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Many men are being unable to pull the foreskin over the penis glans. This is often a reason for panic, although this condition called phimosis isn't serious, just uncomfortable.

What Is Phimosis?

Phimosis is a medical condition in which the foreskin of the penis of an uncircumcised male cannot be fully retracted. Phimosis is usually referred to as a male problem, but can also happen to women: women suffer from clitoral phimosis [1] (in this article we will discuss phimosis in men only). Phimosis can occur at any age, but the highest incidence is seen in infancy and adolescence — a study from the seventies claims that approximately 1% of males older than 16 years have problems with phimosis. [2]    

The term phimosis denotes both the physiological stage of development (which is not referred to as a disease), and a pathological condition when phimosis can cause problems for a person. In most but not all infants, phimosis is physiological rather than pathological, whereas phimosis in older children and adults is more often pathological than physiological. [3]

In the literature, the true definition of phimosis has been confused. Essentially, there are two entities, and they are based on age and pathophysiology:

  • Congenital or primary phimosis: A condition when the subject had phimosis ever since he can remember. Treatment in this case usually includes gentle stretching, since there is a reason to believe that gentle stretching will mobilize the elastic capacity of the skin tissue.
  • Acquired or secondary phimosis (or secondary phimosis of a lichenoid or fibrous type): Secondary phimosis of a lichenoid or fibrous type is a phimosis when the subject can remember developing a phimotic ring. In these cases, such types of phimosis are prone to degeneration and are generally difficult to stretch. In some cases, steroids may help, but recurrent problems require surgery. 

Both terms denote the inability to retract the distal prepuce over the glans penis; however once the foreskin can be retracted so that the glans penis partially appears, phimosis is no longer present. Phimosis is not a disease; phimosis is a condition.        

A report classified phimosis after using steroid creams into 5 types according to retractability of the foreskin after one or more treatments [5]:

  • Type 0 – Full retraction, not tight behind glans, or easy retraction, limited only by congenital adhesions to the glans
  • Type 1 – Full retraction of the foreskin, tight behind the glans
  • Type 2 – Partial exposure of glans, prepuce (not congenital adhesions) limiting factor
  • Type 3 – Partial retraction, the meatus just visible
  • Type 4 – Slight retraction, but some distance remains between the tip and glans, that is neither meatus nor glans can be exposed
  • Type 5 – Absolutely no retraction is possible

There is one more term we have to define: paraphimosis. Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus, and the condition occurs in the incorrectly circumcised or uncircumcised penis. Paraphimosis is a urological emergency in which the retracted foreskin of an uncircumcised male cannot be returned to its normal anatomic position. [6]

While primary and secondary phimosis denotes aggravated or impossible retraction of foreskin over the glans penis, typical of paraphimosis is edema, tenderness, and erythema of the glans or of the distal foreskin. 

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