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  • Phimosis

    Definition

    Phimosis is when the opening of the foreskin of the penis is too small, or the foreskin is too tight or stuck to the head of the penis. This makes it difficult to retract the foreskin back over the tip of the penis.
    Male Reproductive System
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    Causes

    The foreskin is connected to a newborn’s penis at birth. This called physiologic phimosis. As a child grows, the foreskin naturally separates from the head of the penis. In some boys, the foreskin does not separate. The reason why is not known.
    In other cases, called pathologic phimosis, it may happen due to:
    • Infection
    • Scarring
    • Adhesions
    • Repeated forceful retraction of the foreskin
    • Inflammation and swelling

    Risk Factors

    Phimosis is more common in young boys. It may also occur in older boys and men.
    Risk factors for phimosis may include:
    • Trauma
    • Bacterial infections such as balanitis
    • Poor hygiene

    Symptoms

    Symptoms may include:
    • Inability to retract the foreskin
    • Pain
    • Swelling
    • Scarring

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. It will include a genital exam. The diagnosis is made based on the genital exam.

    Treatment

    Phimosis may improve with time. If treatment is needed it will be chosen depending on the cause of your phimosis. Talk with your doctor about the best treatment plan for you.
    Your doctor may advise medication applied to the area. Medication can help decrease swelling and loosen the skin. Medication options may include:
    • Corticosteroids
    • Triamcinolone
    If medication is not successful, the foreskin may need to be removed. This can be done with circumcision.

    Prevention

    There are ways to reduce your chances of getting phimosis. These may include:
    • When able to do so, gently retract the foreskin when urinating and bathing
    • Circumcision to remove the foreskin

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org/home.html

    American Academy of Pediatrics http://www.healthychildren.org

    CANADIAN RESOURCES

    Canadian Paediatric Society http://www.cps.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Blalock HJ, Vemulakonda V, et al. Outpatient management of phimosis following newborn circumcision. J Urol. 2003 Jun;169(6):2332-2334.

    McGregor T, Pike J, et al. Pathologic and physiologic phimosis. Can Fam Physician. 2007 March;53(3):445-448.

    Phimosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 14, 2013. Accessed January 23, 2014.

    Phimosis. National Guidelines Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=12529. Published March 2009. Accessed January 23, 2014.

    Phimosis. University of California, San Francisco website. Available at: http://urology.ucsf.edu/patient-care/children/phimosis. Accessed January 23, 2014.

    Phimosis and paraphimosis. Patient UK website. Available at: http://www.patient.co.uk/doctor/phimosis-and-paraphimosis. Updated May 23, 2011. Accessed January 23, 2014.

    Phimosis (tight foreskin). NHS Choices website. Available at: http://www.nhs.uk/conditions/phimosis/Pages/Introduction.aspx. Updated December 11, 2013. Accessed January 23, 2014.

    Tight foreskin (phimosis). The British Association of Urological Surgeons website. Available at: http://www.baus.org.uk/patients/symptoms/phimosis. Accessed January 23, 2014.

    Tight foreskin (phimosis). NetDoctor website. Available at: http://www.netdoctor.co.uk/diseases/facts/phimosis.htm. Updated February 20, 2012. Accessed January 23, 2014.

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