What is Phimosis, a problem seen in men? What is the treatment?

 What is Phimosis, a problem seen in men? What is the treatment?

Phimosis is a condition in which the foreskin of a man's penis cannot be partially or completely retracted and is normal in 90 percent of newborns at birth.

Severe phimosis can cause problems with sexual activity and affect fertility, which can be treated with circumcision or prepuceoplasty.

Steroid ointments and foreskin pulling exercises are effective in treating phimosis, but surgery is required in severe cases.

Phimosis is a condition in which the foreskin of a man's penis cannot be partially or completely retracted from over the glans (head of the penis). It is normal (physiological) in about 90 percent of newborns at birth and usually opens on its own within 5 years.

However, if it does not open even after puberty, pain or infection persists, it is called pathological phimosis.

Why does phimosis occur?

– Congenital narrowing of the foreskin,

– Frequent infections (balanitis or balanoposthitis),

– Not cleaning the penis regularly,

– Diabetes,

– Skin lesions (such as lichen sclerosus),

– and, tearing from forcible pulling of the foreskin.

Normal phimosis

Is normal at birth. In most children, the foreskin is partially attached. It usually resolves on its own by the age of 5–7.

Pathological phimosis

Is caused by a problem or infection. Pulling back the foreskin causes pain, redness, or difficulty urinating. This requires treatment.

Reversible or temporary phimosis

In some cases, swelling or infection temporarily prevents the foreskin from retracting. The infection or problem returns to normal after treatment.

Impact on sexual life

There are clear differences in sexual participation depending on the type of phimosis. People with a mildly narrowed foreskin can usually have sex slowly and carefully. However, if the foreskin is moderately narrowed, pain may be felt during intercourse. In such cases, premature ejaculation and foreskin tearing may sometimes occur during sexual activity.

In cases of severe foreskin narrowing, sexual intercourse is very difficult or almost impossible. Because the man's penis cannot enter the woman's genitals at all, which has a serious impact on sexual life. Thus, the severity of phimosis varies in the ability to participate in sexual activity and the need for treatment.

Fertility prospects

People with mild phimosis usually have good fertility and no major problems. However, in severe phimosis, there is a possibility that the semen (semen) does not come out at all and ‘freezes’ inside the foreskin of the penis, which may reduce the chances of pregnancy and may affect spontaneous reproduction.

In such cases, after appropriate treatment, such as circumcision or preputioplasty, there is a high chance that fertility will return to normal and sexual health will improve.

Therefore, it is necessary for people with severe phimosis to get timely treatment so that there is no obstacle to reproduction and sexual activity.

The method of urination also differs depending on the type of phimosis. In people with mild phimosis, urination occurs normally, with no obstruction or problem.

In cases of moderate phimosis, the urine stream may be thin and sometimes the foreskin appears to be swollen ‘like a balloon’, which causes discomfort during urination.

People with severe phimosis may have a thin stream of urine, and there is a problem that the flow of urine may be completely blocked, which also increases the risk of infection. Therefore, in cases of severe phimosis, timely and appropriate treatment is necessary to prevent problems with urination and prevent infection.

The problem of phimosis not being included in sex education

In the context of Nepal, the main reasons for not including phimosis in the school curriculum for sex education are cultural embarrassment, religious sensitivity, and not prioritizing sexual health at the school level.

In most Nepali communities, sexual topics are considered awkward to discuss openly, which also results in poor teacher training and the inability to effectively implement sex education. Therefore, students, deprived of necessary sex education, do not receive timely information about their physical changes, sexual health, and related risks.

As a result, complications such as sexually transmitted infections, uncontrolled sexual behavior, and mental stress cannot be identified and treated in a timely manner. This increases the likelihood of unnecessary pain and mental stress during sexual intercourse, which can have long-term health and social implications.

It is crucial to improve and expand sex education in Nepal, taking into account the need to include it in a sensitive manner.

How is it treated?

In the early stages of phimosis, steroid ointments and regular exercises to pull the foreskin back can help. However, in cases of recurrent or severe problems, surgery is the last resort.

Surgical options include circumcision (complete removal of the foreskin), preputioplasty (skin tightening), and in emergency cases, dorsal slit (partial incision of the foreskin).

Complete removal of the foreskin And what happens when you throw it away?

Circumcision, or complete removal, plays an important role in preventing recurrent infections. This is because phimosis causes the prepuce (the skin on the tip of the penis) to become narrow, making it easier for bacterial and fungal infections to occur. Therefore, circumcision reduces the risk of infection by removing that barrier.

When it comes to urine flow, the narrowing of the foreskin in a person with phimosis can obstruct the flow of urine out of the penis, so circumcision works to facilitate the flow of urine. It also prevents irritation and infection in the urethra.

Since phimosis makes it difficult to clean the penis, ‘smegma’, or dirt, can accumulate there, which increases odor and infection. After circumcision, smegma is removed and it is easier to keep the penis clean.

In terms of sexual discomfort, circumcision can reduce tightness and pain in men with phimosis, which can make sexual activity easier.

Risks of Circumcision

In men with phimosis, circumcision is more likely to cause scarring of the skin of the penis, swelling of the penis after surgery, and bleeding. This is because the foreskin of the penis is already contracted, which can increase the risk of complications that affect the surgery. However, circumcision in men without phimosis only has the risks associated with normal surgery.

After circumcision, the natural ‘gliding action’ of the foreskin may be reduced, which can increase dry friction on the surface of the penis. This reduction can make sexual activity uncomfortable. However, the use of lubricants can help reduce this problem.

For the first few weeks after phimosis surgery, the glans penis may be extremely sensitive to direct air, friction from any clothing, and touch, which can cause irritation and extreme pain, itching, or discomfort.

In addition, there may be a temporary tingling or numbness sensation due to the superficial nerves being affected. In the long term, exposure to light touch may result in a slight keratinization of the glans skin (slight drying and hardening due to the effects of the external environment), which may reduce the sensation of light touch, and these sensations may be permanently lost as the special touch receptors in the foreskin are removed.

However, in most cases, sexual pleasure is not significantly reduced after complete recovery, and previously painful conditions may improve and satisfaction may increase.