Phimosis is a condition in which the tight foreskin cannot be retracted back over the glans penis Foreskin is the loose skin attached to and glides over the glans (head of penis) during urination and erection, but in phimosis this skin is tight and does not allow the normal movement. It is usually not a problem unless there are symptoms. This condition is normal in infants and children, Foreskin becomes loose and gradually separates from glans with the child’s age and completely separates by the age of 03 years in 90% of children.
Phimosis can occur in older children and adult(uncircumcised only) due to medical problem(infections, inflammation, forceful stretching/rough handling of foreskin, diabetes) that leads to scarring of foreskin.

 Distention of foreskin during micturition
 Discomfort, swelling or redness of foreskin
 Blood in the urine stream
 Inability to retract foreskin in older children by the age of 3
 Collection or discharge under the foreskin
 Inflammation or swelling of glans penis
 Painful erection
 Urinary tract infection In case of any of these symptoms, medical advice should be sought

The diagnosis is usually clinical based on the history and examination findings of perineal area.

Depending on the examination findings, following treatment options are advised;
 Steroid ointments with Manual massage and stretching of foreskin
 Circumcision

 Is medical or surgical intervention necessary?
The tight foreskin will remain there if not treated and may be a cause of repeated infections due to accumulation of urine and secretions, however the treatment is not always warranted. It definitely needs intervention when causes problems. Routine cleaning of the area under the foreskin is
necessary to avoid infections. Immediately contact doctor in case if it stuck and cannot be retracted back over the glans.
 Is operation safe?
It is generally considered a safe procedure with complication rate of 2%. Complications may include infection, ulceration, bleeding, sexual and psychological problems.
 Is it painful:
With regular mild painkiller, pain is not usually a concern after surgery.
 How long does it take for surgery?
The operation generally takes 30-60 minutes.
 Does it need admission to hospital overnight?
Usually the operation is performed under local anesthesia or intravenous sedation in a day care setting and does not need overnight admission.
 How long it takes for recovery?
Wound healing takes approximately 7-10 days. Initial bed rest for 1-2 days is advised.
 Can it be treated without surgery?
Steroid ointment massage is sometimes advised to make the skin soft and loose. The doctor explains he procedure of massage and stretching of foreskin that is usually performed daily for 4-8 weeks. There are negligible side of effects of this treatment. In cases of scarring, surgical intervention is
usually necessary
 What's the outcome after circumcision?
There will be few stitches which are dissolvable and do not need removal. The penis head may remain sensitive for a couple of months after circumcision, wearing loose shorts initially usually helps. The outcome is fairly good in general with few or no complications.