What is phimosis and how does it affect males of different ages. How can phimosis be treated effectively. When should you seek medical attention for tight foreskin. What are the potential complications of untreated phimosis.

What is Phimosis and Who Does it Affect?

Phimosis is a condition characterized by a tight foreskin that cannot be fully retracted over the glans (head) of the penis. While it’s normal and common in babies and young boys, phimosis can also affect adolescents and adults in some cases.

In newborns and young children, the foreskin is naturally adherent to the glans and gradually separates over time. Most boys will be able to fully retract their foreskin by puberty, though the exact age can vary:

• By age 5, about 50% of boys can fully retract their foreskin
• By age 10, about 90% can retract their foreskin
• By age 17, almost all males can fully retract their foreskin

In adults, phimosis may develop due to scarring, inflammation, or other medical conditions affecting the foreskin. When phimosis occurs later in life after a period of normal retraction, it’s referred to as secondary or acquired phimosis.

What Causes Phimosis to Develop?

There are several potential causes of phimosis, including:

• Natural developmental variation in foreskin separation
• Poor hygiene leading to irritation and inflammation
• Forceful retraction attempts causing micro-tears and scarring
• Balanitis (inflammation of the glans)
• Lichen sclerosus, a skin condition causing white patches and tightening
• Diabetes, which can affect skin elasticity
• Repeated infections of the foreskin or glans

In many cases, especially in children, phimosis resolves on its own over time as the foreskin naturally becomes more elastic. However, in some instances, medical intervention may be necessary.

Recognizing the Signs and Symptoms of Phimosis

The primary sign of phimosis is the inability to retract the foreskin fully over the glans of the penis. However, this alone may not be cause for concern, especially in young children. Other symptoms that may indicate problematic phimosis include:

• Pain or discomfort when attempting to retract the foreskin
• Swelling or inflammation of the foreskin
• Difficulty urinating or a weak urine stream
• Ballooning of the foreskin during urination
• Recurrent urinary tract infections
• Pain during erections or sexual activity (in adolescents and adults)
• Smegma buildup under the foreskin

Is painful urination always a sign of phimosis? Not necessarily. While it can be a symptom, painful urination can have various causes. However, if it occurs alongside difficulty retracting the foreskin, it’s advisable to consult a healthcare provider.

When Should You Seek Medical Attention for Phimosis?

While phimosis is often a normal part of development in young boys, there are situations where medical evaluation is necessary:

1. If there is pain, swelling, or inflammation of the foreskin
2. If urination is difficult or painful
3. If there are signs of infection, such as discharge or an unpleasant odor
4. If an adolescent or adult suddenly develops difficulty retracting the foreskin
5. If phimosis is interfering with sexual activity
6. If there are recurrent urinary tract infections

Can phimosis resolve on its own in children? In many cases, yes. As boys grow, the foreskin naturally becomes more retractable. However, if symptoms persist or cause discomfort, it’s important to consult a pediatrician or urologist.

Conservative Treatment Options for Phimosis

Before considering surgical interventions, several conservative treatments may be effective in managing phimosis:

1. Gentle Stretching Exercises

Under medical guidance, gentle stretching of the foreskin can help increase its elasticity over time. This should be done carefully to avoid causing pain or injury.

2. Topical Steroid Creams

Corticosteroid creams applied to the foreskin can help soften the tissue and make stretching more effective. These are typically prescribed for a limited period under medical supervision.

3. Proper Hygiene Practices

Maintaining good genital hygiene can prevent irritation and inflammation that may contribute to phimosis. This includes gentle cleaning with warm water and avoiding harsh soaps or excessive washing.

4. Treatment of Underlying Conditions

If phimosis is caused by an underlying condition like balanitis or lichen sclerosus, treating these conditions may help resolve the phimosis.

How effective are topical steroids in treating phimosis? Studies have shown that topical steroid treatment can be effective in up to 80% of cases, particularly when combined with gentle stretching exercises.

Surgical Interventions for Persistent Phimosis

When conservative treatments are ineffective or in cases of severe phimosis, surgical options may be considered:

1. Circumcision

This involves the complete removal of the foreskin. It’s a definitive treatment for phimosis but is typically considered only after other options have been exhausted.

