Foreskin, medical circumcision and other treatments
Advice for teenagers and young adults
Read on for more information about foreskin conditions and the treatment options available to you.
If you have been diagnosed with balanitis xerotica obliterans (BXO), you can click here to jump directly to our support guide to help you decide which surgery to choose.
What is a foreskin?
The foreskin is the collar of the skin which covers the end of the penis. In most newborn babies, it protects the end from rubbing against dirt or wet nappies. As boys get older, the foreskin will come away from the head of the penis. For some boys this happens when they are very young – usually during primary school – but for other boys it happens a lot later, even in late teens or early adulthood.
Is my penis normal?
Penises come in many different shapes and sizes and change with age. When boys start going through puberty their penis gets a bit bigger. This happens at different ages for different boy but most boys will notice that their penis has started to change by the time they are 14 years old. Penises grow in different ways, but they still work in the same way, no matter what size.
Why do some people not have a foreskin?
In many different parts of the world, boys may have their foreskin removed when they are a baby because of their religion or culture, through a procedure called a circumcision.
Other boys might have their foreskin removed in childhood or adulthood because of a medical condition. This used to be done very commonly but we now know that most foreskin problems will get better as you get older. Circumcision can reduce the risk of boys getting urinary tract infections so some boys with kidney problems will be recommended to have a circumcision when they are a baby. Circumcision can also reduce (but does not stop) the transmission of sexually transmitted infections.
Everyone’s penis is different. If you have been circumcised, the head of the penis will always be visible, as illustrated.
Keeping your penis and foreskin healthy
It’s important to keep your penis and foreskin clean and wash under the foreskin regularly in the bath or shower. This will help stop any build-up of a natural white or yellow-ish substance called smegma. Your penis produces smegma to help keep it lubricated and prevent dryness. But if smegma builds up, it can start to smell, become infected, or become red, swollen and painful, and you may need to see your doctor for treatment.
If your foreskin is still attached to the head of your penis, it’s really important that you don’t try to force it to move backwards before it’s ready because this can be painful. The foreskin will naturally separate from the tip eventually. But if the skin is being pulled tight and this is causing you pain or discomfort, then you should make sure you go and talk to your GP.
Foreskin conditions
Like every other part of your body, at some point in your life, you might injure or notice changes in your penis or foreskin, such as redness, irritation, swelling or pain. If you do notice any of these symptoms, it’s important that you don’t suffer in silence and you make an appointment with your GP or practice nurse to find out what’s causing the symptoms and how they can be treated. The GP or nurse will ask you some questions and, depending on the condition, take a swab to test for infection.
Below you’ll find a list of common foreskin conditions and the different range of treatments which your GP or a specialist doctor – called a urologist – should discuss with you after they’ve diagnosed what the problem is. You can click here to download a leaflet to help you make the most of your appointment and ask the right questions.
Phimosis (tight foreskin)
A tight foreskin that can’t be pulled back or ‘retracted’ is known in the medical community as phimosis.
Phimosis (tight foreskin)
A tight foreskin that can’t be pulled back or ‘retracted’ is known in the medical community as phimosis. This can occur naturally because your foreskin hasn’t separated from the head of the penis.
For most boys, the separation of the foreskin from the head of the penis happens before they start secondary school. Even as a teenager, phimosis can improve on its own but it can cause pain, especially when boys have an erection. If you get pain, redness or irritation of the foreskin, it is important to go and see your doctor.
A condition called balanitis xerotica obliterans (BXO) can cause phimosis. This is a skin condition which causes scarring of the foreskin and the head of the penis. It stops the foreskin from retracting and sometimes can make it difficult to pass urine. It doesn’t get better on its own and will usually need some form of treatment.
Treatment options
Doctors will recommend one of a range of different treatment options based on what’s best for your specific situation.
Watch and wait
If you are not experiencing discomfort then your doctor might recommend that you watch and wait to see if the foreskin separates from the end of your penis on its own. The doctor might recommend that you gently move the foreskin back and forth twice a day. This should never be painful and is usually done alongside using a steroid cream.
Topical steroid creams
The doctor might prescribe you a steroid cream to rub onto the narrow part of your foreskin to reduce inflammation of the skin and help the skin stretch. The combination of stretching and steroid creams is successful in treating most cases of phimosis, including when a boy has BXO.
Preputioplasty
Preputioplasty is an operation that is performed in hospital under general anaesthetic. A surgeon makes up to 3 cuts to widen the foreskin enough so that it can be pulled back fully and replaced back over the head of the penis. Sometimes a steroid injection is given at the same time. This option is good for boys and men who want their penis to look very similar to before the operation and to keep their foreskin.
