So you or someone you know has phimosis. Does it really matter what caused it? After all, once you’ve developed a condition the only thing you can do at that point is treat it. Right?

Not true!

Phimosis is one of the few conditions where the best treatment option usually depends on knowing what may have caused it.

There are 3 main reasons why knowing the cause of your phimosis helps:

  • It helps you decide which treatment is most likely to work for you
  • It allows you to predict how quickly your problem can be reversed
  • It can prevent your foreskin from retightening once you have fixed it

Bottom line, knowing the probable cause of your phimosis can save you a lot of hassle and increase your likelihood of treating it quickly and effectively.

Why does phimosis happen?

In many ways, to know why phimosis happens is to understand the difference between physiologic phimosis and pathologic phimosis.

In general, people with phimosis develop it because of two reasons:

Either because a tight foreskin is a natural part of their normal physiology
This is called physiologic phimosis.

Or their tight foreskin developed in response to a harmful event
such as a foreskin infection or physical trauma to the foreskin
This is called pathologic phimosis.

Knowing if you have physiologic or pathologic phimosis can help you figure out what your chances of success will be with conservative treatments like manual stretching or if you will need more aggressive treatments such as a circumcision.


Physiologic Phimosis

Physiologic phimosis happens when your foreskin simply grows as it was meant to. In other words, just like length of your fingers or the size of your ear lobes, the “openness” of your foreskin is primarily determined by your genes. The inability to retract the foreskin is very normal in early childhood because boys are born with foreskins that are physically attached to the glans.

As time goes by and the body grows, the foreskin separates from the glans and widens. For some, the foreskin opening grows wide enough to slide completely over an erect glans. For others, the expansion of the foreskin never really catches up to the size of the glans even into adulthood.

This is called physiologic phimosis and while the foreskin of these individuals has always been tight, it is much easier to stimulate it to grow further through stretching exercises and the use of steroid creams. Physiologic phimosis sufferers also see results faster than their pathologic counterparts. Finally, once the foreskin has been successfully stretched, there is a greater likelihood of the problem being permanently fixed in physiologic phimosis cases.


Pathologic Phimosis

Pathologic phimosis happens when our foreskin responds to an offending injury by shrinking. In many ways, pathologic phimosis is closest to a healing process during a disease that leaves your affected tissue negatively changed after it experiences damage.

Take for instance how our liver responds to harmful things such as alcohol or a hepatic virus. In an effort to heal the irritated tissue, our body may form a permanent scar around healthy liver cells. While this is meant to be a healing response by our body, it leaves the tissue less functional. The same applies to pathological phimosis sufferers and their foreskin.

People suffering from pathological phimosis may have been born with a tight foreskin but something along the way happened that turned it from physiological phimosis into its more potent pathological form.

Others may go through most of their adult life with a fully retractable foreskin only to develop it in their 60s or 70s. Here too, somewhere along the line foreskin tissue was forced to change in a way that did not maintain its normal state.

Many things can convert physiological phimosis or a non-phimotic foreskin into pathological phimosis:

  • The act of forcible foreskin stretching by a concerned parent can cause a child’s foreskin to tear away from the glans and develop fibrous tissue.
  • Something as simple as a urinary infection can irritate the foreskin and cause inflammation, resulting in its tightening
  • In some people, acute foreskin injury during sex or masturbation can lead to an inflammatory response that leads to pathological phimosis
  • In others, the aging process can weaken the integrity of the foreskin and increase its chances of injury from normal activity, eventually shrinking the opening

In all cases of pathologic phimosis, the foreskin narrows as an end product of our body’s defense mechanism to whatever irritates the sensitive foreskin tissue.

Note that some of these processes can be totally imperceptible to the individual and the only time they become aware of their condition is when their foreskin has completed its physiological response to the physical, biological or chemical irritant.

The worst part of developing pathological phimosis is that it is usually progressive and hard to treat. Most pathological phimosis cases involve some degree of scarring that increase the likelihood of future foreskin injury and reduce the likelihood of success from stretching or steroid creams.

Even worse is that studies have revealed that pathological phimosis has the highest chance of complications such as development of urinary strictures, recurring infections and even penile cancer.

The best course of actions in these cases are more aggressive treatments that are pursued before any major issues arise.