2. Preputioplasty

This is a less invasive procedure where the tight part of the foreskin is surgically widened without removing the entire foreskin. It preserves foreskin function while addressing the tightness.

3. Dorsal Slit

In this procedure, a small incision is made in the foreskin to relieve the tightness. It’s sometimes used as an emergency treatment for paraphimosis.

Is circumcision always necessary for treating phimosis? No, circumcision is not always necessary. Many cases of phimosis can be treated with conservative methods or less invasive surgical procedures. Circumcision is typically considered when other treatments have failed or in severe cases.

Potential Complications of Untreated Phimosis

While phimosis often resolves on its own or with conservative treatment, leaving severe cases untreated can lead to complications:

• Recurrent infections of the foreskin or glans (balanitis)
• Difficulty with personal hygiene leading to smegma buildup
• Urinary tract infections
• Pain during sexual activity
• In rare cases, sexual dysfunction
• Increased risk of penile cancer (in long-standing cases)

One of the most serious potential complications is paraphimosis, a medical emergency where a retracted foreskin becomes stuck behind the glans, potentially cutting off blood flow to the tip of the penis.

Can phimosis lead to fertility issues? There’s no direct link between phimosis and fertility. However, if left untreated, severe phimosis can interfere with sexual function, which could indirectly affect fertility by making intercourse difficult or painful.

Living with and Managing Phimosis

For individuals living with phimosis, particularly adults who choose not to pursue treatment or are awaiting treatment, there are several strategies to manage the condition:

1. Maintain Proper Hygiene

Even if full retraction isn’t possible, cleaning under the foreskin as much as comfortably possible is important. Use warm water and be gentle to avoid irritation.

2. Be Cautious During Sexual Activity

Use lubrication during sexual activity to reduce friction and potential discomfort. Communicate with partners about the condition to avoid forceful retraction.

3. Monitor for Changes

Keep an eye out for any changes in symptoms, such as increased tightness, pain, or signs of infection. Report these to a healthcare provider promptly.

4. Consider Protective Measures

During activities like sports or cycling, where friction might occur, consider using protective clothing or padding to prevent irritation of the foreskin.

How does phimosis affect daily life? The impact can vary greatly depending on the severity. Mild cases may have little to no effect on daily activities, while more severe cases can cause discomfort during urination, hygiene routines, or sexual activity. Each individual’s experience is unique.

Preventing Phimosis and Promoting Foreskin Health

While not all cases of phimosis can be prevented, especially those related to natural development, there are steps that can be taken to promote overall foreskin health and potentially reduce the risk of acquired phimosis:

1. Avoid forceful retraction of the foreskin, especially in young children
2. Practice good genital hygiene, cleaning gently with warm water
3. Teach proper hygiene practices to children as they grow
4. Address any skin conditions or infections promptly
5. For individuals with diabetes, maintain good blood sugar control
6. Use gentle, pH-balanced soaps and avoid harsh chemicals in the genital area

Is it normal for the foreskin to be tight during puberty? Temporary tightness during puberty is not uncommon as the penis grows. However, if it persists or causes discomfort, it’s worth discussing with a healthcare provider.

By understanding phimosis, its causes, and treatment options, individuals can make informed decisions about their health. Remember, while phimosis is often a benign condition, especially in young children, any concerns should be discussed with a healthcare professional to ensure proper management and prevent potential complications.

Tight foreskin (phimosis) – NHS

It’s normal for babies and young boys to have a tight foreskin (phimosis), but adults can also be affected. See a GP if your or your child’s foreskin is sore or swollen.

Check if you or your child has a tight foreskin

The foreskin is the thin layer of skin that covers the end of the penis. If you or your child has a tight foreskin, it will be difficult to pull it back from the end of the penis.

A tight foreskin is normal in babies and young boys. Most boys’ foreskins do not pull back (retract) before the age of 5, but sometimes it’s not possible until they’re 10 or older.

The end of a boy’s penis may bulge or balloon when they pee, particularly if their foreskin is tight.

