There are a number of conditions that can affect the foreskin (the piece of skin covering the top of the penis). They can affect boys of all ages and are usually easily treated.
The foreskin is the piece of skin that covers the top of the penis. Conditions that can affect the foreskin include:
- Hypospadias – where the hole (meatus) through which urine is passed is not positioned right at the end of the penis, and the foreskin is gathered at the back of the penis rather than the front.
- Tight foreskin (phimosis) – where the foreskin cannot be pulled back to reveal the head of the penis. This is normal in boys under five, but the foreskin should begin to retract on its own accord as boys get older and reach puberty. A tight foreskin in puberty or adulthood can increase the risk of infection and cause problems with urination.
- Paraphimosis – where the foreskin has retracted but gets trapped, restricting blood flow to the head of the penis. The penis will turn dark purple. Paraphimosis requires immediate medical attention as this condition can cause permanent damage to the penis if not treated early.
- Balanitis – an inflammation of the tip of the penis and foreskin usually caused by chemical irritation, bacterial or fungal infection. The head of the penis will become red, swollen and sore and there may be a thick and lumpy discharge.
- Fordyce’s spots – small, red or white pimples that form naturally beneath the skin of the penis. They are harmless and do not need any treatment.
- Yeast infection (thrush) – an itching or burning sensation, accompanied by a smelly discharge as well as red sore patches near the head of the penis or on the foreskin. It can be caused by sexual intercourse with a female who has the infection or be a sign of low immunity, for example after taking antibiotics or in diabetics.
- Genital warts – little white or pink cauliflower spots caused by the human papilloma virus (HPV), which is passed on through skin-to-skin sexual contact with somebody that already has the virus.
Except for hypospadias (which is present from birth), these conditions can develop in boys at any time.
What causes foreskin problems?
Foreskin problems can be the result of:
- poor personal hygiene (not cleaning the head of the penis correctly)
- forcible attempts to retract the foreskin
- complications during circumcision (the removal of the foreskin)
- frequent catheterisation (in children with recurrent bladder or urinary tract infections)
- sexual activity
What are the signs and symptoms of foreskin problems?
The appearance of the foreskin is usually enough to see whether there is a problem. For some conditions, there may also be other symptoms, for example difficulty urinating or having sex.
How are foreskin problems diagnosed?
If you are concerned that a child has a foreskin condition, speak to a GP. They will be able to refer the child to a specialist if necessary, usually a consultant in urology.
In the case of paraphimosis (where blood flow is restricted and the penis turns purple), you should visit A&E immediately as this condition can cause permanent damage to the penis.
How are foreskin problems usually treated?
In the case of infection, a child may be given a course of antibiotics or a steroid cream to reduce inflammation and irritation. The course of treatment may last between two and four weeks, depending on the severity of the strain of infection.
Other conditions may require a surgical procedure, such as:
- Stretching of the foreskin.
- Preputialplasty - where the opening of the penis is widened by an incision without removing the foreskin.
- Circumcision - where the foreskin is removed altogether.
- Surgical reshaping of the foreskin.
All of these procedures are carried out under anaesthetic – a urologist will explain which might be most appropriate, as well as the benefits and risks involved.
Can foreskin problems be prevented?
Good hygiene is key to preventing problems that can be caused by infection.
In babies and children, the best way to clean the penis is by using water and baby soap. Don’t worry that you are not able to pull back the foreskin at this age – it’s very important not to try to retract a child’s foreskin forcibly, because this may cause damage to the delicate tissues of the penis. It could lead to bleeding, inflammation and the formation of scar tissue.
Once the foreskin begins to retract, the glans will naturally become more visible and easier to clean. It is important to be gentle – the less scrubbing the better. When boys reach adolescence, they should be encouraged to retract and clean their foreskin regularly.
Circumcision can make it easier to keep the penis clean but can be a painful procedure (especially for older children and adolescents).
In the case of conditions passed on through sexual contact (genital warts and thrush), these can be prevented by using a condom during sex.
What happens next?
Once treated, a child should not experience any further discomfort and there should be no further impact on his health.