Phimosis

True phimosis occurs when a scar occurs on the foreskin and prevents the foreskin from retracting. It is important to differentiate this from BXO. Normally phimosis can be treated with topical steroids for 4 to 6 weeks. Occasionally if the steroids do not work or the scarring is too excessive circumcision is required.

Symptoms

The vast majority of children with phimosis have evidence of ballooning of the foreskin or are unable to retract the foreskin and some swelling at the tip of the foreskin when it’s been retracted. Discomfort and pain can present. They would be able to partially retract some but not the entire foreskin. They can have discolouration of the glans and penis when it’s partially retracted.

Causes

Phimosis is when the foreskin can not be retracted from the tip of the penis.

A vast majority of young boys have what’s called physiological phimosis. This means it’s a normal variation. When the boy is born the foreskin is partially attached to the top of the penis. It can take time for this to release and for the glans of the penis to become visible.

Most young boys will start to find that their foreskin starts to retract and by adolescence the vast majority of boys have a fully retractile foreskin.

Phimosis can occur however when the foreskin has already been pulled back. This is when the tissue becomes scarred and fibrous and stops the foreskin from retracting properly.

Treatment

Most children do not require any treatment for phimosis. Some children will be successfully treated with a treatment of hydrocortisone if there is no significant scarring or any evidence of BXO. A small number of children will require surgical intervention.

Surgery

In reality there are two options, one of which is a small releasing incision to release the fibrotic scar and another is a Circumcision. Overall we recommend a formal circumcision as the dorsal releasing incision can have quite an unsatisfactory cosmetic result and may require a formal circumcision in later life in order to resolve the appearance.

FAQ’s

Phimosis is when the foreskin can not be retracted from the tip of the penis.

A vast majority of young boys have what’s called physiological phimosis. This means it’s a normal variation. When the boy is born the foreskin is partially attached to the top of the penis. It can take time for this to release and for the glans of the penis to become visible.

Most young boys will start to find that their foreskin starts to retract and by adolescence the vast majority of boys have a fully retractile foreskin.

Phimosis can occur however when the foreskin has already been pulled back. This is when the tissue becomes scarred and fibrous and stops the foreskin from retracting properly.

The vast majority of children with phimosis have evidence of ballooning of the foreskin or are unable to retract the foreskin and some swelling at the tip of the foreskin when it’s been retracted. Discomfort and pain can present. They would be able to partially retract some but not the entire foreskin. They can have discolouration of the glans and penis when it’s partially retracted.
Most children do not require any treatment for phimosis. Some children will be successfully treated with a treatment of hydrocortisone if there is no significant scarring or any evidence of BXO. A small number of children will require surgical intervention.
In reality there are two options, one of which is a small releasing incision to release the fibrotic scar and another is a Circumcision. Overall we recommend a formal circumcision as the dorsal releasing incision can have quite an unsatisfactory cosmetic result and may require a formal circumcision in later life in order to resolve the appearance.
There can be significant pain. It can also impact on the child’s voiding.

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