


Quite often, the decision to treat or ignore a condition is not based on facts.

Take for example something as common as a sinus infection. Statistics show that most doctors recommend a course of antibiotics to the patient, even though less than 3% of sinus infections are bacterial, the rest being viral. Antibiotics do nothing to kill viruses but can cause your body to build a resistance to them, making these drugs less effective when you actually do need them. This kind of, just-to-be-safe treatment can actually be harmful to the patient in the long run. Performing a circumcision on a phimosis patient who doesn’t need it is one such example of over-treatment.

On the other hand, many conditions are wrongfully ignored until the problem gets alarmingly serious. For example, many kidney failure cases are the result of decades of ignored high blood pressure. Whereas at one point simple dietary changes or medications could have staved off kidney damage, many are eventually faced with very limited options such as dialysis or a kidney transplant. An example of the dangers of ignoring phimosis are penile cancer cases that are caught in late stages because of the patient’s inability to see lesions under the foreskin.

So what category does phimosis belong in?

Is it better to treat phimosis immediately
or is it better to let things simply be as they are?

The shortest answer is… it depends.

It depends on 5 things:

  • What is the age of the phimosis sufferer?
  • What stage is their phimosis in?
  • How long have they suffered from phimosis?
  • What treatments has the sufferer tried already?
  • How is phimosis impacting the sufferer’s life?


Let’s take a closer look at each one…


What is the age of the phimosis sufferer?

Phimosis is often over-treated in children and under-treated in adults. A diagnosis of phimosis in a child under the age of 12 is almost always false. Overzealous doctors and concerned parents who have been misinformed, result in an overwhelming number of children being unnecessarily circumcised each year.

The truth is that the foreskin isn’t supposed to retract in male boys under the age of 2. In fact, male children are born with foreskins that are physically fused with the glans. By age 12, one out of four children are still unable to retract their foreskin and this is quite normal as well. By age 18 only 2% of men have a foreskin that won’t retract and those are the true cases of phimosis that warrant any kind of treatment.

Any attempt to treat phimosis before age 12 should be done simply to alleviate serious complications, such as painful urination or recurrent infections. Otherwise, a wait-and-see approach is best during this period.

During teen years, other factors may come into play when deciding on a course of action. Teen boys are more likely to develop anxiety over negative body image that can even affect their self-esteem. In such cases, simple therapeutic approaches should be employed, such as educating them about how common phimosis really is and reassuring them that having a tight foreskin is nothing to be embarrassed about. Since many cases of phimosis resolve by the age of 18, it is recommended to avoid surgical intervention unless absolutely necessary.

If you are an adult with phimosis however, it is very unlikely that it will go away on its own. Once a male has crossed into adulthood, their foreskin has expanded as much as it ever will and their phimosis is either likely to remain the same of get worse with time.

In these cases, it is important to do something about the problem rather than ignore it until the problem progresses. Treatments in adults should be focused on more conservative methods such as using steroid creams or foreskin stretching exercises before moving on to more aggressive methods such as surgery.


  • What stage is their phimosis in?

One of the first things to take into account when considering whether to treat your phimosis or not is to identify what stage your phimosis is in. There are 4 stages of phimosis, ranging from at-risk (stage 0) to pinhole phimosis (stage 4).

Each stage has its set of risks and treatment decisions should be made with them in mind .

Mild phimosis sufferers are more likely to develop paraphimosis and get their glans stuck behind a narrow foreskin – a condition requiring emergency treatment. Treatment at this stage should involve very careful stretching, taking precautions to prevent premature pulling of the foreskin behind the glans during an erection.

Moderate phimosis sufferers are more likely to tear their foreskin from prolonged or extreme stretches. Treatment here should involve multiple conservative approaches such as using steroid creams and consistent yet gentle stretching that is interrupted at the first sign of foreskin inflammation.

