I've treated thousands of uncircumcised men with an agonizing penis problem that's on the rise in America. Few talk about it or realize the issue... but it can be a disaster if left too late: DR PHILIPPA KAYE
It's the painful genital problem that is slowly becoming more common among American men – although few of them want to talk about it.Phimosis is the medical term for the condition where the foreskin cannot be pulled back fully over the head of the penis.It's not uncommon in children, but usually resolves - however it can, and does, last into adulthood, although in my experience men are very reluctant to talk about it. And it can be a debilitating issue, making sex agony and leading to painful tears in the foreskin. It can even make it difficult to maintain an erection.Until relatively recently, it wasn't much of a problem in the US, due to near universal circumcision of male babies up until around the 1970s. Still today, around eight in ten adult American men are circumcised, however that number will keep falling as fewer than 50 percent of babies are given the procedure today. And as they do, rates of phimosis will rise and rise. Many of the men who come to me with the problem – who are often young or middle-aged – are embarrassed to talk about it. They will have probably put off seeking medical help for months, gritting their teeth and hoping the problem goes away.In some cases, they have even hidden the painful condition from their partners, who can't understand why they have started to avoid sex. In some cases, men hide their painful phimosis from their partners – and purposely avoid sex (picture posed by models)I'm always devastated to hear this. Not least because it's a reminder of a major problem that family doctors like me struggle to tackle: that many men put off seeking help for painful and debilitating health problems – often only coming to us when it is too late to help them.And that's another reason why I think it's such a shame that men with phimosis do not seek help – there are a number of effective steps they can take to ease the suffering and improve their sex lives.First, though, it's important to explain what causes phimosis.For some men, it can be a continuation of a problem that began in childhood. Put simply, some reach adulthood with a foreskin that remains tighter than average.For others, phimosis can be triggered by repeated fungal infections – such as thrush – or irritation caused by soaps and shower gels.There is also a condition called lichen sclerosus, a chronic inflammatory skin disease, that results in thin, white patches of skin that can scar and cause phimosis.Phimosis is also linked to diabetes – which raises the risk of repeated fungal infections – and old age, when the skin loses its elasticity.But, regardless of the cause, many of the solutions are the same.Good hygiene is the essential foundation. Patients should wash daily using water and a fragrance-free, non-irritating soap.They must also avoid using anything perfumed, including deodorants, talcum powder or antiseptic creams, on the penis. These products can inflame the skin and make the phimosis worse. GP, author and broadcaster Dr Philippa KayeIn turn, failing to clean the area properly – as so often happens when the skin is sensitive to touch – can lead to severe infections, worsening the pain and swelling.If the foreskin can be gently retracted at all, this is best done in a warm bath or shower, when the skin is at its most supple.The area should then be carefully dried, as trapped moisture increases the risk of further inflammation and infection.Loose-fitting underwear helps reduce friction and irritation throughout the day.For adults with mild to moderate phimosis that is not severely scarred, the first-line medical treatment is a powerful topical steroid cream. This works by gradually softening and loosening the foreskin tissue, making retraction easier over time.A primary care doctor will typically prescribe betamethasone cream, used for one to two months, with clobetasol propionate sometimes recommended for more stubborn cases.Neither is available over the counter, but both are inexpensive when prescribed and, for many men, genuinely effective.One word of caution: there is a great deal of advice online suggesting that daily stretching exercises alone will resolve phimosis. These involve repeatedly raising and pulling at the skin.In the past, these exercises were backed by doctors, but this is no longer the case.This is because repeated forced stretching causes tiny tears in the skin, and as those heal they leave scar tissue – which can tighten the foreskin further, rather than loosen it.If steroid cream fails to help sufficiently, surgery is the next step.In adults, this is most commonly circumcision – complete removal of the foreskin – which resolves the problem permanently.It is a straightforward procedure, usually performed under local anesthetic as a day case, and recovery typically takes four to six weeks.There is, however, one complication of phimosis that demands urgent attention rather than a routine medical appointment.Paraphimosis occurs when the foreskin is retracted behind the head of the penis and becomes trapped there.Unable to be rolled back to its normal position, it causes severe swelling and pain – and, critically, can cut off blood supply to the head of the penis. This is a medical emergency. Anyone in this situation should seek emergency care immediately.More broadly, any man who experiences pain when passing urine, difficulty urinating, bleeding, an offensive smell or discharge, or pain during erections should see a doctor promptly rather than waiting it out.These symptoms can sometimes be a sign of other serious conditions such as cancer.The sooner phimosis is assessed, the more straightforward the treatment options tend to be.The message is a simple one. Phimosis is common, it is treatable, and suffering in silence serves nobody.