A tight foreskin is not usually a problem, unless there are symptoms such as:

• swelling and tenderness
• pain when peeing or a weak flow of pee
• blood in urine
• frequent urinary tract infections (UTIs)
• bleeding or a thick discharge from under the foreskin or an unpleasant smell – these are signs of an infection (balanitis)
• painful erections, which can make having sex difficult

Things you can do if you have a tight foreskin

If your or your child’s foreskin is tight, but is not causing problems like pain or bleeding, there are some things you can do to help ease it and keep the penis clean.

Don’t

• do not pull back the foreskin of a baby or young boy because it could be painful and damage it, leading to problems in later life

• do not use perfumed soap, talcum powder or deodorants on your penis because they may cause irritation

Non-urgent advice: See a GP if:

• your or your child’s foreskin is tight and swollen or painful
• there’s bleeding around your or your child’s foreskin when peeing, a thick discharge from under the foreskin, or an unpleasant smell

Treatments for a tight foreskin

The foreskins of babies and young boys will usually loosen as they get older, so treatment is often not needed.

If your or your child’s foreskin is causing problems, treatments include:

• steroid creams or gels (topical steroids) to help soften the foreskin
• antibiotics if the foreskin or head of the penis is infected
• surgery – removal of the foreskin (circumcision) or a procedure where small cuts are made in the tip of the foreskin so it can be pulled back more easily (usually only suitable for children)

Information:

Find out more

• Circumcision in boys
• Circumcision in men
• British Association of Urological Surgeons: phimosis and phimosis treatments

Complications of a tight foreskin

Sometimes if the foreskin is very tight it can get stuck and cannot go back to its original position covering the end of the penis. The end of the penis can then become very swollen and painful.

This is known as paraphimosis and it’s a medical emergency.

Immediate treatment is needed to avoid serious complications like restricted blood flow to the penis.

A doctor may be able to return the foreskin to its original position. Sometimes surgery to remove the foreskin (circumcision) may be recommended.

Immediate action required: Call 999 or go to A&E if:

• you or your child’s foreskin is pulled back and cannot go back to its original position over the end of the penis

Community content from HealthUnlocked

Page last reviewed: 11 April 2022
Next review due: 11 April 2025

Phimosis and Paraphimosis in Children

ABOUT

CAUSES
DIAGNOSIS

TREATMENT

NEXT STEPS

What is phimosis and paraphimosis in children?

Phimosis and paraphimosis are problems with the foreskin of the
penis. Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the
penis. This is a common problem in young boys. Paraphimosis is when the foreskin is
retracted but can’t move back up. This can prevent normal blood flow in the penis, and
may cause serious problems.

What causes phimosis and paraphimosis in a child?

Phimosis is caused by a tightening
of the opening of the foreskin. This is normal in a newborn baby. Over time the foreskin
loosens and can be pulled down more easily. By age 17, most boys will be able to fully
retract their foreskin. Phimosis can also occur if the foreskin is forced back before it
is ready. This can cause a fibrous scar to form. This can stop the foreskin from
retracting in the future.

Paraphimosis is caused when the
foreskin is retracted behind the crown (corona) of the penis. The foreskin is too tight
to be moved back to the tip of the penis.

What are the symptoms of phimosis and paraphimosis in a child?

Symptoms can be a bit different in
each child.

The most common symptoms of phimosis include:

• Bulging of the foreskin when
  urinating
• Not able to fully retract the foreskin by age 3. In some boys this may take longer.

The most common symptoms of paraphimosis include:

• Swelling of the tip of the penis when
  the foreskin is pulled back
• Pain
• Not able to pull the foreskin back
  over the tip of the penis
• Tip of the penis is dark red or blue
  in color
• Pain when urinating
• Decreased urinary stream

The symptoms of phimosis and
paraphimosis can seem like other health conditions. Have your child see his healthcare
provider for a diagnosis. A paraphimosis is an emergency medical condition. Seek medical
care right away if you think your child has paraphimosis.

How are phimosis and paraphimosis diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. The physical exam will include examining the penis and foreskin.