Severe phimosis carries the highest risk of complications such as development of chronic infections, progressive narrowing of the foreskin that makes urination difficult, narrowing of the urethra and extreme hygiene issues. Treatment here should not be put off for long and should employ stretching devices (since fingers can’t be inserted into the foreskin opening), steroid creams, medications for infections and a strict hygiene regimen that aims to clean the region under the foreskin.


  • How long have they suffered from phimosis?

As researcher W.M. Porter points out in his paper entitled “The dysfunctional foreskin” that even though the foreskin isn’t essential to penile function, its dysfunction is “a cause of considerable morbidity” and is even associated with death from penile cancer. The longer a phimosis problem remains untreated in an adult, the higher the likelihood of a serious complication.

This has to do with what happens to an organ when its function is interrupted, even by a little bit.

The function of your foreskin can be compared to that of your eyelids. Our eyelids protect our eyes from dust, keep them moist and lubricate them. An interruption in their function won’t just cause cosmetic problems but can also affect your eyes and by that token your sight and your life.

In the case of phimosis, a tight foreskin can cause a significant interruption in its natural function. For example, its interrupted gliding action during intercourse can not only interfere with the enjoyment of sex but also increase the likelihood of injuries.

Phimosis can also interrupt the self-cleaning function of the glans and lead to poor hygiene under the foreskin.

The inability to retract the foreskin fully also increases your chances of developing infection of the glans, foreskin and the urinary tract. The effects of chronic inflammation, prolonged exposure to toxins and recurrent infections make phimosis sufferers much more likely to develop penile cancers (squamous cell carcinoma) than the general population.

While it makes sense to wait-out a phimosis problem in children, ignoring the problem as adults is usually not recommended even if the problem is mild or asymptomatic. Usually, how aggressively you treat your phimosis should depend on how long you have suffered from it.

  • What treatments has the sufferer tried already?

Today, phimosis sufferers are fortunate enough to have multiple options at their disposal, ranging from convenient home treatments to circumcision procedures in a hospital setting. What treatment you employ to deal with your phimosis should depend on what you have already tried.

A logical approach would be to start with the most conservative approach, such as manual foreskin stretching exercises and progress towards more aggressive approaches.

Many phimosis patients misjudge the effectiveness of their treatments and either prematurely opt-in for aggressive options or put all their hopes in ineffective treatment methods for months at a time.

For example, not everyone’s foreskin responds well to manual stretching. Some experience injuries while others see no change even after months. Yet some are able to cure their phimosis with nothing more than 10 minutes of foreskin stretching each day.

Some find that steroid creams loosen their tight foreskin within weeks, while others experience foreskin atrophy so severe that it takes months for the tears to heal.

There are even cases where anxious patients undergo circumcisions when simpler methods would have sufficed.

The rule of thumb here is, take it one step at a time. Be patient and if something doesn’t work, don’t lose heart. Move on to the next option and don’t stop until you are cured because there is rarely any case of phimosis that isn’t curable by some way or another.


  • How is phimosis impacting the sufferer’s life?


While we have effectively laid out a sensible action plan on how to approach your phimosis treatment decision, it is important to mention that treatment decisions cannot always be made based on simple, black-and-white evaluations.

Every patient is unique and each phimosis sufferer’s take on their condition is equally unique. Some find it very difficult to live with a tight foreskin simply because of the altered appearance of the penis.

Sometimes a phimosis sufferer’s dissatisfaction with their condition has nothing to do with its severity. Some sufferers face anxiety, depression and embarrassment even with mild phimosis, while others can live with severe forms for life without any major issues.

Some face extreme shyness over discussing their condition with potential mates or doctors, while others openly discuss it with their partners who can be caring and indifferent about the presence of a tight foreskin.

In other words, there are no hard and fast rules when it comes to picking the right solution for you. The best solution is usually the one that you are most comfortable with, no matter how conservative or aggressive the treatment itself.

At the end, the decision to treat the problem should be yours and not driven by friends, family or even a doctor. Just make sure that whatever the decision, that it is an informed one.