Phimosis occurs when a boy (usually age 4 or older) with an uncircumcised penis cannot retract his foreskin behind the head of his penis. Phimosis can also occur in men.
It is normal for the foreskin to remain difficult to retract as a boy ages; however, in 90 percent of boys, the skin is retractable by age 3. Phimosis is usually not diagnosed until a boy is in his adolescent years or the intractable foreskin creates problems such as urinary obstruction.
Physicians strongly recommend that parents not force the foreskin behind the glans. Forcing the foreskin to retract can cause cuts or lacerations, which can cause phimosis.
WHAT ARE THE SYMPTOMS?
If symptoms occur as a result of phimosis, they may include:
- Pain when urinating;
- Urinary retention;
- Urinary tract infections that do not go away; and
- Skin infections around the foreskin and glans.
As a natural part of the process of the foreskin separating from the head of the penis, when a boy nears age 4, he may experience “ballooning.” Ballooning occurs when urine fills the foreskin before being released and causes a balloon-like effect at the tip of the penis.
CAUSES AND RISK FACTORS
Phimosis can be congenital or acquired. Congenital phimosis has no known cause. Acquired phimosis can be the result of one or more of the following:
- Poor hygiene;
- Forcing the foreskin behind the head of the penis; or
- An injury.
DIAGNOSIS
A physician diagnoses phimosis by physically manipulating the penis and foreskin.
TREATMENT APPROACH
In most cases, phimosis does not require treatment. Circumcision, which is the definitive treatment, has fallen from favor in recent years in the United States. As a result, more conservative approaches to treating phimosis have emerged. Treatment for phimosis may include:
Topical cream. The cream is applied to the foreskin once or twice each day for 2 to 6 weeks, based on the type of steroid prescribed.
Preputioplasty. Preputioplasty is a surgical procedure that separates the foreskin from the head of the penis.
Circumcision. Circumcision is a surgical procedure used to remove the foreskin from the penis.
LIFESTYLE
To prevent phimosis as a boy ages, it is imperative that the parent keep the foreskin and penis clean. The American Academy of Pediatrics recommends that parents bathe infant boys’ genitals with soap and water while giving a bath. Do not force the foreskin to retract behind the glans; this will occur naturally over time.
