Some boys complain that their penis “hurts” around the ages of 3 to 5 years – whether they are circumcised or not. This may be their reaction to discovering erections.
Symptoms from a foreskin that does not retract are uncommon. Occasionally, some redness and irritation develops at the tip of the foreskin that may be diagnosed as a skin infection. However, this skin irritation most often does not behave like an infection and goes away without antibiotics. While the tip is red, the boy may complain that it stings when he pees. That is not a sign of a urine infection.
The most common symptom is ballooning of the foreskin when the boy pees. This occurs when the pee exits the urine opening in the penis faster than it leaves the opening at the end of the foreskin, making the foreskin temporarily swell. This may bother older boys. It is first treated with topical steroid cream to the tip of the foreskin for 6-12 weeks, which will usually cause the phimosis to decrease enough to stop the ballooning. When cream does not work, then circumcision can be considered if the symptoms are bothersome enough.
Parents frequently ask if a tight foreskin hinders growth of the penis – it does not!
This boy has phimosis – meaning the foreskin does not retract. This is normal “physiologic” phimosis if there are no symptoms, and does not require treatment. If there are symptoms, such as ballooning, then it is “pathologic” phimosis and treatment with steroid creams, or circumcision, may be needed (see also BXO).
If the foreskin is pulled back and left behind the head of the penis, it will begin to swell and then be more difficult to return back over the head as it normally is. Sometimes this happens when caregivers are mis-informed by medical practitioners to pull back the foreskin in boys to clean it before the foreskin is fully retracting on its own. Cleaning the inside of the foreskin is not necessary in prepubertal boys, as discussed above.
Paraphimosis in a school-age boy. The foreskin was pulled back by parents told they needed to clean the inside. If the foreskin is not ready to retract, this will make a tight ring behind the head of the penis and then the skin will swell like this. That tight area (arrow) has to be pulled back down over the head, which requires a doctor. If paraphimosis happens, caregivers can first apply granulated sugar to a cloth and cover the swollen area, as this sometimes helps reduce the swelling before a doctor is seen. If you can see the head of the penis and swollen skin under the head in a boy who has not been circumcised, this should be evaluated by a medical professional right away.
This condition is also known as “lichen sclerosis”. It develops on the tip of the foreskin, turning the skin white and causing dense scarring so that it cannot retract. Sometimes a boy whose foreskin previously retracted notices it will no longer pull back as it did, and BXO is found. BXO in the foreskin also can cause pain during peeing. Circumcision is the best treatment for BXO of the foreskin, since BXO can progress throughout the urinary channel and cause urinary blockage.
BXO has turned the tip of the foreskin white, and scarred the opening so that it is difficult to see it.