THE 5 SCORES OF PHIMOSIS - AND HOW THEY CAN AFFECT SEXUAL LIFE


​​You have a tight foreskin. Don't worry, you're not alone.
Whether of physiological or pathological nature, phimosis can manifest itself in varying degrees of intensity, making possible the following classification[1,2]:

SCORE 5 - NO RETRACTION IS POSSIBLE

When you try to pull the foreskin back, everything stretches, but nothing moves. The opening does not open at all, and in some extreme cases it's as small as a pinhole. You may be able to see some tiny fraction of what is in there, or it may be completely hidden behind the skin folds.


​score 4 - SOME RETRACTION, BUT NO EXPOSURE

You can retract the foreskin a bit, but the accumulation of skin in front of the meatus (orifice where urine exits the urethra) is so great that everything remains hidden.​


​score 3 - PARTIAL RETRACTION, VISIBLE URINARY OPENING

You can pull the prepuce a little and see the meatus. But it's too tight to go forward.


​score 2 - PARTIAL EXPOSITION OF THE GLANS

You can retract the foreskin slightly, but it does not pass through the corona (the widest part of the glans).

​
​score 1- FULL RETRACTION, BUT SQUEEZING BEHIND THE GLANS

You can pull the foreskin fully behind the glans, but then it's a battle to make it back forward. You have to squeeze the glans with your fingers for it to contract, and suffer to lift the skin back over it. This condition is also called paraphimosis.


​score 0 - EASY RETRACTION AND REPOSITIONING

Of course, this list has its limitations. Like any classification, it is a simplification of reality and does not seek to make your phimosis easily labeled. Also, the fact that the penis can be more or less flaccid or erect, and even the meteorological conditions and emotional state may interfere with the result.
In broad terms, however, it can be very useful for you to have a sense of how far your specific case lies from the extremes, and of the progress (or regression, if your phimosis is pathological) that is going on.

PHIMOSIS AND SEXUAL LIFE

If you have not yet experienced it yourself, it's not hard to imagine that the various degrees of phimosis can negatively impact how things happen in the sex department.

​If your phimosis is score 3 or above, you do not experience the sliding action of the foreskin. This "gliding" would make sex more enjoyable[3] and would require less lubrication from your partner. In addition, the non-exposure of the glans and of the frenular region also makes you feel less pleasure[4].
If your phimosis is score 2, you may feel pain when the foreskin is forced back (the use of a condom, preferably well lubricated, usually helps to feel less pain). And the non-exposure of the frenular region, which is extremely innervated, still deprives you of a series of sensory stimuli[5].

And if your phimosis is score 1, you are afraid that paraphimosis will happen during erections, and you try to avoid them. During intercourse, you tend to be afraid that the foreskin will hurt or get stuck behind the glans, and such psychological tension will prevent you from actually enjoying the sexual relationship.

THE FINISH LINE

For phimosis to be considered resolved, your foreskin should be able to be completely retracted back and repositioned forward, both erect and flaccid, without the need to squeeze the glans.

When this happens, you are ready. It is perfectly normal for the foreskin to offer some resistance to retraction, or to tend to return forward and cover the glans again after retraction. It is also normal for the foreskin not to retract by itself when erect. These characteristics still belong to score 0, and do not require any type of treatment or surgery.

​BUT HOW DO I GET THERE?

There is definitely a way out, as long as yours is not one of the very rare cases of truly irreversible pathological phimosis.
The route can be more or less tortuous, depending even on the quality and exemption of the sources of information that permeate your cultural universe. Would you like to know more about this?

REFERences

  1. Kikiros C, Beasley S, Woodward A (1993). The response of phimosis to local steroid application. Pediatric Surgery International, 8(4):329-332.
  2. Illustrations credit: A Phimosis Journey (Canada).
  3. Taylor JR, Lockwood AP, Taylor AJ (1996). The prepuce: specialized mucosa of the penis and its loss to circumcision. British J of Urology, 77:291-5.
  4. Sorrells ML, Snyder JL, Reiss MD, et al (2007). Fine-touch pressure thresholds in the adult penis. British J of Urology, 99:864-9.
  5. McGrath K (2001). The frenular delta: a new preputial structure. Em: Denniston GC. Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. Nova Iorque: Kluwer/Plenum, 199-206.