Practice 10-Minute Consultation

Tight foreskin

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i4639 (Published 05 October 2016) Cite this as: BMJ 2016;355:i4639

This article has a correction. Please see:

  1. Aditya Raja, clinical research fellow in urology1 2,
  2. Ian Perry, GP principal3,
  3. Hrishi B Joshi, consultant urological surgeon and honorary clinical lecturer1 2
  1. 1University Hospital of Wales, Cardiff CF14 4XW, UK
  2. 2Cardiff University, Cardiff, UK
  3. 3West Essex Clinical Commissioning Group, Epping, UK
  1. Correspondence to: A Raja aditya.raja01{at}alumni.imperial.ac.uk
  • Accepted 18 July 2016

What you need to know

  • Steroid cream is the first line treatment for non-specialists managing suspected phimosis

  • Consider referral for circumcision if the patient’s sex life is affected or steroid creams fail to help after around four weeks

  • Refer urgently patients with symptoms suggestive of cancer, such as a hard lump

A 25 year old man says that his foreskin has been tight for several months. It will not pull back. He is starting to have painful erections and difficulty having sex.

At age 3 years, 90% of boys have a fully retractile foreskin; this rises to 95% of 16-17 year olds.1 2 Phimosis is a common condition in which a band in the foreskin prevents retraction over the glans. Phimosis may persist from childhood or be acquired, often through a process that has resulted in scarring. Asymptomatic phimosis needs no treatment. Patients with symptomatic phimosis may complain of a tight foreskin, difficulty cleaning the glans, and sexual problems such as splitting of the skin and painful erections (fig 1). Rarely, phimosis may present with difficulty passing urine, associated with ballooning of the foreskin.

Fig 1 Splits in the foreskin of a 24 year old’s penis …

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