Foreskin Narrowing (Phimosis): When is Treatment Necessary? (2026)

Foreskin narrowing (medically: phimosis) is a common problem in men of all ages. While a tight foreskin is normal in newborns and infants, persistent phimosis in adolescents and adults can lead to discomfort and require treatment.

In this comprehensive guide, we explain what phimosis is, when treatment is necessary, what options are available, and how Apollon Fold can help with mild to moderate phimosis.

What is Phimosis?

Phimosis refers to a narrowing of the foreskin that makes it impossible or painful to retract the foreskin over the glans. Two forms are distinguished:

Physiological Phimosis (normal in children)

In newborns and infants, the foreskin is naturally adhered to the glans. This is normal and not a disease. The foreskin detaches by itself during childhood:

• Birth: 96% of boys have a tight foreskin
• 3 years: 50% can retract the foreskin
• 10 years: 90% can retract the foreskin
• 17 years: 99% can retract the foreskin [1]

Important: No treatment is necessary for children under 10 years of age, as long as there are no symptoms.

Pathological Phimosis (requires treatment)

Pathological phimosis is present when:

• The foreskin cannot be retracted even after puberty
• The narrowing causes symptoms (pain, inflammation)
• The narrowing resulted from scarring (e.g., after injuries or inflammations)

Prevalence in adults: 1-5% of men over 18 years of age have phimosis requiring treatment [2].

Degrees of Phimosis Severity

Phimosis is classified into 5 degrees of severity:

Degree	Description	Treatment Necessary?
Degree 0	Foreskin can be retracted without problems	❌ No
Degree 1	Foreskin can be retracted, but with slight resistance	⚠️ Optional (if symptomatic)
Degree 2	Foreskin can be retracted to the tip of the glans	✅ Yes (conservative treatment possible)
Degree 3	Foreskin can only be partially retracted	✅ Yes (conservative + surgery)
Degree 4	Foreskin cannot be retracted at all	✅ Yes (surgery usually necessary)

When is Treatment Necessary?

Treatment is required if phimosis causes symptoms or if complications are imminent:

Absolute Treatment Indications (urgent)

✅ Recurrent Inflammation (Balanitis)

• Redness, swelling, pain in the glans or foreskin
• Purulent discharge
• Frequency: >2x per year

✅ Paraphimosis (Emergency!)

• Foreskin is retracted behind the glans and cannot be pulled back forward
• Glans swells and turns blue
• Requires immediate medical treatment (Emergency Room!)

✅ Urinary Retention (Emergency!)

• Urine cannot drain
• Foreskin inflates during urination (ballooning)
• Pain during urination

✅ Scar Phimosis

• Foreskin is narrowed by scar tissue
• Usually after injuries or chronic inflammation
• Conservative treatment often unsuccessful

Relative Treatment Indications (optional)

⚠️ Sexual Problems

• Pain during sexual intercourse
• Impaired sensitivity
• Psychological distress

⚠️ Hygiene Problems

• Smegma accumulation under the foreskin
• Unpleasant odor
• Difficult cleaning

⚠️ Aesthetic Reasons

• Dissatisfaction with appearance
• Psychological distress

Treatment Methods at a Glance

Method	Success Rate	Cost	Duration	Pain	Risks
Stretching Exercises	60-80%	0€	4-8 Weeks	Mild	None
Cortisone Ointment	75-95%	15-30€	4-8 Weeks	None	Minimal
Apollon Fold	0%	20€	-	-	Not suitable!
Phimosis Rings	50-70%	50-150€	8-12 Weeks	Mild	Low
Prepuceplasty	90-95%	500-1.500€	2-3 Weeks	Moderate	Low
Circumcision	100%	500-2.000€	4-6 Weeks	Strong	Moderate

Conservative Treatment (without surgery)

1. Stretching Exercises

Principle: Gentle stretching of the foreskin over several weeks

Instructions:

1. Take a warm bath (relaxes the skin)
2. Gently retract the foreskin until slight resistance is felt
3. Hold position for 30-60 seconds
4. Repeat 3-5 times daily
5. Duration: 4-8 weeks

Success Rate: 60-80% for Grade 1-2 phimosis [3]

Advantages:

• ✅ Free
• ✅ No side effects
• ✅ No pain

Disadvantages:

• ❌ Requires discipline
• ❌ Takes a long time (4-8 weeks)
• ❌ Does not work for cicatricial phimosis

2. Cortisone Ointment + Stretching Exercises

Principle: Cortisone makes the skin more elastic and accelerates stretching

Instructions:

1. Apply cortisone ointment (0.05-0.1% Betamethasone) to the foreskin 2 times daily
2. After 15 minutes of absorption time: Perform stretching exercises
3. Duration: 4-8 weeks

Success Rate: 75-95% for Grade 1-3 phimosis [4]

Advantages:

• ✅ Very effective
• ✅ Inexpensive (15-30€)
• ✅ No pain
• ✅ Reimbursable by health insurance (with medical indication)

Disadvantages:

• ❌ Prescription-only (doctor's visit necessary)
• ❌ Does not work for cicatricial phimosis

3. Phimosis Rings (Phimocure, Glansie)

Principle: Special silicone rings mechanically stretch the foreskin

Instructions:

1. Insert the smallest ring into the foreskin
2. Wear the ring 8-12 hours daily
3. After 1-2 weeks: Use the next larger ring
4. Duration: 8-12 weeks

Success Rate: 50-70% for Grade 2-3 phimosis

Advantages:

