Phimosis

Phimosis
Pronunciation
SpecialtyUrology
SymptomsUnable to pull the foreskin back past the glans[3]
ComplicationsBalanitis,[3] penile cancer [citation needed], urinary retention
Usual onsetNormal at birth[3]
DurationTypically resolves by 18 years old[4]
CausesNormal, balanitis, balanitis xerotica obliterans[5]
Risk factorsDiaper rash, poor cleaning, diabetes[6]
Differential diagnosisHair tourniquet, lymphedema of the penis[6]
PreventionSteroid cream, stretching exercises, circumcision[7]
Frequency1%–2% (in uncircumcised males 18 years or older)[8][4]

Phimosis (from Greek φίμωσις phimōsis 'muzzling'[9][10][11]) is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans.[3] A balloon-like swelling under the foreskin may occur with urination.[3] In teenagers and adults, it may result in pain during an erection, but is otherwise not painful.[3] Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.[3]

In infancy, phimosis is considered physiological (normal).[11] At birth, the foreskin is naturally adhered to the glans, and cannot be retracted. As the child ages, in most cases, the foreskin will naturally detach. In young boys, it is normal not to be able to pull back the foreskin at all.[7] Over 90% of cases resolve by the age of seven, although full retraction is still prevented by balanopreputial adhesions in over half at this age.[5][7] Occasionally, phimosis may be caused by an underlying condition such as scarring due to balanitis or balanitis xerotica obliterans.[5] This can typically be diagnosed by seeing scarring of the opening of the foreskin.[5]

Generally, treatment isn't considered necessary unless the foreskin still cannot be retracted by the age of 18.[4] Efforts to pull back the foreskin during the early years of a young male's life should not be attempted.[7] For those in whom the condition does not improve further, time can be given or a steroid cream may be used to attempt to loosen the tight skin.[7] If this method, combined with stretching exercises, is not effective, then other treatments such as circumcision may be recommended.[7] A potential complication of phimosis is paraphimosis, where the tight foreskin becomes trapped behind the glans.[5]

  1. ^ OED 2nd edition, 1989 as /faɪˈməʊsɪs/.
  2. ^ Entry "phimosis" in Merriam-Webster Online Dictionary Archived 2017-09-22 at the Wayback Machine.
  3. ^ a b c d e f g "Phimosis". PubMed Health. Archived from the original on 5 November 2017. Retrieved 28 October 2016.
  4. ^ a b c "Natural Foreskin Retraction in Intact Children and Teens". Peaceful Parenting.
  5. ^ a b c d e McGregor TB, Pike JG, Leonard MP (March 2007). "Pathologic and physiologic phimosis: approach to the phimotic foreskin". Canadian Family Physician. 53 (3): 445–8. PMC 1949079. PMID 17872680.
  6. ^ a b Domino FJ, Baldor RA, Golding J (2013). The 5-Minute Clinical Consult 2014. Lippincott Williams & Wilkins. p. 138. ISBN 978-1-4511-8850-9.
  7. ^ a b c d e f "What are the treatment options for phimosis?". PubMed Health. Institute for Quality and Efficiency in Health Care. 7 October 2015. Archived from the original on 5 November 2017. Retrieved 28 October 2016.
  8. ^ "Phimosis". Doctors Opposing Circumcision. 6 July 2016.
  9. ^ φίμωσις, φιμός. Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at the Perseus Project.
  10. ^ Harper D. "phimosis". Online Etymology Dictionary.
  11. ^ a b Kirk RH, Winslet MC (2007). Essential General Surgical Operations. Elsevier Health Sciences. p. 365. ISBN 978-0-443-10314-8. Archived from the original on 2017-11-05.