Doctors for Phimosis Treatment

Phimosis is a urological condition that is characterized by the inability of the foreskin to be retracted over the penile glans or the head of the penis. Phimosis can occur for various reasons and does not necessarily require treatment. If your phimosis problem is asymptomatic, it can be left unattended. However, if it becomes symptomatic and starts causing you problems, you may require surgical intervention for effective treatment.

Phimosis is a fairly common condition. In fact, it is found to be present in all newborn male babies. Normally, the foreskin starts to loosen up on its own and resolves itself before adolescence. However, in some cases, it can last into adulthood and cause symptoms such as difficulty urinating, swelling and tenderness in the penis, painful erection, and recurrent penis infections. In some mild to moderate cases of the condition, non-surgical options such as antibiotics and phimosis creams are considered to be effective. But, surgery is typically considered to be the best and the most effective solution for phimosis in adults.

Phimosis is primarily categorized into 2 types:Pathological Phimosis andPathological Phimosis

• Physiological Phimosis: Physiological phimosis, sometimes referred to as primary phimosis, is a type of phimosis that occurs naturally at birth. Most cases of phimosis resolve on their own as a newborn reaches adolescence. In some cases, though, it can persist into adulthood as well. Non-surgical treatment methods such as steroid creams are generally considered to be highly effective in treating physiological phimosis. However, if the condition seems to persist thereafter, your urologist may recommend circumcision surgery.
• Pathological Phimosis: Also known as secondary phimosis, it is a type of phimosis that occurs due to external factors such as scarring, infection, or inflammation of the penis caused by an injury. Pathological phimosis can occur irrespective of age and usually requires surgical treatment. Some of the common phimosis causes in adults include:
• Poor hygiene
• Balanitis
• Posthitis
• Balanoposthitis
• Skin conditions
• Penis infection
• Formation of scar tissue
• Injuries

Circumcision is considered to be the best and the most effective treatment for phimosis in adults. Circumcision is a surgical procedure that involves partial or complete removal of the foreskin itself.

Preoperative diagnosis for phimosis is a relatively simple procedure that usually concludes with a simple physical examination. The urologist will try to gently retract the foreskin over the penile glans manually. If the foreskin is not retractable or the penile glans are not completely visible, it is an indication for phimosis. It is also likely that your urologist will ask you questions about any pre-existing medications you may be on and your entire surgical and medical history. In most cases, the preoperative diagnosis for phimosis surgery concludes here. However, in some cases, your doctor may perform some additional diagnostic tests to better understand your condition. Some additional tests that your urologist may perform include:

• Skin Test: A skin test is a commonly performed test that your urologist may perform prior to phimosis surgery. A skin test will help the urologist identify bacteria, viruses, and fungi that may be present on your penis skin. In this test, the urologist will gently rub a cotton swab over the foreskin. The swab will then be sent to a laboratory for analysis.
• Urethral Discharge Swab: A urethral discharge swab will help your urologist identify bacteria and viruses. In this test, the urologist will carefully insert a cotton swab (about 3/4 of an inch in size) into your ureteral opening and gently rotate it. The cotton swab will then be sent to a laboratory for testing and analysis.
• Urinalysis: A urinalysis examines the visual, chemical, and microscopic aspects of your urine. They’ll look for different causes of your condition, including bacteria or high sugar (glucose) levels, which could be a sign of diabetes. You’ll be asked to urinate into a special cup provided by your healthcare provider. The urine sample will then be sent to a laboratory for testing.
• Blood Test: A blood test is one of the most common tests that your urologist may perform to monitor your overall health and check for signs of any infection that may have caused phimosis. In a blood test, the urologist will use a thin needle to draw a small amount of blood from a vein in your arm. This blood sample will then be sent to a laboratory for testing and analysis.

There are primarily 3 methods of performing a circumcision surgery. While all 3 methods are considered safe and effective, they vary in the overall procedure and equipment.

