Circumcision as Treatment for Phimosis

The first misconception is not that circumcision is an effective, or even the best treatment for phimosis or paraphimosis. It’s that most people have a misconception about the condition itself. So let’s begin there, with the misconception about either condition.

Fused together

When the foreskin forms, it is fused to the acorn-shaped glans underneath by a thin layer of mucosa. Over time, that layer should disappear and allow the foreskin to fold off the glans, onto the upper skin of the penis or bunched behind the corona, the rim just above the glans.

Either phimosis or paraphimosis can occur if the opening at the end of the foreskin is too tight for it to fold over the penis or bunch behind the glans. The entire foreskin can be too tight, especially during an erection. Sometimes, just the opening of the foreskin is too tight but it can still not allow the foreskin to accommodate – or allow – an erection, especially on a penis that is going to grow through the hole, as most do.

Note, however, that neither phimosis (tight foreskin) nor paraphimosis (tight opening in the foreskin) are a lack of separation between the layers of the foreskin and the glans. That is a different problem. Separation requires the mucosa that “glues” the foreskin lining to the skin of the glans to disappear, or dissolve. This can occur during gestation (which it does for 1 in 10 newborns). But it usually occurs in the first five years of a male’s life, and practically always occurs by the time the boy has reached puberty.

One way to relieve the tightness is to stretch the opening with gentle movement, very, very, very gentle movement. That’s because forcing a foreskin to separate, even with what feels like gentle manipulation, can cause miniscule tears in the lining of the foreskin. These tiny tears can cause scar tissue to form. Scar tissue may not be a problem in a young boy, especially if he can move his foreskin off the glans to clean under it. By puberty, however, such scar tissue can make his foreskin too inelastic to move off the glans, for either an erection or for hygiene.

One problem with a tight meatus (opening) is that if it is too tight during masturbation, foreplay or intercourse, it can tear, especially during sexual intercourse. Such tearing can be bloody, painful and render the penis vulnerable to infection. When the tears heal with scar tissue, the less-elastic scar tissue can create phimosis or paraphimosis, and all the problems they present.

It is true that circumcision will eliminate both conditions, especially recurrent phimosis or an opening that is extremely small or inelastic and on a penis that grows quite larger in circumference when erect. But it is also true that the statement that circumcision is the only way to solve the problem of tightness is untrue.

Given the potential seriousness of any medical problem, we advise you to consult with your doctors for further information.

Learn more about phimosis and paraphimosis at:
Medscape