How are phimosis and paraphimosis treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for repeated phimosis may include:

• Putting a steroid cream on the
  foreskin up to 3 times a day for 1 month. This is to loosen the skin.
• Having surgery to remove all or part
  of the foreskin (circumcision) for a child age 10 or older who still has bulging of
  the foreskin when urinating

Treatment for paraphimosis may include:

• Lubricating the foreskin and tip of the penis, then gently squeezing the tip of the penis while pulling the foreskin forward
• Making a small cut (incision) in the foreskin
• Having surgery to remove all or part of the foreskin (circumcision)

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of phimosis and paraphimosis in a child?

Possible complications can include:

• Pain
• Infection
• Trouble urinating
• Death of tissue (necrosis) in the tip of the penis

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms

Key points about phimosis and paraphimosis in children

• Phimosis and paraphimosis are problems with the foreskin of the penis.
• Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the penis. This is a common problem in young boys.
• Paraphimosis is when the foreskin is retracted but can’t move back up. This can prevent normal blood flow in the penis, and may cause serious problems.
• Treatment for either problem may include steroid cream, lubrication, or surgery to remove the foreskin.
• Possible complications can include trouble urinating and death of tissue (necrosis) in the tip of the penis.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

90,000 diagnostics and treatment at the Research Institute of Urology. ON THE. Lopatkin.

Table of contents

Pediatric urology deals with the diagnosis and treatment of diseases and defects of the genitourinary and urinary systems in children. Today, according to expert estimates, every fourth child in the Russian Federation has urological problems. Pediatric urology is aimed at early detection of pathologies and their treatment. All parents should remember that they must be very attentive to the health of their children, because many urological diseases often begin without any obvious symptoms. If diseases of the genitourinary system are not cured in a timely manner in early childhood, then in adulthood a person may encounter irreversible processes that will be expensive and difficult to treat, and sometimes impossible.

Your child was diagnosed with: phimosis ?

We offer you a brief but very detailed overview of this disease. It was prepared by employees of the Children’s Uroandrological Department of the N.A. Lopatkin – a branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia.

Introduction

Phimosis (narrowing of the foreskin) is one of the most common diseases in the practice of a pediatric urologist and pediatric surgeon. The term phimosis is of Greek origin, meaning (muzzle, muzzle), this is a pathological condition in which it is impossible to expose the glans penis. The main cause of phimosis in patients is the presence of a dense, scarring ring of the foreskin.

Classification of phimosis

Physiological phimosis.

There are physiological, hypertrophic and cicatricial narrowing of the foreskin. Treatment, this pathology, only operational, by excision of scar tissue. However, this does not mean that all children need surgery. The congenital narrow opening of the preputial sac at the point of transition of the outer leaf of the foreskin to the inner one is a “physiological” narrowing of the foreskin.

In this situation, the skin of the foreskin does not have cicatricial changes, it is soft and stretches well. When trying to quickly or roughly remove the head, radial

cracks in the junction of the inner and outer layers of the foreskin.
Hypertrophic phimosis or proboscis foreskin: a condition in which there is excess foreskin, when trying to expose the glans penis, the prepuce is pulled into the proboscis. Children with hypertrophic phimosis are usually malnourished and overweight.

Hypertrophic or proboscis phimosis

Cicatricial phimosis is a condition of the foreskin in which there are cicatricial changes in the foreskin (radial white stripes), when trying to remove the head, a dense cicatricial ring was determined, which did not allow examining the head. Inflammatory diseases of the foreskin (balanoposthitis, fungal inflammation) or trauma of the foreskin (rough, simultaneous removal of the glans penis) can lead to such a situation.
Paraphimosis is a pathological condition characterized by the abduction of the narrow foreskin behind the glans penis, at the level of the coronal sulcus, it can pinch the frenulum and cause swelling of the glans penis. Paraphimosis requires emergency care, since prolonged compression leads to impaired blood circulation and there is a risk of developing necrosis (death) of the head.