• ✅ Passive stretching (no active training needed)
• ✅ Discreet (invisible under clothing)

Disadvantages:

• ❌ Expensive (50-150€)
• ❌ Not reimbursable by health insurance
• ❌ Can be uncomfortable

Surgical Treatment (Operation)

1. Preputioplasty (Foreskin-preserving)

Principle: Small incisions in the foreskin to enlarge it (foreskin is preserved)

Procedure:

1. Local anesthesia or general anesthesia
2. 1-3 small incisions in the constricted area
3. Incisions are sutured transversely (enlarges the opening)
4. Duration: 30-60 minutes

Success Rate: 90-95%

Advantages:

• ✅ Foreskin is preserved
• ✅ Sensitivity is maintained
• ✅ Less pain than circumcision
• ✅ Health insurance covers costs (with medical indication)

Disadvantages:

• ❌ Surgical risks (infection, secondary bleeding)
• ❌ Scarring possible
• ❌ 5-10% relapse rate

Costs: €500-1,500 (Health insurance covers costs with medical indication)

2. Circumcision (Foreskin Removal)

Principle: Complete or partial removal of the foreskin

Procedure:

1. Local anesthesia or general anesthesia
2. Foreskin is detached
3. Wound edges are sutured
4. Duration: 30-60 minutes

Success Rate: 100% (phimosis is permanently eliminated)

Advantages:

• ✅ 100% success rate
• ✅ No relapse possible
• ✅ Health insurance covers costs (with medical indication)
• ✅ Additional benefit: Longer sexual stamina

Disadvantages:

• ❌ Irreversible (foreskin is gone)
• ❌ Severe pain (2-4 weeks)
• ❌ Reduction in sensitivity (20-75%)
• ❌ Surgical risks (2-5%)

Costs: €500-2,000 (Health insurance covers costs with medical indication)

Can Apollon Fold help with phimosis?

IMPORTANT: Apollon Fold is NOT suitable for the treatment of phimosis!

Apollon Fold is a technique for retracting the foreskin in healthy men without phimosis. The technique assumes that the foreskin can already be retracted without problems.

Why Apollon Fold does not work for phimosis:

• ❌ Foreskin cannot be retracted (basic prerequisite for Apollon Fold)
• ❌ No stretching effect (Apollon Fold does not stretch, but only holds back)
• ❌ Can cause pain (when attempting to retract a constricted foreskin)

Recommendation: If you have phimosis, first use one of the treatment methods mentioned above (cortisone ointment + stretching or surgery). Afterwards, you can use Apollon Fold to benefit from keratinization and longer stamina.

Treatment Algorithm: Which method for which grade?

Grade 1-2 (Mild Phimosis)

1. Step: Stretching exercises + Cortisone cream (4-8 weeks) Success Rate: 75-95%

If unsuccessful: Preputioplasty or Circumcision

Grade 3 (Moderate Phimosis)

1. Step: Cortisone cream + intensive stretching exercises (8-12 weeks) Success Rate: 60-75%

If unsuccessful: Preputioplasty (preferred) or Circumcision

Grade 4 (Severe Phimosis)

1. Step: Cortisone cream + Phimosis rings (8-12 weeks) Success Rate: 40-60%

If unsuccessful: Circumcision (usually necessary)

Cicatricial Phimosis

Directly: Circumcision (conservative treatment usually unsuccessful)

Frequently Asked Questions

Do I always need to see a doctor for phimosis? For mild phimosis (Grade 1-2), you can first try stretching exercises yourself. For Grade 3-4 or discomfort, you should consult a urologist.

Does health insurance cover the treatment? Yes, with a medical indication (discomfort, inflammation), health insurance covers cortisone cream, preputioplasty, and circumcision.

How long does healing take after surgery? Preputioplasty: 2-3 weeks Circumcision: 4-6 weeks

Can phimosis go away on its own? In children, yes (until puberty). In adults, no – treatment is necessary.

Is phimosis dangerous? Not directly, but it can lead to complications (inflammation, paraphimosis, urinary retention). Treatment should be sought if symptoms occur.

Can I have sex with phimosis? With mild phimosis, yes, but it can be painful. With severe phimosis, sex is often not possible.

Conclusion: Phimosis is highly treatable

Phimosis is a common problem that in most cases can be treated without surgery:

Recommended treatment pathway:

1. Grade 1-2: Cortisone cream + stretching exercises (75-95% success rate)
2. Grade 3: Cortisone cream + intensive stretching, possibly preputioplasty
3. Grade 4: Cortisone cream + phimosis rings, possibly circumcision
4. Cicatricial Phimosis: Circumcision

Important: Apollon Fold is NOT suitable for phimosis treatment. Treat the phimosis first, then apply Apollon Fold.

---

After successful phimosis treatment: Try Apollon Fold

Buy Guide now - €19,99

---

References

[1] Morris BJ, Krieger JN (2020). "Prevalence of Phimosis in Males of All Ages: Systematic Review." Urology, 135:124-132. https://pubmed.ncbi.nlm.nih.gov/31655079/

[2] Oster J (1968). "Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys." Archives of Disease in Childhood, 43(228):200-203.

[3] Berdeu D et al. (2001). "Cost-effectiveness analysis of treatments for phimosis." BJU International, 87(3):239-244.

[4] NCBI Bookshelf (2023). "Phimosis: Learn More – What are the treatment options?" https://www.ncbi.nlm.nih.gov/books/NBK326433/

---

Important note: This article does not replace medical advice. Consult a urologist if you have phimosis.