Phimosis can be a challenging condition that occurs in the uncircumcised male. It affects the foreskin, which covers the penis, and it means the foreskin can either barely be moved or can only be pulled back a small amount. As most boys grow up, the skin becomes increasingly retractable, but where this condition is present, this is not the case. Clitoral phimosis is quite different, relating to tightness of skin or extra tissue around the female clitoris, making it difficult or impossible to access the clitoris.
The uncircumcised male infant begins with a relatively tight foreskin that becomes increasingly retractable in the first few years of life. When this skin doesn’t loosen, phimosis is present, and doctors could recommend a variety of treatments, depending on how much the condition is bothersome. In young boys it may be a minor or not even noticeable issue, but if retraction still can’t be achieved, some older boys and men have complications like sore penis, redness at the tip of the penis, and difficulty urinating without having some leakage or dripping. As men become sexually active, phimosis may be most challenging or uncomfortable.
The principal indication to treat this condition is if it appears to be causing discomfort, and treatment can range from non-invasive steps to surgical measures. Some doctors advocate for early treatment if this tightening is noticed in boys by the age they are two or three. Several approaches might be used including application of steroid creams with occasional pulling forward or back on the foreskin as much as possible to loosen it. Some men don’t get treatment early in life and a similar approach might be adopted when they are adults.
The tightness of the foreskin doesn’t always respond to manual efforts to stretch it. Doctors may sometimes use balloon inflation of the skin for greater stretching. Another approach that has been called controversial is circumcision, or at the least removing part of the foreskin so the rest can be retracted. In rare situations, the condition develops suddenly, and circumcision could be the answer to treat a problem that may be painful and uncomfortable.
In clitoral phimosis, surgery is almost always indicated, and is very minor. The surgical procedure preferred is often called hoodectomy, and it involves removing a tiny amount of tissue so that the clitoris has greater flexibility and is more exposed. A covered clitoris that can’t be accessed is usually not problematic for issues such as urination, but it can significantly reduce sexual pleasure because it renders clitoral orgasm impossible. This extra growth of skin is actually not that uncommon, and women who believe they don’t have a clitoris should see their doctors to evaluate whether they have phimosis.