Phimosis

Phimosis is a condition in which the foreskin is too tight to pull all the way back. Phimosis is normal in all baby boys and may be present for some years, until the foreskin has become supple enough and stretched enough to be pulled back, so that the head of the penis may be seen completely. In some cases, there may be scarring of the foreskin which may result in a permanent phimosis. The scarring may be caused by infection or inflammation of the foreskin, or forced stretching of the foreskin causing splitting, before it is ready to be stretched. Approximately 10% of boys develop scarring with phimosis.

Symptoms of phimosis

Common symptoms of phimosis include:

  • Bulging of the foreskin
  • Difficulty urinating
  • Inability to pull back the foreskin
  • Pain
  • Swelling of the tip of the penis

Causes and Risk Factors of Phimosis

The cause of phimosis is not known. It occurs in uncircumcised males and tends to occur in infants and toddlers. Phimosis typically improves and resolves itself with age. Several factors increase the risk of developing phimosis. Not all boys and men with risk factors will get phimosis. Risk factors for phimosis include:

  • Being uncircumcised
  • Young age

How is phimosis treated?

Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some men with non-retractile foreskins have no difficulties and see no need for correction.

Non surgical methods

Application of topical steroid cream, such as betamethasone, for 4–6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective. It has replaced circumcision as the preferred treatment method for some physicians.

Stretching of the foreskin can be accomplished manually, with balloons or with other tools. Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction. Beaugé treated several hundred adolescents by advising them to change their masturbation habits to closing their hand over their penis and moving it back and forth. Retraction of the foreskin was generally achieved after four weeks and he stated that he never had to refer one for surgery.

Surgical methods

Surgical methods range from the complete removal of the foreskin to more minor operations to relieve foreskin tightness:

  • Circumcision is sometimes performed for pathological phimosis, and is effective.
  • Dorsal slit (superincision) is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.
  • Ventral slit (subterincision) is an incision along the lower length of the foreskin from the tip of the frenulum to the base of the glans, removing the frenulum in the process. Often used when frenulum breve occurs alongside the phimosis.
  • Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin can be an effective alternative to circumcision. It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects.

What are the potential complications of phimosis?

Complications of untreated phimosis can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of phimosis include:

  • Difficulty ejaculating
  • Difficulty urinating
  • Infertility
  • Recurrent infections
  • Scarring of the penile opening