There is a small risk of bleeding after a preputioplasty but it is very rare to need to return to theatre. Often the foreskin becomes quite swollen afterwards and this takes 1-2 weeks to settle. Sometimes when the swelling has settled down, the end of the penis looks a little bit uneven because of the cuts needed to make the foreskin wider. This is often not very noticeable.
About 2 weeks after the operation boys and men are advised to pull the foreskin back and forth twice a day because there is the chance it can become narrow again. This happens in about 1 in 5 boys or men who have the operation done. They may be offered another course of steroid cream or a circumcision.
Circumcision
If manual stretching and steroid creams don’t work, and you continue to experience pain and discomfort, the doctor may offer you a circumcision. You often have a choice between a preputioplasty and a circumcision and you should make sure you take some time to think about which option you prefer.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and you should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and it might feel uncomfortable to pee. If you continue to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact your doctor to check your penis is healing well.
Side effects from circumcisions are rare. Around 1 out of 100 people will experience bleeding and will need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The head of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important for some men as otherwise they can feel dissatisfied and don’t like the way their penis looks afterwards. Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after a circumcision or that sex feels different.
If you have any concerns about circumcision and possible side effects, it’s an important to discuss them with your doctor, and you can always seek a second opinion if you’re not sure.
Frenuloplasty
Frenuloplasty is an operation that is sometimes performed to lengthen the bridge of skin that attaches the foreskin to the underneath of the penis shaft. It is often used when boys or men can retract their foreskin over the head of the penis but the bridge of skin holds it up underneath. This can cause pain, especially during erections or sex. A frenuloplasty can be done under local or general anaesthetic and doesn’t take long so you should be able to leave hospital on the same day.
Side effects of the procedure are rare but include bleeding and tightness of the frenulum because of scarring where the operation has been done. It is recommended not to have sex for 6 weeks after the operation.
Paraphimosis
Paraphimosis is a medical emergency and is common in teenage boys. The condition can occur if the foreskin is pulled back to reveal the head of the penis for too long and can’t be moved forward again.
Paraphimosis
Paraphimosis is a medical emergency and is common in teenage boys. The condition can occur if the foreskin is pulled back to reveal the head of the penis for too long and can’t be moved forward again. The foreskin can become tight behind the head of the penis, restricting blood flow and trapping fluid so the head becomes swollen. If this happens, it is important that you go to A&E for treatment as quickly as possible.
Treatment
There are different ways to treat paraphimosis. Treatment should only be attempted by a qualified doctor and it is important that you see a doctor as soon as possible.
Manual reduction
Your doctor will give pain relief as medicine or an injection and may wrap the penis in swabs soaked in sugar or cold swabs that help to reduce the swelling. Then they place their fingers and thumb on the penis to gently apply pressure and attempt to push the foreskin up towards the tip of the penis.
If the foreskin cannot be moved forward again using this method then you may have this attempted whilst you are asleep with a general anaesthetic. If it is still not possible to replace the foreskin in this way then an operation is performed to widen the foreskin to let it be pulled back over the head of the penis and relieve the swelling.
Balanitis
You may have balanitis if the head of your penis is red, swollen, sore, itchy or feeling really hot.
Balanitis
You may have balanitis if the head of your penis is red, swollen, sore, itchy or feeling really hot. You may also find you have a thick discharge underneath the foreskin. This can start to smell and might cause pain when you pee. In some cases, there might be bleeding around the foreskin. If you have these symptoms it’s important you make an appointment with your GP.
Possible causes
When you talk to your GP, you should tell them everything you can remember that might have caused balanitis so you receive the right treatments. Balanitis is usually caused by not washing your penis properly but also because of:
Phimosis
Very tight foreskin that cannot be pulled back, which can make it difficult to clean.
Sexually Transmitted Infection (STI)
Diseases that are commonly passed on through sex can lead to balanitis. To make sure you avoid catching any STIs, it is important to wear a condom during sex and have a regular STI check.
Eczema, psoriasis and skin irritation
If you suffer from eczema or psoriasis in other parts of your body, the same condition might be affecting the skin around your penis. In some people, certain types of soap, shower gels or condoms can irritate the skin and cause balanitis.
Diabetes
People with diabetes can have high levels of sugar in their pee which can cause thrush – an infection by a yeast known as Candida albicans. Thrush can lead to balanitis.
