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Phimosis: Causes, Symptoms and Treatment

Phimosis is a condition in which the foreskin of the penis cannot be fully retracted over the glans. It can be congenital or acquired.

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Things worth knowing about "Phimosis"

Phimosis is a condition in which the foreskin of the penis cannot be fully retracted over the glans. It can be congenital or acquired.

What is Phimosis?

Phimosis is a condition in which the foreskin (prepuce) of the penis is too tight to be pulled back over the glans (head of the penis). It is one of the most common urological conditions in boys and men. A distinction is made between physiological phimosis, which is natural and developmentally normal in newborns and young children, and pathological phimosis, which may require medical treatment.

Causes

The causes of phimosis can vary:

Congenital (primary) phimosis: A tight foreskin is normal in newborns. In most boys, the natural adhesion between the foreskin and glans resolves on its own during childhood and puberty.
Acquired (secondary) phimosis: Can develop as a result of recurrent inflammation of the foreskin (posthitis) or glans (balanitis), scarring from injuries, or the skin condition lichen sclerosus.
Poor hygiene or excessive mechanical irritation may also contribute to the condition.

Symptoms

Symptoms of phimosis that may require treatment include:

Pain or discomfort when urinating (dysuria)
Weak or reduced urine stream
Pain during sexual intercourse (dyspareunia)
Redness, swelling, or signs of inflammation around the foreskin
Entrapment of a retracted foreskin behind the glans (paraphimosis) -- a medical emergency
Recurrent infections beneath the foreskin

Diagnosis

Phimosis is typically diagnosed through a physical examination by a healthcare professional. The severity is often graded using standardized scales (e.g., the Kikiros scale). Further investigations are usually not required, but a tissue biopsy may be recommended if an associated skin condition such as lichen sclerosus is suspected.

Treatment

Conservative Treatment

For mild to moderate phimosis, conservative treatment is recommended as a first step:

Topical corticosteroid cream: Applying a corticosteroid cream (e.g., betamethasone 0.05--0.1%) to the tight foreskin opening for 4--8 weeks can make the tissue softer and more pliable. This approach is effective in both children and adults.
Stretching exercises: Gentle manual stretching of the foreskin, used alongside the cream, can improve outcomes.

Surgical Treatment

If conservative measures are insufficient, surgical options are available:

Circumcision: The complete surgical removal of the foreskin is the most common operative treatment for phimosis.
Preputioplasty: A foreskin-preserving procedure in which a small incision is made to widen the foreskin opening without full removal.

When to See a Doctor

Parents should consult a doctor if a child experiences pain during urination, shows signs of inflammation, or has a noticeably reduced urine stream. In adults, medical evaluation is advisable as soon as phimosis causes symptoms. Paraphimosis -- in which a retracted foreskin becomes trapped behind the glans -- is a medical emergency requiring immediate treatment.

References

Deutsche Gesellschaft fur Urologie (DGU) - Guideline on Phimosis and Paraphimosis (2022).
Schoen EJ et al. - Newborn circumcision: a long-term strategy for AIDS prevention in sub-Saharan Africa. Journal of Urology, 2006.
Oster J. - Further fate of the foreskin. Archives of Disease in Childhood, 1968.

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