Phimosis in Adults: Causes and Treatment (2026 Guide)
Phimosis in Adults: Causes and Treatment (2026 Guide)
Phimosis (tight foreskin) affects 1-2% of all adult men and can lead to significant discomfort. While many men believe that surgery is the only solution, there are actually several conservative treatment methods that are successful in many cases.
What is Phimosis?
Phimosis refers to the inability to fully retract the foreskin over the glans. In adults, two main forms are distinguished:
Primary (physiological) phimosis: The foreskin has never been fully retractable. This is normal in newborns and infants but should resolve by the age of 16-18.
Secondary (acquired) phimosis: The foreskin was previously normally retractable but has become constricted due to scarring, inflammation, or injury. This form is more common in adults.
Causes of Phimosis in Adults
| Cause | Frequency | Description |
|---|---|---|
| Balanitis (inflammation of the glans) | 40-50% | Recurrent inflammations lead to scarring |
| Lichen sclerosus | 20-30% | Chronic skin condition with whitish discoloration |
| Diabetes mellitus | 15-20% | Increased risk of infection due to high blood sugar |
| Forced retraction | 10-15% | Microtears lead to scar tissue |
| Congenital tightness | 5-10% | Primary phimosis persisting into adulthood |
A study from the British Journal of Urology International (2005) showed that Lichen sclerosus is the most common cause of acquired phimosis in adults, leading to circumcision in 40% of cases.
Symptoms and Severity Levels
Symptoms vary depending on the severity of the constriction:
Grade 1 (mild): Foreskin can be retracted when flaccid, but not during erection.
Grade 2 (moderate): Foreskin can be partially retracted, but the glans is not fully exposed.
Grade 3 (severe): Foreskin cannot be retracted at all, even when flaccid.
Grade 4 (very severe): Foreskin opening is so tight that urination is difficult.
Common complaints include:
- Pain during erection or sexual intercourse
- Difficulty urinating
- Recurrent inflammations (balanitis)
- Smegma accumulation under the foreskin
- Increased risk of infection
Conservative Treatment Methods
Before surgery is considered, conservative methods should be attempted. Studies show that 60-80% of cases can be treated without surgery.
1. Corticosteroid Ointments
Mechanism of Action: Cortisone ointments (e.g., Betamethasone 0.05%) reduce inflammation and make the foreskin more elastic.
Success Rate: 75-95% for mild to moderate phimosis
Application: Apply to the foreskin opening twice daily for 4-8 weeks, combined with gentle stretching exercises.
A meta-analysis of 14 studies (2014) showed that topical steroids led to complete or partial cure in 87% of patients.
2. Stretching Exercises
Technique: Gentle, gradual stretching of the foreskin opening over several weeks or months.
Success Rate: 60-80% with consistent application
Duration: 4-8 weeks for mild phimosis, up to 6 months for severe phimosis
Important: Never stretch forcefully! This can lead to micro-tears and scarring, worsening the situation.
3. Preputioplasty
Method: Surgical procedure where the foreskin is preserved but expanded through small incisions.
Success Rate: 85-95%
Advantage: The foreskin is preserved, unlike circumcision.
Cost: €800-1,500
When is Circumcision Necessary?
Full circumcision is only truly necessary in the following cases:
- Lichen sclerosus with pronounced scarring
- Paraphimosis (entrapped foreskin) as an emergency
- Recurrent severe infections despite conservative treatment
- Grade 4 phimosis with urinary retention
- Failure of all conservative methods after 6-12 months
According to a study from The Journal of Urology (2012), only 15-20% of men with phimosis actually require circumcision.
Apollon Fold as an Alternative?
Important: Apollon Fold does NOT work with existing phimosis. The method requires the foreskin to be fully retractable.
However, Apollon Fold can be used after successful treatment of phimosis to achieve the benefits of circumcision (keratinization, improved hygiene, longer stamina) without surgery.
Treatment Algorithm
| Severity | First Choice | Second Choice | Last Option |
|---|---|---|---|
| Grade 1 (mild) | Cortisone Ointment + Stretching | Preputioplasty | Circumcision |
| Grade 2 (moderate) | Cortisone Ointment + Stretching | Preputioplasty | Circumcision |
| Grade 3 (severe) | Preputioplasty | Circumcision | - |
| Grade 4 (very severe) | Circumcision | - | - |
Complications of Untreated Phimosis
If phimosis is not treated, serious complications can occur:
- Paraphimosis: The retracted foreskin constricts the glans and cuts off blood supply. This is a urological emergency!
- Recurrent Urinary Tract Infections: Bacteria accumulate under the constricted foreskin.
- Penile Cancer: Chronic inflammation and smegma accumulation increase the risk (very rare, but documented).
- Sexual Dysfunction: Pain during intercourse leads to avoidance behavior and psychological problems.
When to See a Doctor?
Consult a urologist if:
- The foreskin suddenly cannot be retracted (possible paraphimosis)
- Pain occurs during urination or sexual intercourse
- Recurrent inflammation despite good hygiene
- Bleeding or purulent discharge
- Conservative treatment shows no improvement after 3 months
Conclusion
Phimosis in adults is treatable, and in most cases, circumcision is not necessary. Corticosteroid ointments combined with stretching exercises lead to success in 75-95% of patients. Surgery is only required in severe cases or when conservative methods fail.
Important: Apollon Fold is not a treatment for phimosis, but can serve as an alternative to circumcision after successful therapy.
Ready to try Apollon Fold?
After successful phimosis treatment, you can achieve the benefits of circumcision without surgery.
Scientific References
-
Oster J. "Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys." Archives of Disease in Childhood 1968;43(228):200-203.
-
Rickwood AM, Kenny SE, Donnell SC. "Towards evidence based circumcision of English boys: survey of trends in practice." BMJ 2000;321(7264):792-793.
-
Kikiros CS, Beasley SW, Woodward AA. "The response of phimosis to local steroid application." Pediatric Surgery International 1993;8:329-332.
-
Lund L, Wai KH, Mui LM, Yeung CK. "An 18-month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo." Scandinavian Journal of Urology and Nephrology 2005;39(3):242-244.
-
Moreno G, Corbalán J, Peñaloza B, Pantoja T. "Topical corticosteroids for treating phimosis in boys." Cochrane Database of Systematic Reviews 2014;(9):CD008973.