Foreskin problems

The foreskin is the fold of skin that covers the tip (glans) of the penis, and a foreskin problem usually means it's difficult, painful or impossible to pull back. This is very common and often nothing to worry about, particularly in babies and young boys, but it sometimes needs treatment.

Symptoms of foreskin problems

A tight foreskin, medically called phimosis, is normal in babies and young boys. Most boys' foreskins don't pull back (retract) before the age of 5, and sometimes not until 10 or older. The tip of the penis may bulge or 'balloon' when peeing if the foreskin is tight, which on its own isn't usually a problem.

See a doctor if a tight foreskin comes with:

• swelling and tenderness
• pain when peeing, or a weak flow of pee
• blood in your urine, or frequent urinary tract infections
• bleeding, a thick discharge, or an unpleasant smell from under the foreskin
• painful erections, which can make sex difficult.

These symptoms can also be signs of balanitis, inflammation of the head of the penis, which can happen at any age but is more likely if you have a foreskin.

Causes and risk factors

In children, a tight foreskin is usually just part of normal development, since the foreskin and glans start off fused together and gradually separate over childhood; this isn't a problem in itself. In adults, a tight foreskin more often develops later in life, usually because of scarring, which can be caused by:

• recurrent infections under the foreskin (balanitis), often linked to a build-up of moisture and skin cells if the area can't be kept clean
• balanitis xerotica obliterans (BXO), also called lichen sclerosus, a skin condition that causes scar tissue at the tip of the foreskin
• thrush infections, which can scar the skin over time
• injury or a tear to the foreskin, which can heal with scarring
• diabetes, which raises the risk of infections that can lead to scarring.

Because it's difficult to clean underneath a tight foreskin, poor hygiene and a higher risk of infection often go hand in hand with foreskin problems, which is part of why the two tend to be treated together.

Types of foreskin problem

Foreskin problems are usually one of a few related conditions:

• phimosis, where the foreskin is too tight to pull back over the glans
• paraphimosis, where a tight foreskin gets pulled back and stuck behind the glans, unable to return to its normal position; this is a medical emergency
• balanitis, inflammation and infection of the glans, or balanoposthitis, when this also involves the foreskin
• balanitis xerotica obliterans (BXO), also called lichen sclerosus, where scar tissue forms at the tip of the foreskin, tightening it over time.

A short frenulum, the piece of skin that connects the underside of the glans to the foreskin, can cause similar symptoms to phimosis, including pain or tearing during sex, but is a separate condition usually treated with a different, smaller procedure.

Diagnosing foreskin problems

Your GP will usually ask about any previous injuries or infections, and how the problem is affecting you, including your sex life if relevant. They'll examine your penis and foreskin, and may check whether a short frenulum, rather than true tightness of the foreskin, could be the cause.

You may also be offered a blood test to check for diabetes and a urine test to check for infection or sugar, and swabs may be taken from under the foreskin to check for infection.

Treatment for foreskin problems

If a tight foreskin isn't causing pain, bleeding or other problems, you can often manage it yourself: wash your penis regularly with warm water, and, if you're an adult, gently pull the foreskin back as far as is comfortable to clean underneath before covering the penis again. Never force back the foreskin of a baby or young boy, since it can be painful and cause scarring that makes the problem worse.

If treatment is needed, options include:

• steroid cream or gel, applied to the foreskin to help soften and loosen it
• antibiotics or antifungal treatment, if there's an infection
• using a condom during sex, which some men find more comfortable.

If these measures don't help, or the cause is BXO, surgery may be recommended. This might be preputioplasty, small cuts made in the tip of the foreskin to widen it, which is mainly used in children, or circumcision, complete removal of the foreskin, which is usually needed in adults with significant scarring.

If a short frenulum is the problem, a smaller procedure called frenuloplasty may be used instead. Stretching a scarred foreskin yourself is best avoided, since there's no evidence it cures the problem and it can cause further tearing and scarring.

When to see a doctor

See a GP if you or your child's foreskin is tight and swollen or painful, if there's bleeding, thick discharge or an unpleasant smell from under the foreskin, if peeing is painful or difficult, or if you're having painful erections.

Get emergency help straight away, call 999 or go to A&E, if a foreskin has been pulled back and can't be returned to its normal position over the tip of the penis. This is called paraphimosis, and it needs urgent treatment to protect blood flow to the penis.