Phimosis
What is phimosis? Everything you need to know about this foreskin condition.
Symptoms and Causes
Phimosis occurs when the foreskin cannot be retracted over the tip of the penis. This condition is normal in newborn boys, but over time, the foreskin loosens and retracts completely. If, by the age of 17, it still cannot be fully retracted, treatment is necessary to resolve the issue.
During routine pediatric check-ups, the development of the foreskin is monitored, and hygiene and care recommendations are provided. It is generally advised to gently retract the foreskin during hygiene routines to aid the natural process, or to apply specific corticosteroid creams. However, abrupt pulling should be avoided, as it may cause permanent scarring and intense pain.
Paraphimosis may also occur when the foreskin is retracted behind the glans and cannot return to its normal position. These cases are more severe, as blood circulation may be compromised.
Symptoms
Depending on individual characteristics and the type of phimosis, treatment may or may not be necessary.
Some symptoms indicating the need for medical intervention include:
- Balanitis or recurrent inflammation of the foreskin.
- Recurrent urinary tract infections.
- Difficulty urinating.
- Patients with urological malformations, such as vesicoureteral reflux.
- Children with megaprepuce, meaning excessive mucosal tissue and insufficient skin.
Causes
Phimosis is a congenital condition that boys are born with, regardless of whether their father has had it or not. In most cases, it resolves naturally without complications, requiring only proper hygiene and periodic monitoring.
In some cases, phimosis develops after repeated urinary infections or as a result of trauma, such as excessive force used to retract the foreskin in young children. This type of phimosis does not resolve on its own and requires medical intervention.
Risk Factors
As mentioned earlier, some of the main risk factors for phimosis include:
- Genetic predisposition.
- Foreskin trauma.
- Poor hygiene.
- Urine accumulation.
- Bacterial infections.
Complications
The main complication is paraphimosis. When the foreskin is too tight and, after being retracted, does not return to its original position, it may obstruct blood and lymphatic flow. If swelling of the glans (edema) occurs, the only way to return the foreskin to its position is through surgery.
In addition to urinary infections and the accumulation of smegma (dead skin cells) or debris, untreated phimosis may increase the risk of penile cancer.
Prevention
When phimosis is congenital, it cannot be prevented. However, certain measures can help avoid its development due to other causes:
- Maintain proper penile hygiene from an early age.
- During bathing, gently and gradually retract the glans to facilitate the natural process.
- Avoid forceful pulling when attempting to retract the foreskin.
Which Doctor Treats Phimosis?
Phimosis is treated in urology consultations. In children, pediatricians are responsible for diagnosing and managing the condition.
Diagnosis
There are no specific tests to diagnose phimosis, as it is typically detected during routine pediatric check-ups. A standard physical examination includes:
- Evaluating the penis and testicles' anatomy.
- Checking the degree of foreskin retraction.
- Observing the mucosal appearance.
- Identifying the presence of adhesions, cysts, or foreskin scarring.
Treatment
Phimosis treatment usually involves allowing the condition to resolve naturally, as in most cases, it disappears on its own. When this does not happen, two different approaches are used depending on the patient’s age and the severity of the condition:
- Steroid and corticosteroid creams: A topical treatment applied daily to improve skin elasticity. These ointments, combined with gentle foreskin retraction, help separate the foreskin from the glans.
- Circumcision: If the foreskin remains unretractable and infections occur, surgery is performed to correct phimosis. During circumcision, the foreskin is completely removed, exposing the glans.
