If you are unable to retract your foreskin fully, especially if it becomes red or painful, you should contact your GP. If a tight foreskin has been retracted and cannot be brought forward again, you should seek urgent treatment in your local hospital
In adults, tightness of the foreskin may cause no symptoms for most of the time. Problems usually become more obvious (and troublesome) when you get an erection and attempt sexual intercourse.
Your GP should work through a recommended scheme of assessment for men or boys with a tight foreskin. This assessment will normally include some or all of the following:
Your GP will take a full history including whether you have had any injuries or infections of the penis at any stage. He/she will also assess the effect that the tight foreskin is having on your sexual activity.
A general physical examination will be performed which will include examination of your penis and foreskin. In some patients, the problems you are experiencing may be caused by a short penile frenulum rather than by genuine tightness of the foreskin.
The usual tests performed are:
The actual tests performed will be left to the discretion of your GP. It is important to exclude diabetes with a blood glucose measurement. No other specific investigations are normally necessary.
Your urine will normally be tested to exclude infection and will be specifically tested for the presence of glucose (sugar).
Your GP may take swabs from the foreskin area to send to the laboratory for bacterial culture.
In children, a tight foreskin is usually congenital but, in adults, it is often due to a scarring disease known as balanitis xerotica obliterans (BXO, sometimes called lichen sclerosus). We do not know the cause of BXO
If simple conservative measures fail to improve the tightness, your GP will normally recommend referral to a urologist for further advice
Circumcision is the mainstay of treatment if the foreskin is scarred by balanitis xerotica obliterans. This is one of medicine’s oldest operations.
Prepuceplasty is effective In children with congenital tightening of the foreskin. Several incisions are made into the tip of the foreskin to expose the head of the penis. The foreskin then needs to be retracted regularly until it has healed completely.
This procedure is totally ineffective in adults
Frenuloplasty is the best option If the tightness is due to a short penile frenulum, rather than a tight foreskin. However, a short frenulum may also be associated with a some scarring of the foreskin, so full circumcision is needed in some patients.
Partial removal of the foreskin is not recommended. Scarring may return in the foreskin remnant and the cosmetic results, particularly during erection, are often unacceptable.