Foreskin Won’t Retract

Q. I am an uncircumcised male. During an erection, my foreskin is tight and will not move and expose my penis. Is this normal, or are there any ways to cure this?

A. You are describing a condition called phimosis, in which the foreskin cannot be retracted behind the glans penis (head of the penis). Normally, the foreskin is loose and can be retracted for proper hygiene. However, when there is scarring of the foreskin, it contracts over time and becomes tight, preventing easy retraction.

I am sure this is uncomfortable while you are erect. In fact, phimosis often doesn’t get diagnosed until after puberty, when boys start having erections. Often it causes pain during sex; the skin and can crack or tear, causing bleeding.

There are more serious concerns as well. Studies have shown an association between penile cancer and phimosis. If you cannot retract the skin to clean the penis, then you also can’t see the surface of the glans, and a cancer there might go undiagnosed. Another worrisome condition is paraphimosis; this happens when a tight foreskin is retracted but cannot be replaced; it remains behind the glans penis, constricting it and causing painful swelling and engorgement of the blood vessels. If not addressed quickly, the swelling can become so severe that it shuts off the blood supply to the glans. This is a surgical emergency.

So, don’t try to force the skin back. Instead, see your doctor. There are several options for you. One is simply to have a circumcision, a surgical procedure to remove the foreskin. The surgery is performed under a local anesthetic (only the penis is put to sleep), and you go home the same day. Another option is called a dorsal slit; in this procedure, the foreskin is cut on one side, relaxing it so that it opens up. Again, this is an outpatient procedure done with a local anesthetic. I hope you will consider one of these two treatments to better protect your health.