Phimosis
Phimosis
Definition
A tightening of the foreskin of the penis that may close the opening of the penis.
Description
The foreskin of a newborn boy is always closely contracted around the penis head (glans). Only a small passage allows the urine to pass through. In the first months the foreskin is stuck to the glans and cannot be pulled back and one should not attempt to do so. During the first couple of years, the foreskin will become gradually looser and in many boys it can in time be pulled back without trouble. Half of all three-year-olds can pull back their foreskin. It is not advisable to try pulling the foreskin back using force, since this may cause small cuts in the foreskin with scars which could finally cause a regular foreskin contraction.
Foreskin contraction, called phimosis, can last throughout life and not cause any trouble at all. It is a voluntary decision whether to have a circumcision operation or not. If any problems do arise, they happen after puberty. The contraction may occur for the first time as an adult and usually requires circumcision, the surgical removal of the foreskin.
Causes & symptoms
Phimosis is caused by the inability of the foreskin to retract from around the opening of the penis. In adults, phimosis can lead to chronic inflammation and cancer.
Diagnosis
A physician usually diagnoses phimosis when there are persistent problems urinating, when there are recurrent infections under the foreskin, or when the opening to the penis is completely blocked by the foreskin. Phimosis is a tight ring of foreskin often made of scar tissue preventing retraction of the foreskin. It may be primary, or secondary to recurrent infection. It may produce urinary obstruction with ballooning of the foreskin. Phimosis is different than having a non-retractable foreskin, which is normal in many boys.
Treatment
If the foreskin cannot be pulled back into place treatment should be sought. If the blood flow to the penis is restricted then emergency treatment is required and if the foreskin cannot be pulled back a surgical cut to the trapped foreskin may be required. Failure to seek treatment can result in permanent damage to the penis. Once phimosis is diagnosed, the available treatments include topical corticosteroids, manual stretching, foreskin surgical repair or plastic surgery, and circumcision. Conservative treatments should be tried in the first instance and surgery used as the treatment of last resort.
A number of studies show that phimosis can be safely and effectively treated by the application of topical steroids in 80-90% of cases. Betamethasone cream 0.05% should be applied to the exterior and interior of the tip of the foreskin two or three times a day. The treatment should be discontinued as ineffective after three months if the foreskin has not become retractile during this time.
A number of corrections are available for the adult or adolescent non-retractable foreskin. These include surgery to repair the foreskin, in which an incision is made through the constrictive band of the foreskin. The underlying tissue is spread with forceps to expose the Buck's fascia (the deep, connective tissue of the penis) and the incision is closed with absorbable sutures. This procedure has less risk of disease and infection than circumcision, and allows the foreskin to be retained.
Circumcision is very traumatic to a child. It is essentially irreversible and should be the treatment of last resort. Phimosis due to balanitis xerotica obliterans (BXO), a chronic, progressive, hardening skin inflammation of the penis, has been considered the one common absolute indication for circumcision.
Alternative treatment
There are no alternative medicine treatments for phimosis.
Prognosis
In most men, phimosis is not a serious problem and will not require treatment. However, it is not expected to improve on its own. With treatment, phimosis in most males can be managed or corrected.
Prevention
Proper hygiene is the most important preventative measure. The American Academy of Pediatrics recommends that the immature foreskin of boys not be forced back for cleaning. The only person who should clean and retract the foreskin is the boy himself. Bubble bath products and other chemical irritants can cause the foreskin to tighten and it is recommended they should be avoided by males with foreskins.
KEY TERMS
Balanitis xerotica obliterans (BXO)— A chronic, progressive, hardening skin inflammation of the penis.
Buck's fascia— The deep connective tissue of the penis.
Circumcision— The removal of all or part of the foreskin from the penis.
Corticosteroids— A synthetic drug similar or identical to a natural corticosteroid, used to reduce inflammation.
Glans— The head of the penis.
Paraphimosis— The entrapment of a retracted foreskin behind the coronal sulcus, a groove that separates the shaft and head of the penis.
Resources
BOOKS
Icon Health Publications. Phimosis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References San Diego: Icon Health Publications, 2004.
PERIODICALS
"GP Registrar: Pictorial-Case Study (Diagnosis of Phimosis)." GP (February 11, 2005): 66.
Berk, David R. "Paraphimosis in a Middle-Aged Adult After Intercourse." American Family Physician (February 15, 2004): 807.
Choe, Dr. Jong M. "Paraphimosis: Current Treatment Options." American Family Physician (December 15, 2000): 2623-2627.
ORGANIZATIONS
American Foundation for Urologic Disease. 1000 Corporate Blvd., Suite 410, Linthicum, MD 21090. (410) 689-3990 or (800) 828-7866. http://www.afud.org.
OTHER
December 19, 2004. Circumcision Information and Resource Pages. Conservative Treatment of Phimosis: Alternatives to Radical Circumcision 〈http://www.cirp.org/library/treatment/phimosis/〉 (Accessed March 31, 2005).