Phimosis

Children Urology

Phimosis

Phimosis is a condition that prevents the foreskin from retracting properly from the head of the penis. The foreskin is usually fixed in place in young children, but it should begin to loosen during early childhood. The foreskin will normally be able to retract and then move back into place over the head or glans of the penis. However, sometimes this doesn’t happen and the foreskin remains unable to retract. In other cases, the problem develops later and the foreskin is no longer able to retract as it used to do.

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. Phimosis surgery is a fairly straightforward procedure that can relieve the discomfort of this condition.

Symptoms of Phimosis

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ballooning of the foreskin or are unable to retract the foreskin and some swelling at the tip of the foreskin when it’s been retracted.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.

One of the most common phimosis symptoms is the bulging or ballooning of the foreskin during urination. This happens because urine builds up inside the foreskin as it makes its way out. It can sometimes happen even if the foreskin is normal, especially in younger boys whose foreskin has not fully retracted yet. In some cases, phimosis can cause other kinds of urinary problems too. Severe phimosis may make it harder to pass urine. It can also increase the risk of issues such as balanitis, which happens when the foreskin gets inflamed due to irritation or an infection.

It is important to be aware that the foreskin cannot usually be retracted at a young age. The foreskin usually becomes looser during early childhood. The process usually begins by age two to three, but it can take longer for the foreskin to be able to retract completely. You should never try to force the foreskin to retract as this could damage it. If the foreskin becomes scarred then it might not be able to retract properly in the future and phimosis surgery may then be required to correct it.

Phimosis isn’t usually anything to worry about unless it is causing pain or other phimosis symptoms. When it occurs at a young age, the problem will often correct itself in time without the need for phimosis surgery. However, if you are concerned that the foreskin is taking longer than expected to retract, it can be reassuring to see a doctor. You should also seek medical advice if your son is experiencing any phimosis symptoms or if the foreskin stops being able to retract later on. Older boys may also feel self-conscious or anxious about phimosis, so it can be important to talk to them about the condition and enable them to speak to a doctor if they wish.

Causes of Phimosis

Phimosis is when the foreskin cannot be retracted from the tip of the penis. By late adolescence, the foreskin can usually be fully pulled back from the glans and is then able to return into place.

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. In most cases, the foreskin will start to retract between the ages of about 2 and 6.

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. Medication or phimosis surgery is only required if this doesn’t happen naturally. It is important not to rush the process by trying to move the foreskin back as this could damage it.

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. When the condition occurs due to scarring it is sometimes known as true phimosis. The foreskin can be damaged in different ways, including by attempts to force it to retract when it is still too tight. Phimosis surgery may then be needed.

Treatments of Phimosis

Phimosis can usually be diagnosed through a physical examination of the penis and foreskin. The doctor will also ask about any phimosis symptoms that you or your child have noticed. The examination will help to rule out balanitis xerotica obliterans, a skin condition that can prevent the foreskin from retracting. The doctor will also check for scarring or damage to the foreskin that could be responsible for phimosis symptoms.

Most children do not require any treatment for phimosis. If there are no signs of damage and the foreskin has never been able to retract then it can be best to wait and see if it happens naturally as long as your child is still young enough and isn’t experiencing any phimosis symptoms.

However, phimosis surgery or other treatments may be recommended for older children if it is unlikely that the foreskin will begin to retract by itself. Phimosis surgery may also be needed if your child is in pain or having issues such as urinary problems.

Some children will be successfully treated with a treatment of hydrocortisone if there is no significant scarring or any evidence of BXO. Medical phimosis treatment usually involves applying a steroid cream to the foreskin in order to encourage it to become looser.

A small number of children will require surgical intervention. Surgery is only recommended for phimosis treatment when the condition is unlikely to correct itself, the symptoms are severe or it is associated with scarring or damage.

Phimosis 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.

Circumcision is a relatively straightforward procedure. When it is performed for phimosis treatment it typically requires a general anaesthetic. The foreskin can then be removed surgically while your child is asleep and unaware of what is going on. The surgical incision will be stitched up and it should heal completely over the next week or two. It is vital to keep the surgical wound clean and dry while it heals to reduce the risk of infection. Your son may also need painkillers to relieve any discomfort.

Once the foreskin has been removed, the glans of the penis will be exposed. Circumcision should solve any issues linked to phimosis, such as urinary problems. However, it is important to be aware that it will change the appearance of the penis and can affect its sensitivity too. You will need to discuss the risks and benefits of circumcision for phimosis treatment with the doctor. It is also important to talk to your son about the procedure in an age-appropriate way so that he understands what is happening.

FAQ’s

Phimosis is when the foreskin cannot be retracted from the tip of the penis. Although this is normal in babies and toddlers, the foreskin should naturally begin to loosen between the ages of about two and six. If this doesn’t happen or if the foreskin stops being able to retract, then phimosis treatment may be required.

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. The tip of the foreskin is also usually too narrow to allow it to pass over the glans. 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. It is important to be patient and to allow the foreskin to retract by itself as forcing it back could damage it.

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.

Phimosis is normal at a young age, but the foreskin should start to become looser in early childhood. Only 10% of boys will still have a tight foreskin at the age of 7 and only 1% will still be affected by phimosis at the age of 17. If there are no signs of the foreskin becoming looser by the age of five or six it can be a good idea to consult a doctor. Treatment might not be required right away, but it can be helpful for phimosis patient UK to talk to an expert about the condition.

Most children do not require any treatment for phimosis. The condition often corrects itself as children grow up. 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. The main surgical option for phimosis patient UK is circumcision. However, sometimes it is possible to remove a smaller section of the foreskin if the problem is caused by scarring.

In reality there are two options for phimosis patient UK, 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.

Some pain and swelling is normal after circumcision, but the side effects are usually manageable. The risk of serious complications is low for phimosis patient UK, but there is still a chance of issues such as an infection, bleeding or allergic reactions to the anaesthetic used during the procedure. You will need to discuss these risks in detail with the doctor before your son has the operation.

There can be significant pain. It can also impact on the child’s voiding. Phimosis can increase the chances of developing infections or balanitis. Boys can also become self-conscious about the condition as they grow older, which could affect their confidence or cause issues such as anxiety. Even if there are no physical phimosis symptoms it can still be important to consider the mental impact of this condition.

If your son is experiencing any discomfort, urinary problems or other phimosis symptoms then you should consult a doctor. It is also a good idea to talk to a doctor if the foreskin isn’t getting any looser by the age of about five or six. Phimosis treatment might not be needed immediately as the foreskin may still retract by itself over time. Treatment may also be required if the foreskin stops being able to retract later on.