How do I know if I or my child have phimosis?

If you have a child who is about two or three years old (maybe a few years older or younger) and you notice that he feels discomfort when urinating, has a swollen glans area, or has difficulty retracting the foreskin, your child may have phimosis. These symptoms may become visible even in the teenage years.

Or, you are the one who has trouble having sex (you feel pain during intercourse), you suffer from recurrent urinary infections or you simply find it hard to uncover the head of the penis, you are one of the few cases of phimosis that persist into adulthood.

In any case, the best thing to do is to go to a specialist doctor, according to the age (a paediatrician for your child or a urologist/andrologist for you).

Does phimosis affect fertility?

You can rest assured for the sake of your baby's future that there is no direct association between the presence of phimosis and fertility problems; in theory, a problem with the male external genitalia (phimosis) should not impair the process of spermatogenesis (where sperm is produced), within the testicles.

However, in a very indirect way, absolute phimosis could make normal ejaculation, and therefore, eventual fertilization, more difficult in one way or another.

Is there a suitable age for this?

Until now, specialists maintain the consensus that surgical interventions and non-surgical treatments aimed at reducing or eliminating phimosis problems have a higher success rate in paediatric patients. Also, the passage of years (for example, in persistent phimosis in adulthood) could aggravate the fusion of the foreskin with the glans, making treatment more difficult.

It is important to rule out this type of health problem at an early age so that treatment is timely and has a higher level of effectiveness.

Does phimosis affect the size of the penis?
There is no direct relationship between the size of the penis and the presence of phimosis, however, having a short, slightly retractable or very narrow foreskin could reduce the length by a couple of centimetres. It often happens that after phimosis surgery (or with the use of topical steroids), the penis may present a slight and apparent increase in size. Although extremely rare, we have also had cases opposite to our Seville practice: after an operation, the penis is shortened by a few centimetres and the existing tension in the erection shows that the stitches have been placed in the wrong (unnatural) place which must be corrected by phalloplasty (mainly by means of small grafts which reduce the tension in the tissues). This type of case is already closer to medical malpractice, and as we say is very unusual.
How long does the post-operative period last and when can the patient live a normal life?

The recovery period of circumcision (and other surgical interventions to treat phimosis) is usually, at most, about 10 days. That is, the time it takes for the wound to heal and absorb (fall out) the stitches.

During this period of time, it is advisable not to do intense physical activity (such as running or cycling) or have intercourse to prevent the wound from opening up again and the need of repeating the process (not to mention that it would be very painful).

Can you have sex while having phimosis?

You can have sex as long as you know your body well and the limits you can go to, otherwise, you could injure your foreskin or glans.

Many men with untreated phimosis have an active sex life without problems. Adequate lubrication is essential when having sex, and maybe even more so in this case.

Is phimosis the same as a short frenulum?

No, a short frenulum is a condition that occurs when the frenulum, a band of tissue that connects the ventral portion of the foreskin to the glans, is short or inelastic in length and for that reason, it is difficult to retract the foreskin.

In many cases, a short frenulum can be accompanied by phimosis aggravating the latter. The most commonly used treatment corresponds to surgical intervention: ventral slit or subincision.

Is it recommended to perform circumcision for balanitis or balanoposthitis?

Balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin) are conditions that in most cases have infectious causes, i.e. produced by fungi or bacteria. These inflammatory diseases of the glans (and foreskin) can also be caused by trauma or injury.

Treatment is therefore usually ointment/cream or oral antibiotic.

A circumcision (surgical removal of the foreskin) would, therefore, have no relevant effect on the treatment of balanitis or balanoposthitis caused by infections. Unless this surgery can reduce the compression of these anatomical structures produced by a narrow foreskin, typical of the most chronic cases of these diseases.

Why perform it in a private medical centre instead of a Social Security centre?

The advantages of carrying out this type of surgery in private medical centres as opposed to public health centres are the short times for carrying out the treatment (around 24/48 hours, whereas in Social Security centres it could take weeks or months to begin) and the quality of the treatment, not only from a medical point of view but also from an aesthetic point of view, especially in cases where surgery is required.

Also, in a private medical centre they will be able to provide you with more personalised, confidential attention, adapted to your needs.

Does a partial circumcision have advantages over a total one? When is each one of them indicated?

A circumcision is partial when the foreskin is not cut completely, leaving a small portion covering the glans, or total when the entire foreskin is removed, leaving the glans completely exposed.

However, total circumcision is considered better than partial circumcision because there is less risk of developing a fibrotic ring around the glans over time.

Whatever the case may be, there are clinical and aesthetic criteria aimed at choosing the best option on an individual basis, as each case is particular and must be treated in consultation with the depth and care it deserves.

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