Foreskin Abnormalities

What are Foreskin Abnormalities?

Foreskin abnormalities refer to any anatomical or physiological variations in Singapore on the foreskin of the penis that deviate from what is considered normal. The foreskin, also known as the prepuce, is a retractable fold of skin that covers and protects the head of the penis (glans). Foreskin abnormalities can be congenital (present at birth) or acquired (developed later in life) and can vary in severity.

circumcised vs uncircumcised penis
A penis with a foreskin (uncircumcised) and without a foreskin (circumcised).

There are several types of foreskin abnormalities; these are:

  • Phimosis: phimosis is a condition in which the foreskin is too tight and cannot be pulled back over the glans. It may appear as a tight ring that surrounds the tip of the penis, which prevents full retraction. This can make it difficult or impossible to clean under the foreskin and may lead to discomfort or pain during erections.
  • Paraphimosis: paraphimosis is a medical emergency that requires immediate medical intervention. It occurs when the foreskin is pulled back over the glans but becomes stuck behind it, resulting in constriction and potential swelling. 
  • Balanitis: balanitis is an inflammation of the foreskin and glans. It can be caused due to poor hygiene, infection, or irritation. Symptoms include redness, swelling, pain, and discharge.
  • Frenulum breve: the frenulum is a band of tissue on the underside of the penis that connects the foreskin to the glans. Frenulum breve is a condition where this band is too short, which restricts the movement of the foreskin. This can cause painful erections and even uncomfortable sexual intercourse.
  • Foreskin adhesions: sometimes, the foreskin may become stuck to the glans, usually common in babies, both circumcised or not. This can lead to difficulty retracting the foreskin. Adhesions typically resolve on their own but may require medical attention if they persist.
  • Foreskin cysts: cysts can form under the foreskin due to blocked oil glands or other factors, but they are usually harmless. They may or may not cause symptoms and only require treatment if they become infected or painful.
Phimosis is a condition where the foreskin cannot retract.

What are the common causes Foreskin Abnormalities in Singapore?

Foreskin abnormalities primarily result from congenital factors, medical conditions, hygiene practices, and injuries. Here are some common causes of foreskin abnormalities:

  • Congenital factors: congenital factors like phimosis and balanitis can lead to foreskin abnormalities. Congenital factors mean that a baby is born with the condition.
  • Posthitis: posthitis is an inflammation of the foreskin (prepuce) and sometimes the glans (head) of the penis, often caused by infection, poor hygiene, or irritation. 
  • Candidiasis: yeast infections, particularly in uncircumcised males, can also result in foreskin inflammation and discomfort.
  • Injury: trauma or injury to the foreskin can lead to adhesions or scarring that may cause abnormalities.
  • Poor hygiene practices: not cleaning under the foreskin regularly can increase the risk of infections and inflammation.
  • Medical conditions: certain conditions, such as diabetes, can increase the risk of infections and inflammation in the genital area, which may lead to foreskin abnormalities.
  • Pre-existing conditions: conditions like lichen sclerosus, a chronic inflammatory skin disorder, can affect the foreskin and lead to abnormalities.

What are the symptoms of Foreskin Abnormalities?

The symptoms of foreskin abnormalities vary depending on the specific condition, as explained below: 

  • Phimosis:
    • Difficulty or inability to retract the foreskin over the glans.
    • Pain or discomfort when attempting to retract the foreskin.
    • Swelling or redness around the foreskin.
  • Paraphimosis:
    • Swelling and constriction of the foreskin behind the glans which may often cause pain and discomfort.
    • Potential difficulty in returning the foreskin to its normal position, which can become a medical emergency if left untreated.
  • Balanitis:
    • Redness, swelling, and soreness of the foreskin and glans.
    • Itching or burning sensations.
    • Discharge under the foreskin.
    • Pain or discomfort during urination or sexual activity.
  • Frenulum breve:
    • Discomfort or pain during erections.
    • Difficulty in fully retracting the foreskin.
    • Potential tearing or bleeding of the frenulum during sexual activity.
  • Foreskin adhesions:
    • Foreskin becomes stuck to the glans, which makes retraction difficult.
    • Potential discomfort or irritation.
  • Foreskin cysts:
    • Small lumps or bumps under the foreskin.
    • Discomfort or pain if the cyst becomes infected or grows larger.
  • Lichen sclerosus:
    • Thinning of the foreskin skin.
    • White patches on the foreskin.
    • Itching, burning sensation, and discomfort.
Balanitis is characterised by an inflamed glans.

However, it is essential to note that some individuals with foreskin abnormalities may not experience noticeable symptoms, especially in the early stages. 

If you are experiencing any of the symptoms stated above, make an appointment with Aare Urocare today for an accurate diagnosis and effective treatment.

Are Foreskin Abnormalities painful?

Foreskin abnormalities vary in pain and discomfort, and the level of pain experienced often depends on the specific abnormality and its severity. 

Individuals experiencing any discomfort or pain related to their foreskin must seek medical help, as prompt diagnosis and appropriate treatment can help alleviate these symptoms and prevent complications.

