The Normal Foreskin

During the first few years of life, the inside of the foreskin is usually stuck to the glans penis. The separation of these two structures occurs slowly and naturally over time; as a general rule, this process cannot be sped up. Attempts to separate the layers and pull the foreskin back prematurely will damage the elasticity of the preputial sphincter (the opening), and cause problems like infection, adhesions, and/or acquired (genuine) phimosis, sometimes so severe that urinary difficulties can occur and circumcision may be needed later.

The foreskin is usually retractable by age eighteen. Even if the glans and foreskin separate before then, the foreskin may still not be retractable because the opening of the foreskin may still be very tight and only flexible enough to allow the passage of urine. 

Different cultures have different opinions about the foreskin.  In America, infant circumcision is common, as it is amongst many world religions.  In Australia however circumcision is usually reserved for people who develop problems later in life.  There are some health benefits associated with circumcision but it is arguable how relevant they are in a society with low rates of HIV. 


Foreskin Problems

Like any part of the body, the foreskin can become diseased and cause problems.  

The most common problem is a tightening of the opening of the foreskin called a phimosis which can make retraction of the foreskin difficult.  An inability to retract the foreskin can be associated with pain on erection or intercourse or difficulty maintaining personal hygiene.  Phimosis can also be caused by skin diseases such as balanitis xerotica obliterans (BXO) which over time can spread and effect the rest of the penile skin or the glans itself.  Phimosis is usually best treated by circumcision, which is removal of the foreskin but other more conservative options such as topical steroids or a dorsal slit procedure can be discussed. 

Paraphimosis is when a tight foreskin is retracted back over the penis and cannot be replaced to its normal position.  It is usually associated with pain and swelling of the tip of the penis.  A patient with paraphimosis should attempt to push his foreskin back over the tip of the penis – if he is unable to he will need to present to a doctor urgently. 

A Tethered Frenulum is when the small bridge of skin between the underside off the penile head and the shaft (the ‘Frenulum’) is too tight.  This can cause downward deviation of the penile head during erection or painful tearing.  A small procedure called a frenuloplasty can correct this without requiring a circumcision.

Penile cancer or infectious diseases can present with lumps and bumps on the foreskin.  If you have any concerns – see your GP or urologist.

Download here: Foreskin Facts

Download hereCircumcision: A Guide for Patients

Download here: Postoperative care instructions after circumcision or frenuloplasty