Recognising foreskin problems in the elderly

Foreskin problems in ageing adults

Many people avoid discussing their genital health for fear of embarrassment or shame, but for elderly men, understanding the importance of foreskin health as they age can help to avoid infections and identify early signs of other issues. This is your stigma-free guide to foreskin health for older males, including common foreskin issues, what causes them, the signs and symptoms to watch out for, the importance of personal hygiene and preventive care, when to seek medical advice for a foreskin issue, and how home care can help.

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about foreskin problems in older adults, we can help.

Why is foreskin health important later in life?

For a lot of older men, discussing genital health–including foreskin problems–may be the last thing they want to do! However, it is vital to recognise any issues that might be developing and bring them up with a healthcare professional or caregiver, as this could avoid more discomfort later if the problem escalates due to a lack of medical attention or appropriate care. A mild infection in the foreskin area could be easy and quick to treat, but if ignored, could become a much more serious health issue, so older adults should never delay diagnoses, treatment or care.

The penis continues to change with age, including changes in physical appearance, urinary function and sexual function due to reduced blood flow, muscle loss, reduced testosterone and other factors. For this reason, it is important to know which changes are considered typical for ageing males, and which could be cause for concern.

As men age, they can become more susceptible to a number of health conditions that cause inflammation of the foreskin, and they could be more at risk of developing issues as easily treated as genital dermatologic problems, or as serious as penile cancer. Regardless of the issue at play, if pain, discomfort or itching are present, or if an older person has difficulty urinating or other symptoms, this can greatly impact their quality of life and therefore it requires a diagnosis.

What are the most common foreskin issues experienced in older age?

Older age can lead to skin becoming thinner, more dry, losing elasticity, and bruising more easily. This can affect skin all over the body, including the thinner and more delicate skin on the genitals. For this reason, there are a number of conditions that can affect the foreskin in older men, including:

Phimosis / Paraphimosis

These two conditions are similar, but one is more serious than the other. Phimosis is when the foreskin is too tight and cannot be retracted to reveal the head of the penis, known as the glans. If trying to do so results in discomfort, pain or tearing, then phimosis might be the issue. Paraphimosis, on the other hand, causes the foreskin to become so tight that when it is retracted over the glans, it is not possible to replace it to its normal position. Paraphimosis should be considered a medical emergency, as this long-term retraction can lead to swelling and reduced blood flow to the penis, resulting in serious issues such as gangrene. This condition will not go away on its own, and requires medical intervention as soon as possible to avoid complications.

Around 2.6% of uncircumcised males are thought to be affected by phimosis, while around 1% of uncircumcised males aged 16 and over are thought to be affected by paraphimosis. Paraphimosis may occur when the foreskin is retracted for cleaning, during stretching if it feels too tight, or due to an infection or physical trauma. The main risk factors include being uncircumcised, having a catheter inserted, relying on a caregiver for hygiene, or having a tight foreskin.

Foreskin Infections

As with many other areas of the body, poor hygiene can result in a bacterial or fungal infection, and this is especially common under the foreskin which is often more challenging to clean. If an infection or dermatological issue is present in the genitals, this may cause itching, pain, redness, lumps or ulcers, but they can also be asymptomatic in some cases.

Foreskin infections can occur due to a build-up of bacteria under the foreskin called smegma, which is a thick substance that tends to give off an unpleasant smell. Infections may look like other types of skin rashes or general irritation, similar to an allergic reaction from harsh chemicals that might cause itchiness, redness, rashes, or dry and cracked skin.

Lichen sclerosus is one of the most common skin conditions that affects the foreskin, causing itchy white patches or scarring to appear on the penis, as well as a tightening of the foreskin. Lichen sclerosus can become more serious over time, so it is important to address it as soon as you notice signs, especially since this is usually easily treated.

The cause of lichen sclerosus is not known, but it is believed this could be linked to the immune system, which becomes less efficient with age. It is thought that this condition is not caused by an infection, is not contagious, and has nothing to do with poor hygiene. With lichen sclerosus, you may be advised to wash daily with warm water only or an unfragranced soap substitute (emollient cream) such as aqueous cream or Zerobase, dab the genitals after urination, apply an ointment to affected areas, and change your clothing regularly.