Treatment
The treatment for balanitis depends on what is causing the condition:
Topical steroid cream
Using a steroid cream can reduce the inflammation caused by eczema, psoriasis, allergies to soaps or the inflammation caused by having a tight foreskin (phimosis).
Antifungal cream/Antibiotics
If you have balanitis as a result of an infection, the doctor will prescribe you an antibiotic or antifungal treatment to clear the infection. Once the infection is gone, the pain or discomfort should go away. If it doesn’t go away, it’s important you book another appointment with your doctor to understand why and receive alternative treatment.
Circumcision
If these treatment options don’t work or the condition keeps coming back, the doctor may suggest that you need circumcision.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and you should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and it might feel uncomfortable to pee. If you continue to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact your doctor to check your penis is healing well.
Side effects from circumcisions are rare. Around 1 out of 100 people will experience bleeding and will need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The end of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important for some men as otherwise they can feel dissatisfied and don’t like the way their penis looks afterwards. Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after a circumcision or that sex feels different.
Balanitis xerotica obliterans (BXO)
Balanitis xerotica obliterans (BXO) is a skin condition that can affect small numbers of people from the age of 4 onwards.
Balanitis xerotica obliterans (BXO)
Balanitis xerotica obliterans (BXO) is a skin condition that can affect small numbers of people from the age of 4 onwards. White, itchy patches form on the skin, causing pain and irritation, and can bleed if scratched. It is very common for this condition to cause pain and discomfort while peeing and during sex. Scar tissue can form in the affected area, causing tightness in the foreskin and increasing discomfort.
Cause
It’s not fully understood why people develop BXO. It is thought to be caused by your body’s immune system attacking your skin by mistake. In some people, certain types of soap, shower gels or condoms can irritate the skin. Some doctors think that it is also because of some genetic conditions which make it more likely for some people to get it than others.
Treatment
Topical steroid creams
Steroid creams can help to reduce inflammation and keep the immune system at bay. They have been shown to stop the symptoms getting any worse, and in some boys and men can improve the scarring. These creams are initially prescribed for two months but can be used to help relieve symptoms if the condition keeps coming back.
Surgical options
Preputioplasty
Preputioplastly is an operation that is performed in hospital under general anaesthetic. A surgeon makes 3 cuts to widen the foreskin enough so that it can be pulled back fully and replaced back over the head of the penis. Sometimes a steroid injection is given at the same time. This option is good for boys and men who want their penis to look very similar to before the operation and to keep their foreskin.
There is a small risk of bleeding after a preputioplasty but it is very rare to need to return to theatre. Often the foreskin becomes quite swollen afterwards and this takes 1-2 weeks to settle. Sometimes when the swelling has settled down, the end of the penis looks a little bit uneven because of the cuts needed to make the foreskin wider. This is often not very noticeable.
About 2 weeks after the operation boys and men are advised to pull the foreskin back and forth twice a day because there is the chance it can become narrow again. This happens in about 1 in 5 boys or men who have the operation done. They may be offered another course of steroid cream or a circumcision.
Circumcision
If manual stretching and steroid creams don’t work, and you continue to experience pain and discomfort, the doctor may offer you a circumcision. You often have a choice between a preputioplasty and a circumcision and you should make sure you take some time to think about which option you prefer.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and you should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and it might feel uncomfortable to pee. If you continue to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact your doctor to check your penis is healing well.
Side effects from circumcisions are rare. Around 1 out of 100 people will experience bleeding and will need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The head of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important for some men as otherwise they can feel dissatisfied and don’t like the way their penis looks afterwards.
Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after a circumcision or that sex feels different.
If you have any concerns about circumcision and possible side effects, it’s an important to discuss them with your doctor, and you can always seek a second opinion if you’re not sure.
Meatotomy and meatoplasty
Sometimes BXO can narrow the hole at the end of the penis where pee comes out of, causing difficulty passing urine and spraying. If this happens, then a number of different techniques can be used to widen the hole.
For most boys, having a clinician stretch the hole or meatus whilst they are under anaesthetic can improve their symptoms. Sometimes this has to continue for a few weeks afterwards too and you may need a parent or partner to assist. If this does not help, or if it becomes narrow again, then an operation called a meatotomy or meatoplasty can be performed to widen the hole. This makes the hole wider towards the underside of the penis, meaning that when men who have had it done pass urine, their stream is sometimes directed downwards. There is still a risk that it can become narrow again after this but it is less likely.
Urinary tract infection (UTI)
A UTI is when you get an infection in your bladder, urethra (the tube you pee out of) or your kidneys.