• Laser Circumcision: Laser circumcision is an advanced and minimally invasive urological procedure that is performed to treat phimosis. The entire procedure is typically performed under local anesthesia and does not take more than 10-15 minutes to complete.
• In a laser circumcision, the urologist uses a highly focused beam of light to cut and remove the foreskin. This laser is manually operated by the urologist and gently moved along a predetermined incision line. Laser circumcision is an extremely precise procedure and, as a result, is widely considered to be best for smooth wound edges and preservation of tissue around the surgical site. Additionally, due to its high operating temperature, it also ensures minimal bleeding. This results in better cosmetic results, minimal risk of complications, and shorter recovery periods compared to traditional methods. Laser circumcision is commonly recommended by most urologists for its better results and faster recovery. Chances of complications in laser circumcision are negligible, and the procedure has proven to provide patients with a better postoperative quality of life.
• Stapler Circumcision: Stapler circumcision is another procedure that your urologist may recommend to treat phimosis. Stapler circumcision is a surgical procedure that utilizes a stapler device, an advanced and disposable surgical tool, to remove the foreskin. This stapler device is placed over the penis glans and fits snugly around the head of the penis. As the stapler device is fired, it cuts and removes the foreskin in a quick motion while simultaneously closing the incision wound with a silicone ring. This silicone ring helps minimize bleeding and promote healing. When the incision wound has completely healed, which generally takes anywhere from 7 to 14 days, the silicone ring will fall off on its own as well. Once the foreskin has been removed, the device is removed, and you will likely be moved to a recovery area. If your condition is stable and there are no immediate complications after the surgery, you can go home.
• Open Circumcision: Medically termed an open-dorsal slit technique, an open circumcision is a more conventional form of circumcision surgery. In an open circumcision procedure, the surgeon uses a scalpel or surgical scissors to make incisions along the upper length of the foreskin from the tip of the corona. Once the incision is made, the foreskin is pulled back to expose the penis glans. Open circumcision is typically performed under general anesthesia and can take anywhere from 40-50 minutes to complete. Compared to laser or stapler procedures, open circumcision is also more invasive. As a result, it requires longer to heal and carries a slightly increased risk of complications such as excessive bleeding or infection. However, actual cases of any major postoperative complications are rare.

Before arriving at the hospital, your urologist may instruct you to follow some simple tips and guidelines, such as:

• Avoid eating or drinking anything for at least 6 hours leading up to the surgery
• Leave any jewelry or ornaments at home. You do not need them in a hospital, and they may interfere with the procedure.
• Make sure to take a shower or bath before arriving at the hospital. It is also advisable to trim down any pubic hair you may have so it doesn't interfere with dressing.
• Wear loose, comfortable clothes. It is also advisable to bring an extra pair of snug, comfortable briefs. You will need to wear them after the surgery to make sure the penis is held in place. Continue to wear them until the soreness and swelling have eased.
• Avoid smoking or consuming alcohol for at least 48 hours prior to surgery. Smoking and alcohol can leave you dehydrated, interfere with the recovery process, and reduce the effectiveness of the anesthetic.
• Take at least a few days off from work. Most patients can return to their daily routine in just 2-3 days after surgery, but each patient has different healing capabilities, and your recovery time after phimosis surgery may take slightly longer to complete.
• It is imperative that you avoid driving home after your phimosis surgery. Due to anesthetic after-effects, you may feel disoriented, nauseous, and blurred vision. It is advisable to plan ahead and have someone drive you home or at least accompany you in a cab.

Complete recovery after a circumcision surgery typically takes around 7 to 10 days. But, most patients are able to return to their daily routines just 2 to 3 days after surgery. It is to be noted, however, that every patient’s healing capability is different, and depending on your overall health, quality of postoperative care, and method of surgery, recovery time may take slightly longer. In such a case, do not panic and contact your healthcare provider. Let them know if you have been facing any odd signs during recovery, and proceed as instructed.

