In the first of our phimosis series, we explored what phimosis is, how it feels, and its various causes. Now, let’s tackle the big question: What can you do about it?
Regarding treatment, one thing cannot be stressed enough: your first step should always be consulting a healthcare professional. Why? Because no two cases of phimosis are the same. A healthcare professional can evaluate the severity of your condition, identify any contributing factors, and tailor a treatment plan that’s right for you.
In this article, we will explore the types of treatments offered at a high level and then delve further into using steroid creams as a treatment option. Whether you’re ready to seek help or just exploring your options, I hope this article will equip you with the knowledge to take the next step confidently.
Are Phimosis treatments effective?
Yes, phimosis treatments can be effective depending on the severity of the condition and the chosen treatment method. Treatment success depends on the individual’s specific condition and adherence to the treatment plan. Some of the common treatments recommended are:
- Topical steroid creams
- Stretching exercises
- Circumcision
- Preputioplasty
Treatment Options for Phimosis: A step-by-step guide
The proper treatment for phimosis depends on its severity. Below is a high-level example of the types of treatment recommended based on severity.
Mild Phimosis (Grade 1-2)
- Topical steroid creams: Applying corticosteroid creams, like betamethasone, can help reduce inflammation and soften the foreskin, making it easier to retract.
- Gentle stretching exercises: regular, gentle foreskin stretching improves elasticity over time. This method works well when combined with steroid creams for added effectiveness.
Moderate Phimosis (Grade 3-4)
- Topical steroids and stretching: For moderate cases, continuing to use steroid creams and stretching exercises can still yield positive results.
- Preputioplasty: this minimally invasive surgical option involves small incisions in the foreskin to widen it, improving retraction without entirely removing the foreskin.
Severe Phimosis (Grade 5)
- Circumcision: for severe cases, circumcision offers a definitive solution by completely removing the foreskin. It is highly effective and eliminates the risk of reoccurrence.
- Alternative surgical options: Procedures like a dorsal slit or partial circumcision may be recommended for those seeking alternatives to a full circumcision, tailored to individual preferences and needs.
General Recommendations for all Stages
- Antibiotics: if an infection contributes to phimosis, treating it with antibiotics is a crucial first step before addressing it.
- Good Hygiene Practices: Proper hygiene and keeping the foreskin clean can prevent infections and reduce inflammation, contributing to better outcomes.
How do Topical Steroid Creams help Phimosis?
Topical steroid creams are often used to treat phimosis because they help soften the skin, reduce inflammation, increase elasticity, and facilitate retraction with stretching exercises.
That sounds good, but how do they do that?
Softening the Skin
Steroid creams contain corticosteroids, which are synthetic versions of hormones produced by the adrenal glands. These hormones help to soften the skin by reducing the production of collagen, which makes the skin less rigid and more pliable. This softening effect makes the foreskin easier to stretch and retract over time.
Reducing Inflammation
Corticosteroids have strong anti-inflammatory properties. They work by inhibiting the production of substances in the body that cause inflammation, such as prostaglandins and leukotrienes. By reducing inflammation, the cream helps decrease any swelling or redness in the foreskin, which can contribute to tightness.
Increasing Elasticity
The reduction in collagen production softens the skin and increases its elasticity. Additionally, corticosteroids can reduce the immune response, which helps prevent further inflammation and scarring. Increased elasticity allows the foreskin to stretch more easily, facilitating gradual retraction.
Vasoconstriction
Corticosteroids cause vasoconstriction, which narrows the blood vessels in the skin. This reduces blood flow to the area, which helps to decrease swelling and redness. Reduced swelling and redness make the skin more manageable and less painful to stretch.
How to use Steroid Creams?
Where do I apply the cream?
The steroid cream is to be applied to the tight part of the foreskin, known as the phimotic ring. This area needs to become more pliable. The phimotic ring is a tight, inelastic band of tissue located at the tip of the foreskin. It is comprised of inelastic cells that prevent the foreskin from stretching adequately. The ring forms around the opening of the foreskin, creating a constriction that limits retraction. The ring develops due to various factors, including infections, inflammation, or scarring.
How much cream do I use?
Use a small amount, typically a pea-sized amount or about a quarter to half a fingertip. This should be enough to cover the affected area without excess. Remember, you are only applying it to the phimotic ring.
How often do I use the cream?
The recommended application is usually twice a day, in the morning and evening. Consistency is critical for the treatment to be effective.
When is the best time to apply the cream?
The best time to apply the cream is after bathing or showering, when the skin is clean and slightly moist, as this will help with the cream’s absorption. After using the cream, gentle stretching exercises are recommended.
How long should I use the cream?
It is essential to follow a healthcare professional’s advice closely and not use the cream for longer than recommended, usually 4-8 weeks. If, after this time, you feel there has been no improvement, I recommend going back to see your healthcare professional to consider alternative treatment options.
