Adult Foreskin

Phimosis (An indications for circumcision)

Phimosis refers to the inability to retract the distal foreskin over the glans penis.

There are three clinical manifestations:

• Inability to retract the foreskin over the glans penis
• The foreskin is partially retractable, only part of the glans could be exposed
• The foreskin is retractable to expose most of the glans, but there would be discomfort caused by the tight foreskin

Phimosis may affect the patients as in the followings:

• Phimosis may lead to inaccurate urine stream or urine stream bifurcation resulting in urine wetting the patients' body, clothing or the surrounding environment.
• Patients with phimosis usually cannot retract and clean their foreskin and glans of penis.  There is often urine and dirt accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitis or even urinary tract infections. Through sexual intercourse, the bacteria inside the foreskin can be passed to patients' sexual partners causing vaginitis, pelvic inflammatory disease, or urinary tract infections.   The bacteria of the female sexual partners can pass her bacteria to the patients with phimosis causing unpleasant odors, balanitis, posthitis or even urinary tract infections.   
• Patients with phimosis often have easy slippage of condom or difficulty in wearing condom.
• Phimosis will affect ejaculation.  The ejaculated semen is usually trapped between prepuce and glans of penis.  This in turn may affect fertility.
• As the glans of penis of patients with phimosis is nearly always covered by foreskin, the glans of penis is usually more sensitive or even hypersensitive comparing to normal guys.  The glans of penis with hypersensitivity, once exposed, may result in premature ejaculation. After circumcision, when the glans of penis is normally exposed, the skin of the glans of penis thickens with time.   Skin thickened glans of penis will become less sensitive, circumcision may improve premature ejaculation.
• Pediatric / Adolescent / Adult patients with phimosis usually cannot retract and clean their foreskin and glans of penis.  There is often urine and dirt accumulating between the glans of penis and prepuce resulting in bacteria overgrowth, unpleasant odors, balanitis, posthitis. or even urinary tract infections.  After infection and inflammation, fibrosis, scar and tissue contraction may set in the prepuce, glans of penis or the shaft of penis, affecting urination, growth of the penis or causing penis shape distortion.
• Patients with phimosis have unusual external sexual features.  Patients may experience a negative psychological impact.

Paraphimosis (An indications for circumcision)

Paraphimosis is the entrapment of a tight retracted foreskin proximal to the coronal sulcus in uncircumcised males. The tight retracted foreskin cannot return to its normal position and forms a tight constricting ring over the distal shaft of penis. It causes vascular and lymphatic obstruction leading to redness and swelling of the penis and prepuce distal to the constricting prepuce ring. Paraphimosis is a medical emergency requiring urgent attention. With time, severe vascular and lymphatic obstruction could lead to penile infarction (necrosis), gangrene and rarely auto amputation if untreated.

Long prepuce (An indications for circumcision)

Long prepuce means that the prepuce / foreskin covers the glans of penis and urethra during erection.

It may have the following effects:

• Patients with long prepuce may have spraying of urine or difficulty in controlling the urine stream resulting in urine wetting the body, the clothing, or the environment
• If the patients with long prepuce do not clean the prepuce regularly, there may be urine and dirts trapped between the prepuce and glans of penis.  As bacteria grow, it may cause bad odor, balanitis, posthitis and urinary tract infection.  During sexual intercourse, bacteria inside prepuce may be passed to the female partner causing vaginitis, pelvic inflammatory disease, or urinary tract infection etc.  Vice versa, the female bacteria may infect the long prepuce male partner causing balanitis, posthitis, or urinary tract infection etc.
• Patients with long prepuce may have easy slipping out of condom.
• During ejaculation, the semen may be trapped inside the prepuce and affect the fertility.  Circumcision can improve this situation.
• As the prepuce covers the glans of penis, the glans of penis is very sensitive once it is exposed and may cause premature ejaculation.  After circumcision, the glans of penis is completely exposed and the skin over the surface thickens.  The glans of penis becomes less sensitive and which improves premature ejaculation.

Foreskin / Prepuce diseases (An indications for circumcision)

There may be diseases in the prepuce requiring surgical treatment, e.g partial prepuce excision or circumcision. These foreskin diseases are indications for circumcision: flat wart, genital wart, sebaceous cyst, recurrent balanitis, recurrent posthitis, seborrhoeic keratosis, balanitis xerotica obliterans, skin cancer etc,.