Urinary tract infection (UTI)
A UTI is when you get an infection in your bladder, urethra (the tube you pee out of) or your kidneys. Some symptoms of a UTI include: needing to pee a lot, a burning feeling when you pee, blood in your pee, pain in your lower tummy, as well as feeling tired and unwell. You should see your doctor if you have any of these symptoms.
Treatment
UTIs can normally be treated successfully with a simple course of antibiotics and circumcision is not routinely recommended for most boys and men. However, in very young boys with kidney or bladder problems, a circumcision can be very useful at reducing the number of UTIs that they get and can reduce the long-term risk of kidney scarring. If your son has kidney or bladder problems, especially if they have had a urinary tract infection, you and your doctor can discuss whether a circumcision could be worthwhile.
Frenulum tearing
The frenulum, also known as the ‘banjo string’ is the bridge of skin that joins the foreskin to the shaft of the penis.
Frenulum tearing
The frenulum, also known as the ‘banjo string’ is the bridge of skin that joins the foreskin to the shaft of the penis. The frenulum can be tight and tear, sometimes during sex, and can lead to painful erections. Using a lubricant during sex can help to avoid this happening.
Treatment
Usually, a tear will heal without any treatment. If it doesn’t heal, or if tearing happens regularly, you will need to go to see your doctor or a sexual health clinic to have it checked.
Frenuloplasty
If you find that your foreskin splits regularly, or that erections are painful because the frenulum pulls the underside of the foreskin up very tightly, you may need to have a small operation called a frenuloplasty. This makes the bridge of skin longer, to reduce the chance of any more tears. The procedure can be done under general or local anaesthetic and won’t take long so you should be able to leave hospital on the same day.
Side effects of the procedure are rare. Most people experience swelling in the days after the surgery but the swelling will go down. You shouldn’t have sex for 6 weeks after the operation.
Lengthening the frenulum can change the way your penis looks and feels, so it’s important you discuss the decision with your doctor and take time to consider your options.
Circumcision
If these treatment options don’t work or the tearing continues, the doctor may suggest that you need a circumcision.
‘Zipper trauma’
It’s quite common for boys and men to get their foreskin trapped in zips in their trousers.
‘Zipper trauma’
It’s quite common for boys and men to get their foreskin trapped in zips in their trousers, especially if they are not wearing any underwear, which can be painful and tear the foreskin. It’s important to make sure you are careful when zipping up trousers. Usually, a tear will heal without any treatment. If it doesn’t heal, you will need to go to see your doctor or a sexual health clinic to have it checked.
Hypospadias
Hypospadias is a relatively common condition that boys can be born with.
Hypospadias
Hypospadias is a relatively common condition that boys can be born with. It can cause the hole where pee comes out of (the urethra) to be somewhere on the underside of the penis. This can be anywhere from the underside of the head of the penis in mild cases to where the scrotum is in severe cases. The foreskin can be a hood over the end of the penis, rather than a collar wrapping all of the way around. Hypospadias can also cause some boys to have a downwards bend in their penis, especially when they have an erection.
Mild cases don’t require any treatment but operations can be done to make the penis look like other boys’. However, some boys may need surgery to bring the urethra further towards the end of the penis and to straighten the penis, and this is usually performed at a young age. Children with hypospadias should never have a circumcision until they have seen a hypospadias specialist.
This is because sometimes the foreskin is needed to correct the hypospadias condition, A circumcision may be performed as part of the hypospadias correction, but in mild cases of hypospadias, the foreskin can be reconstructed. It is worthwhile having a discussion about this with your doctor if this is something that you have strong feelings about.
Decision support guide for balanitis xerotica obliterans (BXO)
We have developed this support guide to help you decide which treatment option might be right for you. If you have been diagnosed with BXO, you may feel anxious or unsure about what to do. Our guide explains the two surgeries you can choose from – preputioplasty or circumcision – and the different factors you might want to consider when making your decision.
Circumcision and preputioplasty are the surgical procedures that can be used to treat BXO. A steroid injection may also be used during a preputioplasty to improve the BXO. Topical steroid creams can be tried before surgery but do not always fully treat BXO, so surgery can still be needed.
Sometimes BXO can make the hole at the end of the penis which pee comes out of very narrow. This can be improved by a procedure to gently stretch or open the hole. This can be performed at the same time as a preputioplasty or circumcision under anaesthetic if it is needed.
This support guide is only intended to help you make a decision to treat BXO. Choosing to have a circumcision for religious or cultural reasons is very common, and could be a factor in your decision, but is not explored in this guide.
Review your choices
Choose between the different answers to see which treatment option might be better for you.