Who is at risk of developing Foreskin Abnormalities in Singapore?

Foreskin abnormalities can affect individuals of all ages, but certain factors may increase the risk of developing these conditions. These risk factors are:

  • Uncircumcised males: individuals who have not undergone circumcision are more susceptible to certain foreskin issues, as the foreskin is more prominent and requires regular hygiene to prevent problems like infections or inflammation.
  • Young boys: foreskin-related conditions, such as adhesions and phimosis, are more common in young boys, often before puberty. This is because the foreskin may still be attached to the glans or not have fully separated yet.
  • Poor hygiene: inadequate or improper genital hygiene can increase the risk of foreskin abnormalities. Proper cleaning under the foreskin is essential to prevent infections and irritation.
  • Infections: sexually transmitted infections (STIs) or other bacterial or fungal infections can lead to conditions like balanitis, which can cause foreskin abnormalities.
  • Diabetes: individuals with diabetes may be at a higher risk of developing infections and inflammation in the genital area, which can contribute to foreskin issues.
  • Genetic predisposition: some foreskin abnormalities may have a genetic component, and individuals with a family history of these conditions may be at a higher risk.
  • Lichen sclerosus: this chronic inflammatory skin condition can affect the genital area and is more common in males with uncircumcised foreskin.

It is important to note that while these factors can increase the risk of foreskin abnormalities, anyone can develop these conditions regardless of their risk factors. Proper hygiene, regular medical check-ups, and prompt attention to symptoms or discomfort are crucial to preventing and managing foreskin issues effectively.

How are Foreskin Abnormalities diagnosed in Singapore?

Foreskin abnormalities are typically diagnosed through a combination of medical history, physical examination, and, in some cases, laboratory tests. 

  • Medical history: medical history will be analysed; this includes symptoms, any previous occurrences of foreskin issues, sexual history, and hygiene practices.
  • Physical examination: a thorough physical examination of the genital area will be conducted to examine the foreskin, glans, and surrounding tissues for any signs of abnormalities, such as redness, swelling, discharge, or adhesions.
  • Laboratory tests: laboratory tests may be necessary depending on the symptoms and suspected cause of the abnormality. The most common one is a swab test, primarily administered to identify the presence of bacteria or fungi, particularly in cases of infection.

What are the treatment options for Foreskin Abnormalities in Singapore?

The treatment options for foreskin abnormalities vary depending on the specific condition and its severity. Here are some common treatment options for foreskin abnormalities:

  • Phimosis:
    • Topical steroid cream: steroid cream may be prescribed for mild cases to help soften the foreskin and improve its flexibility, allowing it to be gradually retracted.
    • Dilation: manual stretching of the foreskin may be attempted under medical supervision to widen the opening.
  • Paraphimosis:
    • Manual reduction: the foreskin can be manually reduced by a specialist to its normal position by gently squeezing and pushing the swollen foreskin back over the glans.
    • Surgery: severe cases may require a minor surgical procedure to relieve the constriction and return the foreskin to its normal position.
  • Balanitis:
    • Antibiotics or antifungal medications: depending on the cause, antibiotics or antifungal medications may be prescribed to treat the infection.
    • Hygiene education: proper hygiene practices are often emphasised to prevent future occurrences.
  • Frenulum breve:
    • Frenuloplasty: a surgical procedure performed under local anaesthesia to lengthen or release the frenulum to improve foreskin mobility. 
  • Foreskin adhesions:
    • Manual separation: adhesions will usually separate as a child grows. A doctor may gently separate any remaining adhesions during a physical exam.
  • Foreskin cysts:
    • Excision or surgery: a cyst may be excised or surgically removed if it recurs or causes persistent problems.
  • Lichen sclerosus:
    • Topical steroid cream: helps manage symptoms and reduces inflammation.
  • Circumcision:
    • Circumcision to remove the foreskin may be recommended if other treatment methods fail.
Medical circumcision may be recommended if other treatment options fail.

Treatment choice depends on the specific condition, its severity, the patient’s age, and overall health.

Schedule an appointment with Aare Urocare, where we prioritise our patients’ needs and offer precise diagnoses and personalised treatments.

Frequently asked questions

Your foreskin is likely normal if it can be comfortably retracted to expose the glans (head of the penis) without pain or difficulty. Consult a urologist for a proper assessment if you have concerns or experience discomfort or symptoms.

Yes, it is normal to live with a foreskin as it is a normal part of the male genital anatomy. However, if you are uncircumcised, it is essential to maintain good hygiene by regularly cleaning under the foreskin to reduce the risk of infections and other related conditions.

In some cases, mild foreskin abnormalities, like adhesions, may resolve on their own as a child grows. However, some foreskin issues, such as phimosis, require medical attention and may not improve without treatment. 

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, she spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital.

She believes in treating urinary incontinence in a holistic way using minimally invasive methods – this ranges from laser treatment, neurotoxin injections, electromagnetic nerve stimulation to minimally invasive surgeries, etc. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice.

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