Balanitis

Balanitis is an inflammation of the head of the penis, which includes the foreskin, causing symptoms such as redness, swelling, irritation, pain and discharge. Between 3 and 11% of men are thought to experience balanitis at some point in their lifetime, and it is mostly caused by factors such as catheterisation, diabetes, bacterial and fungal growth, morbid obesity, physical trauma, or poor hygiene. Those who are uncircumcised are also at a higher risk, and sometimes dermatologic conditions may be responsible, like psoriasis, lichen sclerosus, or allergic reactions.

As well as typical symptoms like swelling or redness, balanitis may also look like an ulcer or an STI symptom, but this is less likely. It is associated with a 3.8-fold increase in the risk of penile cancer, and up to 45% of those with penile cancer have a history of balanitis, so prompt diagnosis and treatment is vital.

Penile cancer

Many areas of the body can develop cancer, and the penis is no exception. Penile cancer is rare, and thought to account for less than 1% of all new cancer cases in males, according to UK data from 2017-2019. It tends to be more common in men who are uncircumcised and have a history of inflammation, or in those who have poor hygiene. Lesions, rashes or dark spots can all be signs of penile cancer, but they may also be harmless, so it is always best to get checked if in doubt.

An estimated 95% of penile cancers begin in the squamous cells, which are mostly found on the foreskin or the glans. If discovered and treated early, penile cancer is slow to grow, and is curable.

What are the signs that an older person has a foreskin issue?

If you are an older man who maintains your own personal care without the help of a caregiver, it is important to notice and address any signs or symptoms of foreskin issues as soon as possible, in order to diagnose and treat the issue quickly and avoid complications.

Research finds that 26% of people have delayed seeing a doctor about something they consider embarrassing, so older people may be reluctant to discuss their genital health with family or medical professionals. Oftentimes the signs of a foreskin issue will be obvious, but motivation to have this assessed by a doctor may be lacking. Doing so unfortunately has a stigma attached to it, but this could be the difference between a quick-fix with a prescribed ointment, and a major surgical procedure, so the sooner you can seek a check-up with your doctor, the better.

The symptoms of a foreskin problem may include:

Pain
General discomfort
Itching around the foreskin or on the head of the penis
Redness
Swelling or inflammation
Discharge
White patches
Cracked skin or scarring
Tightness, or an inability to retract the skin of the foreskin
Trouble urinating
Recurrent infections or inflammation (which could be a sign of an underlying condition)

Remember, if you are a caregiver for an older person, particularly someone with mobility issues or cognitive decline, they may be unable to report symptoms or even notice them independently, so it is important to pay attention to signs like their toilet habits, or signs they may be experiencing discomfort.

If you or they are uncomfortable discussing genital health, it may be helpful to take them to their GP for a more clinical, shame-free conversation with a medical professional, and/or enlist the services of a professional caregiver on a temporary basis who can help with any symptoms they are experiencing.

What causes foreskin problems in older adults?

Several factors can lead to the development of foreskin problems in older adults, including:

Poor hygiene – This is the case for many older people who may struggle to perform their own daily personal care duties due to reduced mobility or dexterity which makes it challenging to reach their penis or thoroughly clean under the foreskin. An estimated 45% of pensioners in the UK have a disability, and may need help with their daily hygiene which includes foreskin health. Ignoring personal hygiene can lead to an increase in the risk of bacterial or fungal infections, so regular and thorough cleaning is required to maintain genital health. Keep in mind that wearing damp underwear can also cause infections, so continence care is important for older adults.
Other health conditions – Some other health conditions increase the risk of foreskin problems, such as diabetes, which can increase their susceptibility to infection. A 2024 study found those with type 2 diabetes aged 30-69 had a higher risk of needing a circumcision.
Ageing and more sensitive skin – With age, the skin of the penis can lose its elasticity, become more sensitive to irritants like soaps, and the sebaceous and sweat glands are less efficient, leading to skin issues around the genitals. Skin becomes thinner, which can cause more skin tears and sensitivity, and the risk of developing a dermatologic condition such as lichen sclerosus or psoriasis also increases with age.
Not noticing or acting on simple issues – Many more serious foreskin problems may develop when an older person or their caregiver either does not notice the beginnings of an issue, or does not act on it immediately to treat the problem while it is in the early stages and manageable, to avoid complications.

When should I seek medical advice for foreskin problems?