After the surgery, it is expected to have slight swelling, pain, redness, and bruising around the penis. These side effects are typically considered to be normal and do not indicate any complications. They should subside on their own in a few days after surgery. To minimize swelling and discomfort, your urologist may advise you to place an ice pack on the groin every 2 hours for at least 10 to 20 minutes. To further minimize the chances of any postoperative complications and boost recovery, your urologist may instruct you to follow some simple tips and guidelines such as:

• Stay hydrated. It is generally advised to drink at least 2 to 3 liters of water every day. It is also advised to avoid carbonated beverages and include healthy fluids in your daily diet, such as coconut water and fresh fruit juice.
• Avoid excessive consumption of any junk food. Instead, opt for more nutritious food and include more fiber and protein-rich foods in your diet.
• While some low-impact exercises such as walking are recommended, avoid strenuous exercises or activities such as running or heavy weight lifting. Such exercises may exert excessive force on the surgical site and hinder recovery.
• Avoid going to swimming pools or using public lavatories for at least a few weeks after surgery.
• Refrain from any sexual intercourse at activities for at least 4 to 5 weeks after surgery or until the urologist thinks it's safe to do so. Engaging in sexual intercourse or activities before giving your penis sufficient time to heal could lead cause you significant pain and lead to infection.
• Avoid wearing baggy boxer shorts. It is advisable to wear comfortable, snug underwear that can hold the penis in place.
• Make sure to attend every follow-up consultation scheduled by your doctor. If there are any complications during your recovery, these consultations will allow your doctor to identify and address them.

Before going forward with surgery, your healthcare provider may recommend some non-surgical alternatives to circumcision that may help you reduce phimosis symptoms and provide effective phimosis treatment without surgery.

Infections are some of the most common reasons behind pathological phimosis in adults. If the urologist suspects an infection to be the primary reason behind your condition, he or she may prescribe you some antibiotics for effective phimosis treatment. Some medications that your urologist may prescribe are given below:

• Amoxicillin: Amoxicillin is a penicillin-type antibiotic that is commonly prescribed by healthcare providers to treat bacterial infections. Amoxicillin typically comes as a capsule or chewable tablet and is taken by mouth with or without food and as directed by your doctor. It is imperative to continue taking this medication until the full prescribed amount is finished.
• Doxycycline: Doxycycline is a medication that belongs to the Tetracycline class of drugs and is commonly prescribed by healthcare providers to treat various infections. Doxycycline is also prescribed by healthcare providers to treat certain Sexually Transmitted Infections (STIs), such as chlamydia, gonorrhea, and syphilis. Doxycycline is usually taken with a full glass of water. It is also advised not to drink alcohol while taking doxycycline because it can stop it from working properly. Examples of doxycycline include Vibramycin-D, Efracea, and Periostat.
• Metronidazole: Metronidazole is an antibiotic medication that belongs to a class of drugs called nitroimidazole antimicrobials and works by killing the bacteria causing the infection. Metronidazole is commonly prescribed by healthcare providers for treating anaerobic bacterial infections and protozoal infections. Generally, Metronidazole 400 mg twice daily for one week is recommended for effective phimosis treatment.
• Clarithromycin: Clarithromycin is a macrolide antibiotic that is primarily used to treat bacterial infections. Therefore, it will not work against viral infections. Clarithromycin should be taken exactly as prescribed by your doctor. It is important to avoid taking this medication in smaller or larger amounts than what is recommended.

There are several steroid and non-steroid-based phimosis creams and ointments that are prescribed by urologists to treat mild cases of phimosis. These creams help loosen the foreskin, and when paired with some foreskin stretching exercises and home remedies, they can be effective phimosis treatments. Some of the most commonly prescribed phimosis creams and ointments are given below:

• Betnovate-N: This is a commonly prescribed phimosis cream that contains a steroid named betamethasone valerate as its active ingredient. Betnovate majorly helps relieve eczema, psoriasis, and lichen planus and can help you treat phimosis caused by these skin conditions. Apply this ointment at least twice or thrice daily and continue to do so for 4 to 6 weeks.
• Temovate: Temovate is another steroid-based phimosis cream that your urologist may recommend to treat phimosis. Temovate contains propionate 0.05% as an active ingredient and, similar to betnovate-N, acts against skin conditions such as eczema and psoriasis. Temovate should be used for at least 2 weeks and in amounts recommended by your doctor. It is also to be noted that prolonged use of this cream can result in some side effects. Before using Temovate, it is important to consult with your urologist first.
• Canestan: Canestan is a topical phimosis cream that is commonly prescribed by urologists to treat phimosis caused by a fungal infection. Canesten mainly contains clotrimazole and helps reduce inflammation and soreness caused by a tight foreskin.
• Elocon: Elocon primarily consists of a mild steroid named mometasone furoate 0.01% and is usually prescribed by urologists for its anti-inflammatory effects on tight foreskin. Elocon can help you get significant relief from common phimosis symptoms such as swelling, redness, and itching. However, it is not recommended for children under the age of 2 years.
• Ilotycin: Ilotycin is a cream that contains erythromycin as the main component, an effective antibiotic against bacterial infections. Ilotycin can be used as an effective treatment for tight foreskin caused by excessive bacterial growth.

