Phimosis

Phimosis is the inability to pull the foreskin back over the head of the penis (glans). The head of penis is covered by a tissue called the foreskin. The foreskin is usually loose and slides easily over the head of the penis. This movement allows the child to urinate or to become fully erect (in adolescents). Sometimes, though, the foreskin is too tight. It can close over the glans and become unable to move. This condition is called phimosis.

Treatment Phimosis is not life threatening, but the symptoms are uncomfortable.

Treatments include:

  • Topical steroid for phimosis without scarring.
  • Surgical removal of the foreskin (circumcision) shows the decision-making process for treating phimosis. 

What causes phimosis?

Phimosis is natural in very young male children. In older boys, it might be caused by damage or scarring. It is more likely to occur in boys with:

  • Urinary tract infections that keep coming back
  • Infections of the foreskin
  • Repeated rough handling of the foreskin
  • Trauma that affected the foreskin  

Phimosis typically becomes a problem when symptoms occur. Symptoms include:

  • Redness, soreness, or swelling of the foreskin
  • Ballooning of the foreskin while urinating
  • Inability to fully pull back the foreskin by age 3 or older
  • Inflammation of the head of the penis
  • Thick discharge under the foreskin If your child has any of these symptoms, take him to see the doctor. The diagnosis of phimosis is relatively simple. The doctor will do a physical exam, which consists of assessment of your child´s penis and testes. 
The doctor may ask some questions:

  • How long have there been problems with the foreskin?
  • Has the foreskin been red or sore?
  • Does your child take any medication?
  • Does your child have diabetes? The doctor may ask parent(s) to be present or to help during the examination, particularly for younger children and infants. 

If your child has scarring from an earlier injury, circumcision is needed. If no scarring is present, your child might be able to use a steroid cream or ointment to loosen the tight foreskin. Topical steroid For boys who have phimosis without scarring, a steroid cream or ointment applied directly to the foreskin often works well. Your doctor will show you how to apply the ointment to the tight skin. The ointment softens the foreskin when used every day for 4–8 weeks. This treatment has few or no side effects.

Phimosis needs to be distinguished from agglutination, which is a rather common condition. With agglutination, some foreskin tissue stays attached to the glans . This protects the infant’s penis from direct contact with faeces and urine, which can cause irritation. Agglutination usually goes away on its own over time. Once the foreskin can be pulled all the way back, use of the ointment can be stopped. This treatment has few or no side effects.

Sometimes treatment with a topical steroid does not work. Sometimes your child’s phimosis can’t be treated that way. In that case, the doctor may recommend circumcision. Circumcision is a surgical procedure to remove the foreskin . It is necessary to treat phimosis with scarring from previous injury. It can also treat phimosis that causes frequent infections of the foreskin or the urinary tract. Circumcision may be needed if your child’s foreskin causes problems.

In fact, circumcision is not a very painful procedure. Anaesthesia dulls pain during the surgery. Urination does not cause pain after surgery because the urethra (the tube that passes urine from the bladder) is not touched.

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