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Tight foreskin

The foreskin is the hood of skin that covers the head of the penis. If you have been circumcised, you will not have a foreskin.

In small children the foreskin is tight and stuck to the glans, but normally begins to separate at about the age of 3 or 4. If the hole in the foreskin looks abnormally tiny, ask your doctor to check.
After the age of 7, it is usually possible to pull the foreskin back over the head (or glans) of the penis, but in some boys this is not possible before the age of 14 or 15. So if you are 13 or 14, do not worry – this is perfectly normal.
If you are 15 or over and cannot pull your foreskin back, it may be too tight.

A tight foreskin is called phimosis . If you have phimosis, you will not be able to wash under your foreskin properly, so a white, cheesy material called smegma can accumulate. Also, if the condition is severe, it may be painful when the penis is erect.

Some men have phimosis from childhood, but it can also occur late in life, perhaps as a result of several thrush infections affecting the head of the penis. Another common reason is a skin condition called balanitis xerotica obliterans, which makes the foreskin pale and thickened. The cause of this condition is not known; it is not an infection.

Treatment
If it is very tight, there is no point in trying to force the foreskin back: you will only cause painful cracks on the inside of the foreskin, which will scar as they heal and make it worse. NORM-UK suggests that you try gentle stretching, and advises on how to do this.

If this does not solve the problem, you probably need an operation.

Circumcision is the most common operation. The surgeon separates the foreskin from the head of the penis (if it is stuck down), cuts the foreskin away and closes the incision with stitches. The glans will seem very sensitive after the operation, because it is not used to being exposed. Most men have erections during their sleep, so for a few weeks after the operation, you may wake in the middle of the night with a sore penis; taking a pain-relieving medication at bedtime will help. Wear loose boxer shorts and use a condom during sex for the first month or two.

If the doctor thinks the cause is balanitis xerotica obliterans, steroid creams will be used first; this often relieves the condition for several years, but eventually circumcision is usually needed.

Preputioplasty is a lesser operation. It involves making a vertical incision in the foreskin and then stitching it crosswise to widen the opening; it usually leaves a very normal appearance.