Private foreskin problems clinic in London, same-day men's health.

In boys

• Physiological phimosis — normal non-retractility. Needs nothing at all.
• Ballooning during urination is common, usually harmless, and settles as separation occurs.
• Smegma pearls — white lumps under the foreskin. Normal shed skin cells, not infection or cysts. Leave them.
• Balanitis — redness and soreness at the tip, common in nappies and in young boys. Usually settles with simple care.
• When it is not normal: a white, scarred, thickened ring that will not stretch; recurrent infections; painful urination; or persistent inability to retract in an older teenager. These need assessing.

Balanitis in adults

• Irritant — soap, shower gel, over-washing, or not drying properly. The commonest cause, and made worse by more washing.
• Candida — itchy red patches, sometimes with a partner who has thrush. Also a recognised presentation of undiagnosed diabetes, which is worth excluding in recurrent cases.
• Bacterial, and occasionally sexually transmitted infection — testing is sensible if there is any risk.
• Skin conditions — psoriasis, eczema, lichen planus.
• Lichen sclerosus (BXO) — a white, scarred, thickened foreskin that progressively tightens. This one matters: it is the commonest medical reason for adult circumcision, it does not resolve with creams alone in established disease, and it carries a small long-term cancer risk if left.

Self-care

Treatment for a tight foreskin

• Topical steroid cream with gentle daily stretching resolves a large proportion of cases in boys and many in adults, over four to eight weeks. It is the first thing to try.
• Treating the underlying cause — antifungal, antibiotic, diabetes control, or treatment of a skin condition.
• Circumcision where steroid treatment has failed, where there is lichen sclerosus, recurrent infection, paraphimosis, or difficulty passing urine or with sex.
• Preputioplasty — a smaller operation that widens the foreskin without removing it — is an option for some.