A tight foreskin in adults usually occurs as a result of chronic low-grade infection or inflammation of the foreskin. Often the foreskin was a bit tight to start with, and together with suboptimal hygiene this can lead to inflammation of the surface of the foreskin, infections, cracking of the skin, drying out of the inner foreskin and scarring which causes a vicious cycle and gradually worsening narrowing of the opening of the foreskin. Eventually the problem might deteriorate to the point where the foreskin cannot be retracted at all and the patient has trouble urinating through a very narrow hole at the end of the foreskin, together with pain and bleeding with erection and attempted intercourse.
Treatment of this problem can be with steroid cream in the first instance if the condition is not too advanced, but only a fraction of men derive a satisfactory long-term result with cream alone.
Usually definitive treatment involves removal of all or part of the foreskin through the operation of circumcision. This is usually done as a day stay procedure under a short general anaesthetic of about 30-40 minutes. The abnormal foreskin is removed and a new join of healthy skin is made behind the head of the penis. Dissolving sutures are used which fall out after about 14 days and patients can return to work the next day if required. It is very rare for there to be any ongoing problems after a circumcision has been performed.