Phimosis in adults: common questions before surgery

Phimosis is a condition in which the foreskin of the penis is narrowed, so it cannot be pulled back, or only with difficulty, over the head of the penis. In boys a tight foreskin in the first years of life is usually normal, and in most it gradually becomes retractable by puberty. In adult men phimosis is different: it usually develops because of repeated inflammation of the head of the penis and foreskin or because of scarring of the foreskin, for example with lichen sclerosus, a long-term skin condition that can cause scarring.

Phimosis in adults can make hygiene difficult, cause pain or skin tears during erection and intercourse, and with marked narrowing, make urination difficult.

With milder narrowing the doctor sometimes suggests treatment without surgery first. A urologist usually suggests circumcision when:

• the narrowing remains despite treatment,
• inflammation of the head of the penis and foreskin keeps coming back,
• there is scarring of the foreskin,
• paraphimosis keeps recurring, a condition in which a retracted foreskin cannot be returned to its place.

The decision always depends on the findings and the doctor's assessment. If a retracted foreskin cannot be returned and the head of the penis is swelling, urgent examination is needed. In that case go to the nearest emergency department or call the emergency service on 194.

The examination starts with a conversation about symptoms: how long the narrowing has lasted, whether there has been inflammation, pain or difficulty urinating, and which medicines you take. The urologist then examines the foreskin and the head of the penis and assesses the degree of narrowing and whether there is scarring. The examination is short, and the doctor explains what they are doing.

Based on the findings the urologist suggests treatment, explains the procedure if it is needed and answers questions. If needed, they may request tests before the procedure.

Before deciding it helps to ask at the examination:

• whether there is treatment without surgery in your case,
• what the procedure involves and under which anaesthetic it is done,
• what stitches are used and whether they are removed,
• how long recovery takes and when you can return to work, sport and intercourse,
• what the penis will look like after the procedure and whether sensation changes,
• what the price includes.

For day-by-day recovery after the procedure, see also the separate article on recovery after circumcision.

At Maja Hospital adult circumcision is done under local anaesthetic: the patient is awake and the area is numbed. Preparation usually includes:

• Tell the urologist which medicines you take, especially blood thinners, and whether you have allergies, diabetes or other long-term conditions. Do not stop any treatment on your own.
• On the day of the procedure come clean, after a shower, in comfortable, loose clothing.
• Bring your results and a list of medicines.
• Arrange for someone to accompany you home after the procedure.

After a procedure under local anaesthetic an overnight stay is usually not needed, and you receive wound care instructions and a check-up appointment before going home.

In boys a tight foreskin in the first years of life is usually normal, and in most boys the foreskin gradually becomes retractable by puberty. A child's foreskin should not be pulled back by force. Whether treatment or a procedure is needed is decided by a doctor after an examination, usually a paediatric surgeon or paediatric urologist. This article is about phimosis in adults. Whether the procedure is done for children at Maja Hospital can be checked when booking.