Q. My phimosis is getting worse. Will this lead to lichen sclerosus?

Answered by
Dr. Gajanan Bhat
and medically reviewed by Dr. Nithila A

Hello doctor,

I have phimosis as long as I can remember. Around my 20s, my phimosis started getting worse, and my foreskin kept getting tighter to the point where the opening is now about 4 mm, and I have ballooning of the foreskin. I am 40 now and would like to get it treated once and for all.

Here are my questions and concerns,

1) Is the progressive tightening always a sign of BXO (lichen sclerosus).

2) If the opening is only about 4 mm and I went for an initial visit to a urologist, how would they visualize the glans for any suspect lesions?

3) If I wanted to confirm the health of my foreskin and glans (especially the presence of BXO or cancer), how can the urologist carry out his tests such as visualizations under the foreskin and taking biopsies without performing a circumcision?

4) While I know that BXO is a risk factor for penile cancer, I would like to get an idea of my risk in terms of numbers if possible. Is it possible that my BXO if present could have turned to penile cancer without me exhibiting symptoms? The only symptoms I usually feel are the foreskin tightening even in the absence of stretching it and occasional frenulum pain.

5) When I roll back my foreskin, the part behind the opening looks lighted (I have attached image). Could this be an indication of lichen sclerosus?

Dr. Gajanan Bhat

General Surgery Urology


Welcome to icliniq.com.

I have gone through your case, and the following are my pointwise answers.

1. The progressive tightening foreskin is not always suggestive of BXO. Instead, gradual tightening is an age-related process when a male does not retract foreskin often and clean the undersurface.

2. Proper inspection of the suspect lesion is only possible after adequate circumcision. Hence the first step in such cases is circumcision.

3. As I pointed out before, the histopathological examination of circumcised skin is the only evidence to prove or disprove BXO. Any other method is incomplete and inconclusive.

4. Though BXO is a risk factor for penile cancer, the occasional pain and tightening on its own does not amount to cancer. However, his to pathology is the only proof for definitive diagnosis.

5. As you have phimosis, you are unable to pull back foreskin completely. Hence, the undersurface of the foreskin is not visible. However, the discoloration and fissuring are indications of BXO, though it needs to be confirmed histopathologically. I hope I have answered all your queries.

Thank you doctor,

I have one follow-up. The images that I uploaded do show both discoloration and fissuring in your opinion?

Dr. Gajanan Bhat

General Surgery Urology


Welcome back to icliniq.com.

Though I cannot tell it is BXO, it is an indication that it could be BXO. I suggest you undergo circumcision and send foreskin for a histopathological exam. That will answer the question.

Hi doctor,

I took pictures of the area under the foreskin. The glans has white patches; the area at the top of the glans looks like it is attached to the foreskin and has a white fibrous tissue connecting the tip of the glans to the foreskin. From what I understand, the frenulum should be under the glans, but this fibrous tissue is on top. Does this look like penile cancer? Could it be adhesion or scar tissue buildup over the years?

Dr. Gajanan Bhat

General Surgery Urology


Welcome back to icliniq.com.

As I had written earlier, cancer is a histopathological diagnosis and not a visual diagnosis. Hence, no picture suggests cancer unless proved. The same is the case here.

In view of the phimosis, I suggest, you undergo circumcision and get the excised skin examined for cancer.

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