Reviewed on : 10 May 2018

Reviewed by : Dr Anthony Blacker, Consultant Urologist

Expires : 10 May 2020

Phimosis – If a foreskin is tight and un-retractable.

Paraphimosis – If foreskin already pulled back but will not go forwards again.

It should be reduced.  If not possible, send to the Emergency Department.

If the phimosis is symptomatic, management is either medical or surgical.

If asymptomatic, it can be left alone.

Medical Management

Use very potent steroid cream (Dermovate: Clobetasol 0.05%).

The patient should be advised to:

• Massage a small pea sized amount of cream into the tight part of the foreskin (inside and outside), after a week of treatment, the skin will be noticeably thinner;
• Start stretching exercises on the foreskin, usually best by pulling the foreskin back until it feels tight (but not painful), and holding it back under tension for 10 minutes – usually after a bath or shower twice a day.
• Warn the patient about paraphimosis.
• Once wide enough, stretching can be done by easing apart with 2 fingers, again holding for 10 minutes at a time.
• Often very potent steroid required for 2 months or more.
• Aim to wean either frequency of dosing or potency as soon as it has worked.
• Medical treatment is effective for >50% of patients.
• Phimosis may recur.

Surgical management

Procedure: preputioplasty or circumcision.

These are usually done under local anaesthetic.

Circumcision is a Low Priority Procedure (follow link for more information)

Surgery may only be funded if medical treatment has been tried and failed.

Circumcision is not permitted for religious reasons.

Accepted clinical indications for referral are:

• Paraphimosis
• Pathological phimosis e.g. due to scarring
• Recurrent balanitis
• Suspected penile malignancy

Suspected penile cancer should be referred under 2WW.