Are there any potential side effects to using a steroid cream down there?
Whilst using topical steroid creams for phimosis can be effective, there are some potential side effects to be aware of:
- Skin thinning: prolonged use of corticosteroids can cause the skin to become thinner and more fragile, which can make it more susceptible to injury or irritation
- Local irritation: Some people may experience redness, itching, or a burning sensation at the application site. This irritation can be uncomfortable and may require stopping using the cream.
- Increased risk of infection: As mentioned above, steroids can suppress the local immune response, potentially increasing the risk of skin infections. This can lead to bacterial or fungal infections in the treated area, which is why proper hygiene is recommended.
- Hypopigmentation: The treated skin may become lighter in colour compared to the surrounding skin, which can be noticeable, especially on darker skin tones.
To minimise these risks, it is important to follow the recommended application steps. If you notice any adverse effects, please seek medical advice.
How can I prevent side effects whilst using the cream?
- Use the lowest-potency steroid cream that is effective for your condition. Higher-potency creams are more likely to cause side effects.
- Do not use the cream for longer than prescribed, usually 4-8 weeks, as prolonged use increases the risk of skin thinning and other side effects.
- Use only a tiny amount of cream to cover the affected area.
- Regularly check the area for signs of side effects such as thinning skin, discolouration, or increased irritation.
- Keep the area clean and dry to prevent infections.
What do I do if I experience side effects whilst using the cream?
- Stop using the cream: discontinue using the cream immediately if you notice any adverse effects such as skin thinning, increased irritation or signs of infection.
- Contact your healthcare professional: Go see your doctor to discuss the side effects you’re experiencing. They can provide guidance on whether you need to stop using the cream completely or if adjustments to how you are using it can be made.
- Monitor the affected area: Keep an eye on the area where the cream was applied. If you see any signs of worsening symptoms or new issues, inform your doctor.
- Avoid Self-Medicating: I know the majority of people who ask me for phimosis advice are risk-averse to seeing a healthcare professional for their issue. But it is crucial that if you are using a steroid cream and exhibit side effects, you do not try to treat the side effects on your own. Some products can exacerbate the problem.
What cream do I use, and do I require a prescription?
The potency and dosage of steroid creams can vary depending on the severity of phimosis. The availability of creams will differ across countries as to whether or not a prescription is required. Below is a general guideline to assist:
Mild Phimosis (Grade 1-2)
- Cream: Hydrocortisone 1%
- Usage: apply twice daily for 4-8 weeks
- Brands: Locoid, Cortizone-10
- Availability: Often available over-the-counter in some countries, but a prescription may be required in others.
Moderate Phimosis (Grade 3-4)
- Cream: Betamethasone 0.05%
- Usage: apply twice daily for 4-8 weeks
- Brands: Betnovate, Diprosone
- Availability: Prescription required
Severe Phimosis (Grade 5)
- Cream: Clobetasol Propionate 0.05%
- Usage: apply twice daily for 4-8 weeks
- Brands: Temovate, Dermovate
- Availability: Prescription required
In most countries, steroid creams for treating phimosis require a doctor’s prescription due to their potency and potential side effects. Think of it as a protection mechanism. The prescription means that someone, i.e., a doctor or pharmacist, knows you are taking it, so they can be mindful to check that you are using it correctly, aren’t exhibiting any side effects, and, more importantly, are getting results from it. Over-the-counter options are generally limited to lower-potency steroids like hydrocortisone.
Thank you for the information, but I want an over-the-counter cream I can start using.
I get it. Going to the doctor can feel intimidating, given the area where the issue occurs, and you are looking for options you can try on your own. So, while my first recommendation is to consult a healthcare professional for the best results, there are steps you can take at home that might help improve your phimosis. What can you try safely and effectively, keeping in mind that progress takes time and consistency?
If you’re looking for an over-the-counter option to help with phimosis, hydrocortisone 1% is the commonly available choice. There are things you need to be aware of if you choose this option:
- Effectiveness: hydrocortisone is a mild steroid and may not be as effective as prescription-strength options. It might help with mild cases but may not be sufficient for more severe phimosis.
- Gently pull back the foreskin as much as possible without causing pain and apply only to the phimotic ring. Ensure the skin is clean and dry before using.
- Monitor for any side effects.
- Consistent application is vital. Use the cream as directed and combine it with gentle stretching exercises to improve effectiveness.
If you don’t see any improvement in 4 weeks, I recommend you see a healthcare professional. The cream may be too mild for your level of phimosis, or alternative treatment options suitable to your situation can be discussed.
Stay tuned for the next article in this series, where we’ll discuss the recommended stretching exercises for treating phimosis.