If you are at all in doubt about your own genital health or that of a loved one, a visit to your GP is often the best course of action, as they can provide a regular general check-up to make sure your genitals are free from infections or other issues. While this might be embarrassing, it could save you a much more difficult conversation and potentially invasive treatment down the line.

You should seek prompt medical attention if you are experiencing changes such as significant pain, an inability to empty your bladder, a lump on your penis, bleeding from or on your penis, or sudden swelling. An inability to return the foreskin to its original position after retraction should also be treated as a medical emergency.

Any other issues, such as redness, itching, discharge, or irritation should be addressed promptly in order to diagnose the potential problem and begin antibiotics (if relevant) as soon as possible. Older adults with diabetes or mobility limitations should be especially alert to any changes as they may be more prone to infections and complications. Remember, if you have a suspected foreskin problem, do not allow embarrassment to delay the care you need.

Your doctor will likely perform a physical check of your penis and foreskin, and if they think it is necessary, they may take a swab of any discharge to check for the presence of an infection. Treatments will then be offered depending on the cause of the issue, which may include antibiotics, steroid ointments, or antifungal ointments. For issues with retracting the foreskin, they may recommend certain stretches to loosen this, or surgery in the form of circumcision. If penile cancer is found, radiation and/or chemotherapy may be needed.

Why is personal hygiene so important for older adults?

Personal hygiene is an important part of anyone’s routine, but for older adults who perhaps cannot manage this entirely independently, they may need help, home adaptations or reminders to ensure this is done as it should be. One of the most important aspects of personal hygiene is genital health, since this is an area of the body that produces things like sweat and discharge. Helping an older adult maintain a personal hygiene routine can:

Help them to avoid developing infections that are more common in older people
Help them to avoid worsening health conditions
Create a regular routine that gives their day more structure
Make them more willing to go out and socialise
Make them feel fresh and clean each day, which promotes their dignity and comfort

For men, personal hygiene helps to maintain their foreskin health so they can avoid infections such as the ones mentioned above. If they suffer from things like arthritis, incontinence or dementia, they may not be able to manage this independently, so caregivers can create a regular personal care routine for them to maintain their wellbeing, dignity, and genital health.

For general foreskin health, it is important to eat healthy, hydrate, get daily exercise (if possible), avoid smoking, clean the glans (under the foreskin) with warm water only or an unfragranced soap substitute (emollient cream) every day, and perform regular checks to make sure there are no new signs of infections or other problems.

You can read more in our guide to the importance of personal hygiene care for the elderly.

How can I help an older loved one feel comfortable discussing genital health?

For some older people, discussing their genital health is not something they will feel comfortable doing with their family. If this is the case for your loved one it may be best to:

Arrange regular check-ups with their GP to make sure they are in good health
Provide access to the information they need about any suspected issues (i.e. helping them find websites that will inform them of the best practices for foreskin health)
Ensure their home environment is set up so that they can independently manage their personal hygiene as easily as possible

Having an open, honest conversation about foreskin and genital health is usually best, so if your loved one is open to this, you can prompt a discussion about any signs of infection they may have noticed, or any other issues they may be facing. This requires a safe, respectful, patient and judgement-free environment, so it is important to answer any questions or concerns they have without conveying discomfort or embarrassment yourself.

If they will be attending a GP appointment about their genital health but are embarrassed by what they need to discuss, suggest that they write down the questions and symptoms they have if they do not feel comfortable voicing these.

How can home care help with personal care?

Personal care is a big part of daily home care, as it not only helps to keep older adults free from infection and feeling good, it also provides an opportunity for caregivers to notice anything out of the ordinary, such as skin problems, cuts/bruises, swelling, and other physical signs of health issues. Home care can help by providing personal care assistance if an older person cannot do this independently, which might also include things like cleaning during postoperative recovery, wound care to prevent or treat infections, catheter care if needed, and more.

Our Care Professionals are knowledgeable and experienced at providing dedicated and tailored personal care to help older men with foreskin problems, both as a preventive measure and to help them recover from any issues they currently have. We offer either visiting care or live-in care depending on how much assistance the person needs, and what they can still manage independently. Home care enables older people to manage health conditions in the place where they feel most comfortable, so reach out to your local Home Instead office to discuss how we can facilitate this for you or your older loved one.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.