Tight Foreskin (Phimosis) and Circumcision in Birmingham

A tight foreskin is a common problem that can make washing, passing urine, erections and sex uncomfortable. Mr Subramonian, consultant urologist, offers assessment and treatment – including circumcision, preputioplasty and frenuloplasty – at The Priory Hospital and HCA Harborne Hospital in Birmingham.

Book an appointment: The Priory Hospital, 0121 446 1668 · HCA Harborne Hospital, 0121 812 3051.

What is phimosis?

Phimosis means the foreskin is too tight to be pulled back (retracted) fully over the head of the penis. In adults it often causes discomfort or pain, especially when the penis is erect.

In young boys, a foreskin that does not pull back is normal. Most boys cannot fully retract the foreskin before the age of five, and the foreskin may continue to loosen naturally until around ten years of age or later. This does not need treatment unless it is causing problems such as infections or difficulty passing urine.

What causes it?

  • Natural tightness present from childhood that does not loosen with age.
  • Scarring after repeated infection or inflammation of the foreskin (balanitis), or after an injury.
  • Lichen sclerosus (also called balanitis xerotica obliterans, or BXO) – a skin condition of unknown cause that leaves the tip of the foreskin white, firm and scarred. It is the most common cause of phimosis starting in adult life.
  • A short frenulum – the band of skin on the underside of the penis. This can cause pain or tearing during sex even when the foreskin itself is not tight.

Diabetes makes foreskin infections more likely, so a tight or repeatedly inflamed foreskin can sometimes be the first sign of it.

Common symptoms

  • The foreskin will not pull back, or is painful when it does
  • Pain, splitting or tearing of the foreskin during erections or sex
  • The foreskin balloons, or the urine stream is thin or sprays, when passing urine
  • Redness, soreness or discharge under the foreskin
  • A white, shiny or thickened ring at the tip of the foreskin

Seek urgent help (A&E) if the foreskin has been pulled back and will not return over the head of the penis (paraphimosis), or if you cannot pass urine. Paraphimosis causes painful swelling and needs treatment the same day.

How is it assessed?

Mr Subramonian will ask about your symptoms and any past infections or injuries, and examine the foreskin. A urine test and a blood sugar check are used to look for infection and diabetes, and a swab may be taken if an infection is suspected. In most cases the right treatment can be agreed at the first consultation.

Treatment options

  • Steroid cream: a short course can loosen mild tightness, particularly in boys. In adults with scarring the improvement is often temporary once the cream is stopped.
  • Treating infection: antibiotic or antifungal treatment when a swab or examination shows infection, along with gentle daily hygiene.
  • Stretching: sometimes suggested, but there is no good scientific evidence that it works, and forcing the foreskin back can cause small tears that lead to more scarring.
  • Preputioplasty: small cuts are made to widen the opening while keeping the foreskin. It works well for natural tightness in children, but is less suitable for adults and is not recommended when lichen sclerosus is active.
  • Frenuloplasty: a short day-case operation to lengthen a tight frenulum. Occasionally a circumcision is still needed later.
  • Circumcision: removal of the foreskin. It is the most reliable permanent treatment for a scarred foreskin and for lichen sclerosus. Removing only part of the foreskin is generally not advised, because the scarring can come back.

What to expect from circumcision

Circumcision is usually carried out as a day case, most often under general anaesthetic, and takes around 30 to 45 minutes. Dissolvable stitches are used, so they do not need to be removed.

  • Swelling and bruising are common for the first few days; simple painkillers are usually enough.
  • The stitches normally dissolve within two to three weeks.
  • Most people return to desk-based work within a few days. Sex and masturbation should be avoided for around four to six weeks, or as advised, while the wound heals.
  • As with any operation there are small risks, including bleeding, infection and changes in sensation or appearance. Mr Subramonian will explain these fully before you decide on surgery.

Why choose Birmingham Urology Clinic?

Mr Subramonian has been a consultant urological surgeon for over 21 years and performs circumcision, preputioplasty and frenuloplasty as part of his private practice. You will be seen by him personally, from consultation to surgery and follow-up, with clinics at The Priory Hospital (0121 446 1668) and HCA Harborne Hospital (0121 812 3051). Most patients are seen within a week.

Further reading

Patient information from the British Association of Urological Surgeons: Tight foreskin (phimosis).