What is Phimosis?

Phimosis is simply the tightening of the foreskin. The two types of phimosis are ‘primary phimosis’ and ‘secondary phimosis’, and there are also 5 grades of phimosis to differentiate it’s severity.

In short, primary phimosis would happen since birth, while secondary phimosis is developed later on in life, mainly due to recurrent infection leading to scarring.

The treatment for phimosis would be to treat the underlying infection, if any. Other possible treatments would include hydrocortisone cream or circumcision.

Figure: Uncircumcised and circumcised penis.

Medication
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Hydrocortisone/ steroid cream

Steroid cream helps soften and reduce inflammation of foreskin- this may help reduce tightness of foreskin to a certain degree.

Usage Method:
Depending on product, however in general 2-3 times a day for at least up to one month

Common side effects:
Steroids may cause recurrent infection at site of application as it suppresses local immunity response.

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Tadalafil (Cialis)

Duration of effectiveness/half-life: 17.5 hours Dosage: 2.5mg, 5mg, 10mg, 20mg Common side effects: Hot flushing, headache, stomach upset, back pain, stuffy nose, dizziness

Duration of effectiveness/half-life:
17.5 hours

Dosage:
2.5mg, 5mg, 10mg, 20mg

Common side effects:
Hot flushing, headache, stomach upset, back pain, stuffy nose, dizziness

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Vardenafil (Levitra)

Duration of effectiveness/half-life: 4.5 hours Dosage: 2.5mg, 5mg, 10mg, 20mg Common side effects: Hot flushing, headache, stomach upset, back pain, stuffy nose, dizzines, flu-like symptoms

Duration of effectiveness/half-life:
4.5 hours

Dosage:
2.5mg, 5mg, 10mg, 20mg

Common side effects:
Hot flushing, headache, stomach upset, back pain, stuffy nose, dizzines, flu-like symptoms

Treatment

Principle of therapy:
Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised.

Duration of Surgery:
45 minutes to 1 hour

Pre-procedure preparation: Advisable to come with a family member/friend. Prior topical anaesthesia will be given to be applied over penile shaft and base to reduce pain during surgery and nerve block injection.

Post-procedure care:
Minimal bleeding is normal post circumcision. Compression bandage and bed rest may be advised during first day post procedure. Wound would be bandaged for at least 3 days. Wound inspection would be done on day 3 after surgery, after which bandage would be removed and further follow up usually not required unless further complications should happen. Wound should be kept dry at all times after surgery. Make sure to dry/ blow dry with hair dryer after shower. Sutures used are usually absorbable suture – no need for removal.

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