Young boys are born with physiologic phimosis. Their foreskin stays in place naturally at first. As the natural adhesions between the inner surface of the foreskin and the head of the penis dissolve over time, boys learn to retract the foreskin and pull it forward again as they explore their genitals. Usually, they are able to do so by age 7, but some boys need more time.
Pathologic phimosis happens in teenage boys and adult men. It can be caused by a naturally tight ring at the tip of the foreskin, poor hygiene, infection, or inflammation. Sometimes, paraphimosis occurs. This is similar to phimosis, except the foreskin cannot be pulled forward once it has been retracted.
More serious cases of phimosis may require circumcision, a procedure in which part or all of the foreskin is surgically removed. If only part of the foreskin is removed, recurrence of phimosis is possible.
Another surgical option is preputioplasty or dorsal slit, in which an incision is made to widen the foreskin, thus loosening it. No part of the foreskin is removed, but it should be easier to retract and pull forward.
Paraphimosis is an emergency and needs immediate medical attention to avoid further problems, like tissue death.
If the foreskin is tight, there is also a danger that it might get stuck behind the head of the penis (glans) when it is pulled back, forming a ring that restricts the blood supply to the glans. This is known as paraphimosis. It is a medical emergency that should be treated by a doctor immediately.
In the first few years of life, the foreskin doesn’t have to be pulled back completely to be able to keep the penis clean. Washing it from the outside is enough. It’s not a good idea to try to clean the space between the foreskin and the head of the penis with an object like a cotton swab because that could damage or hurt the sensitive skin there.