Cicatricial phimosis

Treatment

The presence of physiological or hypertrophic phimosis in children, as a rule, does not require surgical treatment. The solution to these states is to apply gradual gentle stretching of the foreskin (avoiding even minimal tears and cracks) . Only in a small number of cases with hypertrophic phimosis is surgical assistance required.
Indications for surgical treatment are recurrent balanoposthitis and recurrent urinary tract infections against the background of anomalies in the development of the foreskin. Cicatricial phimosis is an absolute indication for surgical treatment. Operative treatment of phimosis consists in radical (full) or pastic (partial) circumcision of the foreskin of the child. When performing a partial circumcision, part of the foreskin is preserved, but this surgical intervention is accompanied by the risk of recurrence of the disease. During the operation, the adhesions (synechia) between the inner layer of the foreskin and the head are also separated, the plastic of the frenulum (elimination of its shortening) and meatoplasty (expansion of the external opening of the urethra) are performed. A contraindication to circumcision is the presence of congenital anomalies in the development of the penis and urethra (hypospadias, epispadias, hidden penis), since the foreskin can be a material for performing reconstructive plastic surgery.
In the case of paraphimosis, the physician compresses the edematous tissue of the foreskin and attempts to pull back the taut, tense skin of the foreskin through the glans penis. If the manipulation is ineffective, the compression ring is cut along the anterior-upper surface of the penis.

Where can children’s urological diseases be cured?

Treatment of diseases of the penis – symptoms and causes

There are quite a few types of conditions and diseases of the penis. Some of them are minor and do not cause much problems, and some require emergency medical care or surgery. Diseases of the penis can be congenital or develop over time.

General symptoms of diseases of the genital organ

• pain, swelling, burning;
• abnormal discharge;
• itchy rash, blisters, sores or small red dots;
• blood in urine or semen;
• an erection that lasts 4 hours or longer.

Types of diseases of the penis

The group of pathologies of the penis includes:

Balanitis (balanoposthitis)

Balanitis is an inflammation of the foreskin and glans penis. The most common causes are the presence of pathogenic flora (E. coli, staphylococci), candidiasis, papillomavirus, and poor hygiene (especially in uncircumcised men). Symptoms of balanitis may include penile pain, swelling, itching, rash, and foul-smelling discharge. If an infection is the cause, treatment will include antibiotics and antifungals. If balanitis is severe and recurs, circumcision may be the best treatment option.

Penile warts

The causative agent of the disease is the human papillomavirus. Despite the benign nature of the neoplasms, the risk of oncological diseases, including penile cancer, is high. Depending on the stage of the disease, warts are removed by surgery or laser therapy.

Epispadias

Epispadias is a rare birth defect characterized by the incomplete development of the urethra, resulting in an inability to properly expel urine from the body. Symptoms of epispadias in men include an abnormally located opening in the urethra, an enlarged pubic bone, curvature of the penis, urinary incontinence, and urinary tract infections. Cases range from mild to severe. In mild cases, surgery may not be required, but in most cases, epispadias requires surgical correction. The goal of treatment is to maximize the function of the penis as well as to give it a normal appearance. In cases where the bladder is affected, surgery should also create a pathway for the normal passage of urine and help maintain fertility.

Peyronie’s disease

Peyronie’s disease occurs when scar tissue called plaque forms inside the penis and makes the erection crooked and painful. In many men, an erect penis is slightly curved, and this does not cause any problems. But when it’s painful or the bend is significant, it can lead to erectile dysfunction and even make intercourse impossible. Signs of Peyronie’s disease include scar tissue that can be felt under the skin of the penis, significant bending of the penis, difficulty getting or maintaining an erection, penile pain and shortening. Sometimes Peyronie’s disease is mild and does not cause serious problems. In this case, treatment may not be required. However, if your penis hurts or bends causing problems during intercourse, see a urologist. If the disease is severe, surgical intervention is possible.

Phimosis and paraphimosis

This is a narrowing of the foreskin and the inability to expose the glans penis. Mostly of a physiological nature. It occurs in more than 90% of newborn boys. Physiological phimosis disappears by 6-7 years. Pathological phimosis develops as a result of trauma to the penis, poor hygiene. Paraphimosis is a narrowing of the foreskin under the head of the penis. It develops as a complication after phimosis. This pathology is eliminated exclusively by surgery. Symptoms of paraphimosis include the inability to return the foreskin to its normal position, difficulty with ejaculation and urination, discoloration or bruising of the penis, and swelling.

Priapism

Priapism is a persistent erection that lasts more than four hours and does not go away with orgasm.