Foreskin problems and circumcision

The foreskin is a roll of skin that covers the end of the penis. When you’re born, the penis has a foreskin. People who have been circumcised have had their foreskin removed for cultural, religious, medical, or aesthetic reasons.

If you do have a foreskin, it’s important to look after it. This means gently washing inside and outside your foreskin with soap and warm water daily. It also means paying attention to any changes to your foreskin. If it becomes difficult to pull back, red, swollen, or inflamed, or develops lumps, it’s a good idea to see a doctor, to make sure you avoid any long-term damage.

Learn more about penis lumps.

Foreskin diagram
Balanitis

What is balanitis?

Balanitis (bal-an-eye-tis) is a common infection that occurs at the head of the penis. It can happen at any age, but it’s more likely to develop if you have a foreskin.

 

What are the symptoms of balanitis?

Balanitis can cause the following symptoms:

  • A foreskin that can’t be pulled back

  • Itchiness or a rash

  • Pain or tenderness at the head of the penis

  • A red or swollen foreskin

  • Discharge from the penis.

 

What causes balanitis?

Balanitis happens when you don’t keep the inside of your foreskin clean. This can be because your foreskin isn’t pulled back, or can’t be pulled back, when washing the penis. It’s common for the inflammation to be caused by bacteria or fungus.

Balanitis can also be caused by irritation from chemicals — the kinds found in household soap, clothing, washing powder, and the latex in condoms. Other causes include allergies to certain medicines, viruses such as HPV (human papillomavirus), and diabetes.

In adults, balanitis can be a sign of diabetes. Because diabetic people have increased levels of sugar in their urine, the combination of sugar and moisture can lead to bacterial or fungal growth if urine gets trapped under their foreskin. If you have a problem with recurring balanitis, it’s a good idea to ask your doctor about a test for diabetes.

 

What treatments are there for balanitis?

Usually, washing the penis and the inside of your foreskin with soap and warm water will help prevent balanitis. If balanitis is caused by an infection, you can use antibiotic or antifungal ointments/creams to treat it.

Balanitis xerotica obliterans (BXO)

What is balanitis xerotica obliterans (BXO)?

Balanitis xerotica obliterans (BXO, also known as lichen sclerosis) isn’t the same as balanitis. BXO is a condition where scar tissue forms at the tip of the foreskin, tightening the foreskin and making it difficult to pull back.

If you’re worried about white scarring on your foreskin, you can talk to your doctor. BXO gets worse over time, so it’s important to seek help as soon as possible.

Both balanitis and BXO increase the chance of developing penis cancer, although penis cancer is still very uncommon (one in 100 of all male cancers).

Phimosis

What is phimosis?

Phimosis (fi-mo-sis) is a condition where your foreskin is too tight, or the tip of your foreskin has narrowed and can’t be pulled back to expose the head of the penis.

 

What are the symptoms of phimosis?

Phimosis is often found in children or young adults, usually before puberty.

Boys and men with phimosis can have the following symptoms:

  • Pain when urinating

  • Urinary retention (when the bladder is not completely emptied during urination)

  • Urinary tract infections (UTIs)

  • Skin infection of the penis.

Phimosis can cause you to experience severe pain when you have an erection or during sexual intercourse. It can also cause injury to the foreskin, leading to minor bleeding and infection. In these situations, you might need to be circumcised.

 

What causes phimosis?

Phimosis can happen after infection or as a result of inflammation (balanitis).

Phimosis can also happen after an injury that causes your foreskin to tear (called secondary or acquired phimosis). As the tear heals, scar tissue can make it more difficult for your foreskin to stretch. Scarring from BXO can also cause phimosis.

 

What treatments are there for phimosis?

You can treat phimosis with steroid creams, applied once or twice daily for a couple of weeks.

If steroid creams don’t work, or the phimosis is severe, circumcision might be the best option. If you have phimosis, you should also be checked by your doctor for balanitis, BXO, diabetes, and penis cancer.

Paraphimosis

What is paraphimosis?

Paraphimosis (pa-ra-fee-mo-sis) happens when your foreskin is pulled behind the head of the penis, and can’t go back to its original position.

If your foreskin stays in this position, it can cause pain and swelling and can stop blood flow to the penis.

This is a serious medical problem, and has to be treated immediately so that you avoid long-term damage to the penis.

 

What causes paraphimosis?

Paraphimosis can be caused by an injury to the head of the penis. It can happen at any age, including infants if a parent pulls back the foreskin and either doesn’t, or isn’t able to, pull it forward again.

 

What treatments are there for paraphimosis?

The first thing to do is to apply ice to the area to help reduce any swelling, and then try to move your foreskin forward, using lubricant, to its usual position.

Your doctor can also inject certain medicines that reduce swelling.

If the foreskin does not go back to its normal position, a surgeon may have to cut the foreskin to release it, or an urgent circumcision may be needed.

Circumcision

What is circumcision?

Circumcision is the surgical removal of the foreskin.

In Australia, circumcision was once widespread, but now only around one in seven infant males (10-20%) have it done. Most parents choose to circumcise their children for family, religious, and cultural traditions.

Older people usually only get circumcised to treat a medical condition, such as balanitis, phimosis, paraphimosis or BXO. Some people choose to be circumcised for personal reasons.

Circumcision in older people is a more complex operation, although it’s usually successful. In infants, about one in 200 circumcisions have some complication, but in older people, the risk of complications is roughly ten times higher.

Serious complications are rare. The most common problems are inflammation, bleeding and infection, which are easily treated in most cases.

Circumcision lowers the risk of urinary tract infections (UTIs), infections under the foreskin, tearing of the foreskin, and sexually transmissible infections (STIs) such as HPV, genital herpes and HIV. Circumcised men also have a lower risk of penis cancer.

Your doctor’s appointment

Questions to ask your doctor

  • What treatment options are available for my foreskin problem?

  • What could happen if I don’t treat the problem?

Things to think about before your appointment

  • When did you notice a change to your foreskin?

  • What problems are you having? I.e. not being able to pull back your foreskin, new lumps on the head of the penis,  itchiness, rash, redness, swelling tenderness, discharge, problems urinating.

Email these questions to yourself to take into your doctor's appointment.

Resources

Foreskin Hygiene Fact Sheet Image Tile

Fact sheet

Foreskin hygiene