Definition

Phimosis is an abnormality that occurs in the penis that has not been circumcised or circumcised. Normally, the foreskin is elastic so it can be pulled to the base and part of the penis can be seen. In phimosis, the outer skin of the penis or foreskin cannot be pulled towards the body or the base of the penis. The foreskin is the skin that is at the tip of the penis and covers the penis from the outside.

Phimosis generally occurs in children, although it can also be found in adult men who have not been circumcised. In all boys, the foreskin will slowly change to pull the skin to the base. It is estimated that only about 1% of people will have phimosis by the time they are 16 years old.

Phimosis is usually not considered a problem if it does not cause complaints. However, if phimosis causes symptoms or is classified as severe, where the opening at the tip of the penis becomes very small, inflammation can occur and increase the risk of infection.

Causes

Phimosis occurs because the foreskin or prepuce becomes too tight, so it cannot be pulled towards the base of the penis. There are two types of phimosis, namely:

• Physiological phimosis 
• Pathological phimosis

Physiological phimosis is generally related to the child's age. Normally, the foreskin of the penis is tight when the baby is born and will loosen when the child is 2 - 6 years old. The loosened foreskin will begin to separate from the head of the penis, although phimosis is still common in children as young as 10 years old. Physiological phimosis will improve as the child's age increases.

Meanwhile, pathological phimosis is a condition caused by skin tissue that is not elastic or due to other medical disorders, such as:

• Poor hygiene

This condition can cause or increase the risk of phimosis. Foreskin that cannot be opened will prevent the penis from being cleaned thoroughly. Any remaining urine that is left behind can cause infection.

• Certain skin disorders can cause phimosis because the skin around the penis changes to become itchy, dry, and cracked. Examples of these skin disorders are:
  • Psoriasis is a long-term skin inflammation that causes thick, reddish-white scales. 
  • Lichen planus, inflammation of the skin and/or mucous membranes (inner lining of the nose, mouth, lungs, gastrointestinal tract, genitals).
  • Lichen sclerosis is a skin disorder in the genital area that can be triggered by hormonal imbalances or the body's immune response.
  • Atopic dermatitis is skin inflammation associated with an allergic reaction from the body. 
• Other medical conditions, such as:
  • The foreskin of the penis is attached to the tip of the penis head, or there is connective tissue that makes the foreskin stick and cannot be pulled from the tip of the penis.
  • Recurrent injury to the penis, especially at the tip.
  • Infections, such as sexually transmitted infections and urinary tract infections.

Risk Factor

Factors that can increase a man's risk of experiencing pathological phimosis include:

• The penis has not been circumcised or circumcised.
• Have a history of skin disease, especially in the genital area.
• Unclean lifestyle.
• Engaging in unsafe sexual activities.
• Having recurrent urinary tract infections.

Symptoms

Symptoms of phimosis are usually only felt when the foreskin feels too tight for a long time, or when there is infection or inflammation of the penis. A symptom that phimosis sufferers will definitely experience is not being able to completely retract the foreskin of the penis to the base of the penis. When urinating, the tight foreskin can reduce the opening of the penis, causing urine to accumulate at the tip of the penis. The buildup of urine makes the tip of the penis enlarge when urinating.

Some other symptoms that can occur when the phimosis condition gets worse are:

• Change in skin color to red on the penis.
• Swelling due to infection or inflammation.
• Pain or discomfort.
• Pain when urinating or urinating.
• Pain during erection or sexual intercourse.
• Recurrent urinary tract infections.
• Blood in the urine or around the foreskin of the penis.

Diagnosis

Phimosis can be diagnosed by symptom interviews and physical examination to confirm the condition of the penis. Sometimes, no further examination is needed because the doctor only needs to ensure the skin cannot be pulled completely. However, other tests can be carried out to find the cause or if phimosis is accompanied by infection, including:

• Blood laboratory test
• Urine test
• Penile tip swab examination to diagnose penile tip infection or balanitis

Management

Management of phimosis is adjusted to the condition of phimosis experienced. Physiological phimosis usually does not require special treatment because the condition will improve with age and generally does not cause significant problems. Meanwhile, in pathological phimosis, doctors need to carry out special treatment. Some of the treatment therapies that can be given are:

• Use of steroid cream, which is applied to the foreskin of the penis.
• Educate patients to stretch the foreskin after 2 weeks of using steroid cream. Stretching the skin is done slowly, the patient is asked to try to pull the skin towards the base of the penis without causing pain.
• Antibiotics can be given if a bacterial infection occurs on the foreskin or tip of the penis.
• Circumcision or circumcision operations can be performed from children to adults. This procedure is carried out by removing excess foreskin skin so that the tip of the penis can be free and no longer covered.
• Education to maintain penis cleanliness by cleaning the penis every day using warm water.

Complications

Medical complications can occur from procedures or treatments that have been carried out, for example, from long-term use of steroid cream or due to circumcision procedures. Complications that can occur after circumcision are:

• Bleeding
• Infection
• The foreskin becomes too long or short
• Pain

After the circumcision procedure, healing can be achieved within 7-10 days.

Another medical complication that can also occur with phimosis is paraphimosis. Paraphimosis occurs when the foreskin cannot return to the tip of the penis, causing the penis to swell and cause severe pain. Paraphimosis is an emergency condition and must be treated quickly.

Prevention

Physiological phimosis cannot be prevented, because this condition has existed since the baby was born into the world. What needs to be considered is the cleanliness of the penis, especially in children. Parents or caregivers must clean their child's penis regularly and there is no need to panic if the baby's foreskin cannot be completely retracted. Older children should be taught how to clean their own penis to avoid the risk of infection.

Also avoid using smelly soap, loose powder, and deodorant on the penis because they can cause irritation. Use a condom or contraception when having sexual intercourse.

When to See a Doctor?

See a doctor immediately if your phimosis condition starts to bother you or if you feel the symptoms above. You can also consult a doctor if you are worried about the condition of your child's penis, or if your child complains of pain and swelling in his penis.

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