskin that is tight from birth. The condition usually resolves by age 6 or 7.

Pathologic phimosis

Pathologic phimosis is caused by:

Conditions that cause pathologic phimosis include:

Balanitis

Balanitis, or inflammation of the head of the penis, can lead to a tight foreskin, painful urination, and other symptoms. Some people will also have a thick discharge beneath the foreskin.

Balanoposthitis

When both the glans and foreskin are inflamed, it is called balanoposthitis. Several types of infections can cause balanoposthitis, including the yeast infection Candidiasis.

Infections may lead to scarring, which can contribute to the tightness of the foreskin.

Sexually transmitted infections (STIs)

Some STIs can cause inflammation of the glans, which may lead to tightness and discomfort. Common STIs that may be responsible for tightness of the foreskin include:

Skin conditions

Some skin conditions that may cause or worsen symptoms include:

  • Eczema: A common condition that leads to dry and scaly patches on the skin.
  • Lichen planus: A rash characterized by shiny, flat bumps.
  • Lichen sclerosus: A condition that causes white patches to form on the foreskin and glans. It can also cause scarring.
  • Psoriasis: A chronic condition characterized by crusty, dry patches of skin.

Age

Advancing age may lead to the development of phimosis. As skin loses elasticity, it can become stiffer and less pliable.

Causes of paraphimosis

Group of men playing football.
Physical injuries to the penis, such as injuries sustained in contact sports, may cause paraphimosis.

Paraphimosis may be caused by:

  • phimosis
  • infection
  • physical trauma to the penis
  • pulling the foreskin back for extended periods of time
  • pulling the foreskin back too roughly

Paraphimosis can also occur when a medical professional fails to return the foreskin into position following an examination or procedure.


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Treatment

People without symptoms often do not need treatment. The following methods may reduce symptoms.

Good penis hygiene

Best practices for adults include:

  • Gently washing the penis every day in warm water: If using soap, choose a mild and fragrance-free variety.
  • Gently pulling back the foreskin to wash the underside: Note that the foreskins of babies and young boys should not be pulled back, as this could cause pain and damage.
  • Gently drying the penis: Remember to dry the foreskin after washing and urinating.
  • Avoiding chemicals: Try not to use products with talc or deodorant on the penis.

Tightness can often be prevented or treated by employing good hygiene techniques.

Stretching exercise

Manually stretch the foreskin to preserve elasticity. This can help to prevent and treat tightness. Gently pull the foreskin backward and forward when cleaning the penis. This exercise should be performed as soon as the foreskin separates from the glans, usually at age 7.

Consult a doctor before teaching children to perform this exercise, as not all boys develop at the same rate. A doctor can also advise on the proper way to perform this exercise.

Medication

Several medications are used to treat a tight foreskin. The best choice will depend on the cause of the condition. Below are some options to consider.

Over-the-counter medications

Using a topical steroid cream may alleviate most cases of tight foreskin. The creams have a softening effect and should be massaged into the foreskin daily for up to 2 months. Many will contain the steroid hydrocortisone.

These medications work best when a person is also performing the manual stretching exercise described above. Even after steroid use is discontinued, exercises can prevent recurrence of tightness.

In the short term, some people may also benefit from using pain relievers such as ibuprofen (Advil).

Prescription medications

If a tight foreskin is caused by infection, a doctor may prescribe antibiotics such as bacitracin or antifungals such as clotrimazole (Lotrimin AF).

If the cause is something else, a doctor may prescribe a topical steroid. It will be stronger than the over-the-counter varieties mentioned earlier. Prescription steroids include betamethasone (Celestone) and triamcinolone (Aristospan).

Local anesthetic

In some cases of paraphimosis, a local anesthetic gel may be applied to the penis so that the foreskin can be pushed forward without too much discomfort.

Surgery

When other treatments have proven ineffective, surgery may be required. Types include:

  • Preputioplasty or frenuloplasty: In these procedures, a surgeon cuts the foreskin to loosen it. However, the procedures do not always prevent recurrence of the issue.
  • Circumcision: Severe cases of phimosis and paraphimosis, as well as persistent balanitis or balanoposthitis, may require surgical removal of the foreskin, known as circumcision.

Circumcision carries risks of bleeding and infection. Doctors only recommend it as a last resort.

Prevention and complications

Man washing in shower.
Gently washing and drying the penis daily may help to prevent a tight foreskin.

There are several ways to prevent a tight foreskin.

These include:

  • Practicing good hygiene, which involves washing and drying the penis daily.
  • Manually stretching the foreskin, from a young age.
  • Treating skin conditions as they arise.
  • Practicing safe sex by using condoms to prevent the spread of STIs.
  • Using a lubricant during intercourse to prevent pain or splitting, which often occurs in men with phimosis.
  • Seeking immediate treatment for infections of the penis or foreskin, which will help to prevent scarring.
  • Discussing any concerns with a doctor.


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Takeaway

In most boys, a tight foreskin will resolve before adulthood. Cases of phimosis that persist into adulthood may cause pain, discomfort during sex, increased risk of infection, or difficulty urinating.

If symptoms are present at any age, it is important to see a doctor. Paraphimosis, in particular, requires prompt medical attention, to prevent further complications.

Any of the many treatments options available can successfully resolve both phimosis and paraphimosis. To prevent tightness of the foreskin, practice good hygiene and stretching techniques.

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