Phimosis is a problem that occurs in men, caused by the inability to discover the head of the penis or glans, due to the narrowness of the opening of the foreskin. This anomaly affects newborns, children, youth, and adults. That’s why many moms with baby boys have this concern at some point in their child’s development.

At birth, the glans is completely covered by the foreskin.

The glans is at the end of the penis. This part is very sensitive. Above it is a thin piece of stretchable skin: the foreskin. The foreskin is attached to the back of the penis with a kind of “strap.” The foreskin looks different for each child. It varies from almost no foreskin to a spacious foreskin in a kind of “beak.”

The foreskin and glans often stick together at birth, this is natural. From the age of 4, the foreskin can recede gently in most children. If the backward slip does not work (correctly), do not force it. This can hurt and cause cracks in the skin. This results in scars and the foreskin may become even narrower. In most children, the foreskin finally comes off by itself.

A narrowed foreskin is usually caused by a skin defect. The strap that secures the foreskin to the penis may also be too short.

If the foreskin cannot (properly) be pushed back over the glans, this should not cause any complaints. However, it can be difficult to clean properly under the foreskin.

The foreskin is attached to the lower part of the penis with a strap called the frenulum. There is an artery in that belt that can bleed a lot if the frenulum accidentally tears. If the foreskin cannot be removed, the glans cannot be fully exposed. This is how phimosis occurs in children, or what it means, the narrowing of the foreskin.

 

What are the different types of pediatric phimosis?

There are two types:

Physiological phimosis

Physiological phimosis is when the tight foreskin is present at birth and usually resolves without treatment between 5 and 7 years.

Pathological phimosis

Pathological phimosis occurs later in life and is due to scars, infection or inflammation. With children, there is generally no cause for concern.

In children, it is completely normal that the foreskin cannot be pulled back completely or that it cannot be pulled. The foreskin may narrow and adhere to the glans until puberty.

In the course of growth and puberty (12 to 15 years), spontaneous erections make the foreskin enlarge so much that it is easy to slide over the glans.

Therefore, treatment is rarely indicated before puberty, unless complaints arise.

 

Possible complaints

Too close to the foreskin can make hygiene difficult, which can lead to infections and further aggravate the foreskin. Too close to the foreskin can also make urinating difficult or painful. Complaints about sexual intercourse can occur later in life when you reach adulthood.

In addition, there is a phenomenon called paraphimosis or Spanish collar. In this case, the foreskin gets stuck behind the edge of the glans and swells. Medical intervention is usually necessary to remedy that. A doctor should be consulted urgently in case of paraphimosis.

 

When is phimosis treated?

If the slide back of the foreskin fails, it is better not to force it. After all, that could make the foreskin no longer enter the normal position, or small cracks and scars that make it even narrower.

For most children, the foreskin finally releases on its own. It can last until puberty. The treatment is only recommended:

– If the foreskin prevents urination: the foreskin swells during urination due to the accumulation of urine (‘balloon urination’)

– When urinating is painful or difficult (urinating with a weak beam, urinating in small streams) with pain in the glans.

– If erections become painful because the foreskin does not slip.

– With repeated infections or inflammation of the glans (balanitis), because the glans is not easy to clean or because there is urine between the foreskin and the glans.

– If lichen sclerosus is diagnosed: a disease of the foreskin that causes narrowing and hardening of the foreskin.

 

Treatment

Who sees phimosis? A pediatric urologist, it is very important that you be a pediatric surgeon.

How to cure without operating. In childhood, a narrow foreskin is often treated first with cortisone. This offers a cure potential of more than 70 percent.

Usually, the narrowing of the foreskin is not so bad and your child’s skin naturally becomes smoother.

If necessary, first use a cream that can make the foreskin more flexible. The cream is applied to the foreskin twice a day for 6 weeks. Subsequently, an attempt is made to carefully pull the foreskin back.

After this treatment, the urologist will see how things are.

When is surgery suggested?

If the cream treatment is unsuccessful, surgery is performed. Currently, the need to operate a phimosis child, for health reasons, is reduced to isolated cases. It is contemplated in very severe phimosis situations that do not resolve naturally, local recurrent infections (balanitis) or urinary system malformations that cause infections.

This may be necessary, for example, when the foreskin is very narrowed by rigid scar tissue. When an operation is necessary, there are several options:

– The foreskin is released.

– The foreskin is loosened and partially removed.

– The foreskin is completely removed.

– The strap that secures the foreskin is loosened.

– The operation is performed under general anesthesia. After the operation, the penis will look normal. In the hospital, you will be fully informed about the course of events before the operation. You will also receive advice for the home, after the operation.

 

Phimosis at an adult age

If the foreskin narrowing occurs later in life, it is usually the result of repeated inflammation or a skin disease such as lichen sclerosus. With lichen, the upper part of the foreskin is systematically thicker and harder.

All the information we give you in this article is for orientation since each person is different, so to establish a diagnosis and treatment it is essential that you go to your doctor.

 

 

Carolina González Ramos

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