Most people with phimosis simply know it as a tight foreskin condition that prevents the glans from being fully exposed. However, there are many varying degrees of severity when it comes to phimosis and knowing what stage your phimosis is at can help you determine your risk and the best way to treat it.
Here are the 4 stages of phimosis:
Stage 0: At Risk
Simply stated, anyone with a foreskin belongs in this category. This includes all uncircumcised males regardless of age. Any intact male of any age can develop phimosis at any point in their life. This is because foreskin tissue always has the potential to tighten in response to various aggravating factors, even if the person has always been healthy and never had problems with their foreskin their entire life.
Unlike popular belief, not everyone suffering from phimosis is born with it. Quiet often an infection or injury to the foreskin during adulthood can cause it to progressively tighten and develop into phimosis.
On the other hand, while most children have a foreskin that does not retract, a diagnosis of phimosis before the age of 10 is usually incorrect. To diagnose a child with phimosis, there have to be other factors at play, such as the inability to comfortably pass urine due to a very small foreskin opening.
Bottom line: If a male still has his foreskin, then he is, at the very least, at stage 0 and always at risk of developing phimosis.
Your risk: Minimal. A foreskin that functions as it’s supposed to is a healthy part of the male anatomy and no cause for concern.
What you can do about it: Since this stage simply reflects a normally functioning foreskin, there is no need for preemptive treatment. Undergoing a circumcision simply to prevent a future occurrence of phimosis is unwarranted. The best thing you can do at this stage is maintain proper penile hygiene and care to prevent aggravating the foreskin or the development of phimosis.
Remember, a non-retractile foreskin is normal in uncircumcised male children and does not always warrant intervention. To learn more, read this article on how to care for a child with a foreskin that does not retract.
Stage 1: Mild Phimosis
During this stage, a person is able to fully retract the foreskin during both the flaccid and erect state, however pulling the foreskin past the glans during the erect state is painful. In other words, the foreskin is wide enough to easily move past a flaccid glans but tight enough to cause discomfort when moving across an erect glans.
Sufferers often complain of soreness after sex or masturbation. This soreness tends to ease once the foreskin is given rest from any aggravating action.
People at this stage are most likely to progress further to more severe stages of phimosis. That’s because the sufferer usually continues to pull the foreskin back despite the irritation and often considers their condition a nuisance they can live with.
Mild phimosis sufferers are in a unique position when it comes to their condition. Since their foreskin is only slightly tight, they can easily resolve their condition with minimal efforts. However, they are also most likely to ignore their condition and continue to chronically injure the foreskin by continuing the cycle of irritation, inflammation and tightening.
On the positive side, penile hygiene is not an issue since you are able to retract the foreskin during the flaccid state and cleanse it properly.
Bottom line: Don’t ignore your problem. At this stage, the foreskin is not functioning as it should and repeated injury can cause your condition to progress to Stage 2 or worse.
Your risk: The biggest risk here is further tightening of the foreskin. Once that happens, the sufferer is automatically exposed to the risks associated with higher stages of phimosis.
What you can do about it: This is one of the few cases where a prescription steroid cream and manual stretching may work better than anything else. Also, the patient would be well advised to practice care when pulling their foreskin back and use lubricants when necessary to ease its gliding action.
Stage 2: Moderate Phimosis
During moderate phimosis, the sufferer is not able to retract their foreskin over the glans during the erect or flaccid state. However, the top of the glans is partially exposed even though the foreskin is not wide enough to slide over the corona (widest part at the bottom of the glans).
At this stage, the condition is severe enough to affect the sufferer’s life in many ways:
- Aesthetic impact – Since the foreskin never retracts over the foreskin, the penis takes on an unconventional look during an erection. Even in the erect state, the glans remains covered with foreskin and the sufferer’s condition becomes visibly apparent.
- Emotional impact – Moderate and severe phimosis sufferers often report embarrassment relating to their condition and are reluctant to share it with potential partners or even their physicians. This emotional impact is often amplified in situations when a person may be required to be in the nude where it often becomes a source of anxiety (such as locker rooms, public showers, physical exams by a doctors, etc.)
- Hygiene – The area under the foreskin tends to collect dirt, secretions from the glans, bacteria and other debris that need to be cleansed on a daily basis. While the opening of the foreskin at this stage is wide enough to allow water through, the inability to pull back the foreskin completely makes it difficult to clean hard to reach areas such as the region under the corona where dirt tends to accumulate.
- Sexual function – During normal intercourse, the foreskin rolls back to the point where the glans is completely exposed. However, much of this movement is limited in moderate phimosis especially if the erection leaves little room for the foreskin to move any further. The range of motion often is so limited that the foreskin barely moves over the glans in the presence of an erection. This translates to reduced sensitivity and greater soreness during sex or manual stimulation. The role of sensation by the glans is forced to be replaced by the less sensitive outer foreskin. In some cases, this can even lead to premature impotency.
