What is phimosis

Phimosis is a condition in which the foreskin cannot be retracted in order to expose the glans.

Physiological Phimosis

Phimosis is a normal condition for newborns and up to puberty. For most newborns, the foreskins (prepuce) is fused with the glans and does not stretch or detach (adhesion or balano-preputial lamina). This is a perfectly normal condition and doctors and parents should not attempt to forcibly retract the foreskin which will cause inelastic scar tissue to develop and a permanent phimosis to develop into the adult boy. This is called Premature Forcible Foreskin Retraction (PFFR), a practice that was wrongly done by parents, doctors, nurses, babysitters and caregivers unfortunatelly too often due to ignorance. In time (this varies wildly in age but up to and slightly past puberty), the foreskin will very slowly detach from the glans and it's opening will start stretching progressivelly until it can stretch wide enough to expose the full glans. During this progress, a boy may experience balooning, which means the foreskin inflates during urination. This is simple fluid dynamics, if it is easier to inflate the foreskin (now partially detached) then flowing though the opening (probably still not very wide and stretchy), then it does. This is not a problem but a normal phase, it will not cause infections or other problems. The child at this stage may be simply instructed to start retrating as far as he can (with no force or pain) during urination. In time this retration will help widen the orifice and follow normal course until one day the child will have full normal retractability. Smegma is a lump of dead cells that looks like some thick white substance. Remember that balano-preputial lamina membrane, it's the equivalent of a girl hymen and it's dying as normal part of puberty, if you see smega during puberty coming out, it is simply normal, those cells need to get out, it's not an infection or bad hygiene.

Pathological phimosis

Phimosis is only considered a medical problem (pathology) when it's still present in the adult (18 years old). It can be cause by many factors such as premature forcible retraction, infection (balanitis), yeast infections, physical damage causing a scar, alergies to some soaps, etc.

Phimosis can mainly be cause by 3 things:

• A tight foreskin where the orrifice at the tip of the foreskin is too small to retract over the larger glans. This is normal in children and adolescents and should stretch during puberty if nothing caused a phimotic ring like a premature forcible foreskin retraction or other scar-producing trauma.
• The inner surface of the foreskin is fused with the glans penis. Also normal in children but that balano-preputial lamina membrane should dissolve during puberty.
• The frenulum is too short to allow complete retraction. This is called frenulum-short and it's technically not really phimosis but is often confused with it.

There are various cases of phimosis (levels) in adults:

1. Full retraction of the foreskin over the glans, but it is tight and hard to bring back to it's normal position (para-phimosis).
2. Partial retraction to show most of the glans but does not pass the glans end.
3. Retracts enough to expose the urinary meatus (peehole) but most of the rest of the glans cannot be exposed
4. Slight retraction but no enough to expose the full meatus
5. No retraction, just a very small orifice (pinhole phimosis) This is what I had to start with

Although pathalogical phimosis is not normal, it may not be an issue. If you don't have regular infections, if you have no problems with intercourse and if you urin flow is adequate and painless, you can live with phimosis totally fine. However if you have any of these issues or simply want to discover your glans you may want to cure your phimosis.

Treatment

Treating phimosis can be done with non-surgical solutions such as using a topical steroid cream such as betamethasone combined with regular stretching exercises. The stretching should be gentle to not cause any tears (which would only cause new scar tissue to form which is harder to stretch. Stretching the foreskin will cause it to replace dead cells (which naturally die anyway) with more new cells to accomodate that empty room. In time more cells will make the opening wider. When doing such stretching, the body will see this as a trauma and start a defense mechanism called inflamation which will cause an inrush of blood to the area that will cause swelling and will hinder your stretching efforts. This is where the steroid cream comes in, it minimizes that inflamatory reaction and will allow you to stretch a bit quicker and easier. It is possible to stretch wihtout that cream (which is a prescription drug), you simply need way more patience. If the opening is large enough, stretching can be done with fingers only, when it is not large enough, some companies sell phimosis stretching kits which consist of silicon rings of different sizes that you insert in the opening to stretch a phimotic ring that is smaller than a finger. Those rings however are not very useful at very small sizes if you have pinhole phimosis or similar. For those cases, some creative means need to be used such as using q-tips, ear streching tapers or even kniting needles.

For those who can't or don't want to go though this complex non-surgical process (I strongly advise you to try it though), then there are also surgical solutions that range from removing adhesions preputioplasty (partial circumcision that often fails) all the up to a full circumcision (thus loosing a very important and sensitive organ). The foreskin is not simply a skin fold, it is a complex 3 part organ:

• The outer skin, this is only the part you see when flacid or when you have phimosis, it's normal skin as the rest of your your skin.
• The inner mucausa is not skin, this is a mucous surface just like the inside of your mouth. It lubricates and protects your glans and also helps with the physics of intercourse.
• The ridged band is the tissues that connects the outer skin to the inner mucausa, it is a very complex organ comprised of some skin, some muscle (yes), and a lot of nerve endings that are very sensitive to bending. Many (including myselft) will tell you that this is more sensitive than the glans itself. The didged band is what becomes the phimotic ring when you have phimosis. As you progress through the stretching journey you will fell it like a tight strong string, then it will start feeling like a strong rubber band and finally it will become fully stretchable and feel like a wrinkled large pleasurable band.