Thank you for contacting the Health at Hand team with your medical concern.
Tightness of the foreskin also known as phimosis may not cause any symptoms but sometimes it can cause passing water or having intercourse uncomfortable.
Phimosis is the inability to retract the foreskin. Usually children under 5 years of age are unable to retract their foreskin but by the age of 10 years the foreskin becomes fully retractable. In some children phimosis is due to congenital disorder.
Paraphimosis is the entrapment of a retracted foreskin behind the coronal sulcus. Paraphimosis is a disease of uncircumcised or partially circumcised males.
Phomisis can affect adults due to scaring of the tissue of the foreskin. It can be due to poor hygiene which may lead to recurrent infection of the foreskin known as balanitis or balanitis xerotica obliterans. Sometimes forcing the foreskin to retract can cause micro abrasions or tears which can lead to swelling. Elderly men are more prone to phimosis because as we get older the skin loses its elasticity.
The penis needs to be washed once or twice a day, after fully retracting the foreskin or as much as you can. Instead of using soap, washing with emollients such as Oilatum bath additive, Oilatum shower gel, Cetraben bath additive, Oilatum plus shower gel Doublebase shower gel or Doublebase bath additive may be used.
You should not retract any skin that appears to be damaged as this will cause further scarring and worsen phimosis. This will need surgery in later life. Therefore, we suggest you should avoid using ‘phimocure’ or tuboids.
After washing it is important to dry the penis and any area between the foreskin and the penis thoroughly before applying any medical moisturizer or cream.
Studies have shown that applying a steroid cream or ointment can help up to 95% cases of phimosis and help to reduce the inflammation.
The difference between cream and ointment is that a cream is water-based and rubs into the skin readily, whereas an ointment is oil-based and may leave an oily feel but tends to stay on longer. Stronger steroid creams such as Betnovate is often prescribed because it tends to work more quickly than a mild steroid cream such as hydrocortisone.
Your GP may prescribe recommend 0.1-0.05% betamethasone dipropionate applied to the preputial orifice twice a day for 4-6 weeks.
Steroid creams or ointments should be spread thinly on the inflamed skin only using a very small amount of the cream or ointment once or twice daily. It should be used continuously on a daily basis until the phimosis has disappeared altogether.
You may have no or only partial improvement at the start of using the Betnovate cream or ointment, but by about 2 months the phimosis may have greatly improved.
Once the phimosis has cleared it is important to continue to keep the area clean, dry and moisturised daily. Your doctor may prescribe moisturisers such as Oilatum, Diprobase cream or ointment, Doublebase cream, Epaderm, Hydromol Zerobase or Zerocream.
Long-term use of steroid creams can lead to thinning skin and other side effects. Normal regular use during flare up is unlikely to lead to thinning skin. If the skin does start to thin, stopping the use often reverses this effect.
Your doctor may take a swab to check for infections. If the swab results indicate that there is an infection, the doctor may prescribe antibiotics.
As you mentioned other treatments mostly consist of various surgical methods, including circumcision. We suggest you discuss this matter further with your GP. If the GP is unable to resolve this condition, they may refer you to a urologist. While circumcision is unlikely to be your first treatment option at this stage, the procedure could help eliminate the issues you are experiencing, should medications fail to resolve the problem satisfactorily.
The British Association of Urological Surgeons (BAUS) website has more information that you might find useful.
Answered by the Health at Hand team.
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