Phimosis is the inability to pull the foreskin back over the head of the penis (glans). The head of the 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. Phimosis affects only boys and is normal in infants and toddlers. If an infant’s foreskin has not been removed surgically (circumcision), it is attached to the glans for the first few years. The foreskin typically separates between ages 2 and 6. Forcing your child’s foreskin back can cause pain and damage. In most cases, it will detach naturally on its own. Phimosis becomes less common with age. The foreskin can be pulled back behind the glans in about half of 1-year-old boys and in nearly 90% of 3-year-olds. Less than 1% of boys aged 16 – 18 years have 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.

How is it diagnosed?

The diagnosis of phimosis is relatively simple. The doctor will do a physical exam, which consists of an assessment of your child´s penis and testes. The doctor may ask some questions:

  • How long have there been problems with the foreskin?
  • Does your child take any medication?
  • Has the foreskin been red or sore?
  • 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.

diagnosis of phimosis


How is it treated?

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

Treatments include:

  • Topical steroid for phimosis without scarring
  • Surgical removal of the foreskin (circumcision)

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.

Circumcision sometimes treatment with a topical steroid does not work. In that case, the doctor may recommend circumcision. Circumcision is a surgical procedure to remove the foreskin.

For circumcision in young boys, a numbing medication (local anaesthetic) will be used on the penis to reduce pain. Older boys and men who need circumcision will be asleep (general anaesthesia) for the procedure. To remove the foreskin, the surgeon holds it with a grasper and cuts the skin away from the penis .The skin below the glans is stitched to the skin of the shaft to heal. The wound is covered with gauze treated with petroleum jelly or antibiotic ointment.

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. Recovery from circumcision is usually quick. Very few patients have problems or side effects after circumcision. Light bleeding or discharge 2-3 days after surgery will stop on its own. Bruising or swelling of the penis skin can last for a few weeks. Treat with cold packs and nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes not enough skin is removed, and another operation is needed. More serious problems like damage or major bleeding are very rare.

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