Men of all ages may harbour concerns about their foreskin if this splits, cracks, becomes inflamed or will not retract fully. For most men this is only a problem if the penis is erect. In this situation, men usually present with discomfort during sexual intercourse. However, in severe cases, a tight or obstructing foreskin may interfere with passing urine. If this is a persisting problem, men should seek medical advice.
Tightness in boys is usually congenital and surgery not always indicated. In adults, one of the most common reasons is scarring due to balanitis xerotica obliterans (known as BXO or lichen sclerosis). The causes of BXO are not known. Inflammation of the foreskin can be caused by bacterial infections or fungal problems, the most common being thrush. Men with recurring foreskin problems should generally be assessed to exclude diabetes as an underlying factor.
If simple measures such as softening or lubrication with creams fail to resolve the problem, circumcision (removal of all of the foreskin) is most commonly advised. If the main problem is with tightness of the frenulum (band of skin below the head of the penis), then a procedure known as frenuloplasty may be used to lengthen it. In younger boys a procedure known as prepuceplasty may be used but this is not effective in adults with scarring of the foreskin. Some men may request circumcision for religious, cultural or social reasons.