Phimosis
Phimosis is an inability to retract the foreskin over the head of the penis. In adults it is considered pathologic (rather than the normal physiologic phimosis of childhood) and is evaluated per guidance summarized in a 2024 Cochrane review.
Symptoms
Difficulty or inability to retract the foreskin, sometimes with pain, ballooning during urination, or recurrent irritation and infection underneath it.
Causes and risk
In adults, phimosis usually follows chronic inflammation, infection, or a scarring skin condition (lichen sclerosus); diabetes raises risk through both infection susceptibility and skin changes.
How it is evaluated
Diagnosis is by exam; adult-onset phimosis, especially with diabetes or suspicious skin changes, is worth a lower threshold for in-person evaluation to rule out lichen sclerosus or other causes needing biopsy.
Treatment
Topical corticosteroid cream applied for 4-8 weeks is first-line and more than doubles resolution rates compared with no treatment. Circumcision is the definitive option for cases that don't respond or that recur.
When to seek care
Paraphimosis -- a retracted foreskin that becomes trapped and cannot be pulled back, causing swelling of the glans -- is a true urologic emergency needing immediate treatment to prevent tissue damage.