- Paraphimosis – In all other stages of phimosis the foreskin can either slide over an erect glans (stage 1) or come nowhere close to it (stage 3). However, moderate phimosis (stage 2) is the only stage where the foreskin may be slightly narrower than the glans and deceive the sufferer into thinking that if they pull down hard enough their problem can be fixed. In an effort to expose the glans, the person may forcibly pull back their foreskin and in turn trap it behind the glans. This condition is called paraphimosis and it requires emergency care because it can lead to rapid swelling, choking off blood flow to the foreskin or glans. In short, never try to force your foreskin behind the glans if it doesn’t retract easily.
Bottom line: Moderate phimosis is more than a nuisance by this stage and should be treated seriously. While the opening of the foreskin may seem too narrow to pull the glans through at this point, remember that the foreskin can be stimulated to grow at any age.
Your risk: There are high chances of serious injury from forcible retraction. You are also at higher risk of foreskin inflammation (balanitis) from injury, tissue scarring from repeated trauma and progressing towards severe phimosis.
What you can do about it: There are several ways you can treat your condition at this stage. Start a regimen of consistent stretching that stimulates your foreskin to grow over time. Steroid creams may not be beneficial because long term use isn’t recommended and your foreskin may take time to grow. While circumcision is an option, it may be wise to reserve it as an option of last resort. After all, the foreskin isn’t useless and circumcision is permanent.
Stage 3: Severe Phimosis
Severe phimosis is also sometimes referred to as pinhole phimosis. By this stage the foreskin is so tight that no part of the glans is visible. Pulling back the foreskin simply reveals a small opening which usually looks like a tiny hole (thus pinhole).
At this point, phimosis stops being a problem just limited to your foreskin and can begin to affect your overall health.
In addition to all the risks posed by moderate phimosis (stage 2), there are 3 reasons why severe phimosis is even more damaging:
- Repeated injuries to the foreskin become unavoidable and cause ongoing pain – Severe phimosis puts extreme stress on your foreskin even in the flaccid state. It is so restrictive on the foreskin that simply passing urine can be painful. Most sufferers experience recurring injuries to the foreskin each time they urinate or have an erection. Unlike stage 2, where you can provide rest to your foreskin by abstaining from any manual movements, you can’t abstain from passing urine. This inevitably leads to chronic irritation and ongoing inflammation, which can lead to excessive scarring of the foreskin. Scarring can lead to further narrowing and since scar tissue easily tears, the sufferer gets trapped in a worsening cycle of increasing pain.
- Interruption to the free flow of urine can be dangerous – During urination the bladder empties its contents out of the body through the urethra. The urethra starts at the bladder and ends at the tip of your glans and normally urine never encounters any obstructions on its way out. However, during severe phimosis urine empties out of the bladder faster than it can empty out past the narrow foreskin opening. This causes ballooning of the foreskin from urine piling up outside the glans.
Unfortunately, this obstruction to urine flow can cause many serious problems such as recurrent urinary infections that can spread upward towards the bladder, prostate or even the kidneys.
Unless the flow of urine is returned to normal, this increase in pressure can begin to cause abnormalities in penile tissue such as thickening of the tip of your glans or even narrowing of the urethra called urethral strictures. This kind of narrowing of the urinary tract can cause serious complications and needs prompt medical attention.
- It can cause severe hygiene issues – The outer layer of our glans sheds dead cells each day, the sebaceous glands frequently secrete a substance called smegma and wastes are constantly being released from the body through urine. While a normally functioning foreskin has self-cleaning properties, improper aeration or cleansing during severe phimosis can lead to a buildup of toxins, bacteria and cellular debris under the foreskin.Pinhole phimosis sufferers often report foul smells emanating from their genital region and tend to develop infections far more often than the general population. Penile hygiene is also important because it has been implicated as a contributing factor for penile cancers by some experts.
- Inability to inspect glans tissue for serious problems such as penile cancers or STDs – Penile cancer is predominantly diagnosed in uncircumcised men. Within this group, phimosis sufferers have the highest risk of developing penile cancers. What compounds this risk even further is that severe phimosis sufferers are most likely to be unaware of cancerous lesions developing under their foreskin.Where an uncircumcised male will quickly notice a change in their penile tissue, a severe phimosis sufferer may go blissfully unaware of the growing threat for months or even years. This inability to visually monitor the health and condition of your glans increases the likelihood that serious problems will be caught at later stages when they may have progressed further.
Bottom line: If you have severe phimosis, the time to act is now. If the constant pain and irritation are not reason enough then remember that not all damage being caused by your condition is immediately obvious. Your penile tissue could be undergoing physical changes from the increased stress that may require more drastic medical intervention in the future. Learn as much as you can about your condition, about your options and take action sooner than later.
Your risk: There are multiple threats at this stage that can cause progressive damage to your penile tissue, your urinary system and your overall health. This stage warrants immediate and effective care because exposure to increased pressure affects everything upstream from the penile tip. Also, you may very well save your own life if you are able to catch cancerous lesions in its earliest stages.
What you can do about it: Try the prolonged stretch vs intermittent stretch approach. Visit a urologist if possible and discuss your condition with him or her. If there is a situation in which a circumcision may be warranted, this is it. Whatever you do, don’t ignore your problem, especially when there are plenty of things you can do to resolve it permanently.
So there you have it. The good, the bad and the ugly of phimosis and its effects on your health. If knowledge is half the battle, then you are twice as armed with knowledge and in a better position to make informed decisions.
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