To help you ease some of the phimosis symptoms you may be facing, your urologist may suggest you to follow some simple home remedies such as:

• Yogurt: Yogurt is a known probiotic, and adding it to your diet can help you significantly relieve symptoms of phimosis. Yogurt promotes the growth of positive bacteria and effectively counteracts fungal infections such as candida and thrush. You can also apply small amounts of plain yogurt directly over the penis.
• Coconut Oil: Coconut oil consists of lauric and caprylic acid, which is considered to be very soothing for irritated skin. Therefore, coconut oil is one of the ideal remedies to get fast relief from phimosis symptoms. The best thing about coconut oil is that it is easily available while not being overly expensive.
• Apply Castor Oil: Castor oil is a vegetable oil that is derived from castor beans. Castor oil is rich in essential fatty acids that moisturize the skin and can help you relieve some phimosis symptoms. Lubricating the penis with castor oil can help you prevent pain and scarring. However, be sure not to let the oil stay on the penis for long and wash it off with lukewarm water after use. This can further help you get rid of any dirt and dead cells that may have accumulated in the area under the penis.
• Foreskin stretching exercises: Mild to moderate cases of phimosis can be managed by simple foreskin stretching exercises recommended by your urologist. Gently pulling the top of your foreskin using just 2 fingers may ease some of the symptoms you are facing. It is highly advised to be careful while performing these exercises and avoid any forceful stretching.
• Retracting exercises: Retracting the foreskin over the penis glans regularly may also encourage better stretching of the foreskin. It is advised to use lubricants such as coconut oil or water while performing such exercises for easier retraction. It is important to use extra caution during such exercises and avoid forcefully stretching the foreskin.
• Maintain good penile hygiene: For mild cases of phimosis, maintaining proper hygiene of the penis can prove to be quite effective. Use mild soap and thoroughly clean the penis regularly with lukewarm water. Also, make sure to keep the area under the foreskin clean. You can use cotton swabs for this purpose. Maintaining good penile hygiene is a great way to avoid excess buildup of any bacteria or smegma.

Some benefits that are commonly associated with phimosis surgery are given below:

• Better Penile Hygiene: As the foreskin is removed, it becomes a lot more easier to regularly wash the penis and maintain good hygiene. A good genital hygiene helps prevent the accumulation of bacteria and smegma under the foreskin and minimizes the chances of phimosis.
• Relief from Symptoms: A circumcision surgery is considered to be the best and the most effective phimosis treatment. It can help you relieve phimosis symptoms such as redness, soreness, swelling, and painful erection.
• Low Risk of Recurrence: A circumcision surgery involves the complete removal of the foreskin itself. As a result, chances of recurrence after a phimosis surgery are almost zero.
• Preventative Measure for Foreskin Issues: Circumcision is often performed as a preventative measure for various foreskin-related conditions such as balanitis, balanoposthitis, paraphimosis, and posthitis.
• Prevents Further Complications: A phimosis surgery can help you prevent your condition from worsening further. If left untreated, phimosis can lead to serious consequences that require additional, more complex procedures for treatment.

If left untreated for a long period of time, phimosis can lead to severe consequences such as recurrent penis infection, gangrene, urinary retention, and in some serious cases, complete loss of the penis. Certain studies also suggest a correlation between phimosis and an increased risk of developing penile cancer further down the line.

If you are struggling with painful phimosis symptoms, it is highly recommended to get in touch with us and consult our highly qualified and experienced urologists!