What is phimosis?
The penis is covered by a ring of tissue called the foreskin. The foreskin is loose and slides over the penis, covering and uncovering the head of the penis (glans). It can also cover and uncover the opening of the penis (meatus). If the foreskin is too tight, it is unable to move. When this happens, the foreskin can close over the glans, causing a condition called phimosis. As a result, a tight ring of scar tissue forms over the head of the penis, which prevents the foreskin from retracting from the glans.
The severity of phimosis varies:
- In milder forms of phimosis, the foreskin retracts partially.
- In severe phimosis, the foreskin cannot retract. It completely closes the opening of the penis (meatus).
If your child has phimosis, a health-care provider will refer them to a urologist.
What is paraphimosis?
If the foreskin is not returned forward to its usual position, it can become stuck, creating a tight band around the penis shaft. This is a condition called paraphimosis. It causes swelling and pain and is considered a medical emergency. If this occurs, take your child immediately to the nearest emergency department.
Paraphimosis rarely requires surgery, but only a health-care provider should unretract the foreskin. Before unretracting the foreskin, the health-care provider will apply an anesthetic cream. They may also prescribe pain medicine to relieve any discomfort. As the swelling reduces, the health-care provider will gently unretract the foreskin. Most children will need pain management or even sedation for this procedure.
There are two types of phimosis
Physiological phimosis: this type of phimosis is naturally occurring at birth. As the child grows, the foreskin slowly detaches from the head of the penis (glans) and the urethral opening (meatus) becomes visible. Physiological phimosis can resolve at different ages for different children; however, in most children it should resolve around puberty.
Pathological phimosis: this type of phimosis develops when the child is unable to retract the foreskin to see the urethral opening (meatus). Pathological phimosis is usually caused by:
- improper foreskin care
- repeated swelling of the foreskin, called balanitis, that can cause scarring.
Signs and symptoms of phimosis include:
- inability to retract the foreskin while cleaning or bathing, once your child has reached puberty
- inability to retract the skin enough to see the urethral opening (meatus)
- ballooning of the foreskin while urinating
- painful erections
- bleeding
- repeated infections of the bladder or kidneys (urinary tract infections)
- infection or inflammation of the skin of the penis glans (balanitis)
- difficulty emptying the bladder or weak flow of urine
- new onset of leaking of urine (in children who use the toilet)
How common is phimosis?
About 96 out of 100 male babies are born with natural phimosis. About 10% of male babies may have a milder form of physiological phimosis where the foreskin can partially retract. This usually resolves within the first few years of life. By the age of 16, a child with male anatomy should be able to easily retract the foreskin and only 1% of individuals will continue to have true phimosis.
Treating physiological phimosis
This type of phimosis resolves on its own. The foreskin slowly detaches from the glans over time as the child gets older. There is no need for treatment.
Treating pathological phimosis
- Topical steroids: Applying topical steroids to the foreskin is an effective form of treatment. It needs to be applied twice a day for four to six weeks. Up to 85% of cases of mild-to-moderate phimosis respond well to this treatment. However, this treatment may be temporary. Sometimes, the condition may reappear several months after completing treatment.
- Circumcision: If the foreskin still cannot be retracted after use of a topical steroid, your child’s health-care provider may suggest circumcision. Circumcision is a procedure where the foreskin is removed, releasing the constricting band on the foreskin.
- In newborns, this procedure can be completed in a clinic with local pain relief and no form of sedation or anesthesia.
- In older babies and children, this procedure is completed under anesthesia in the operating room.
- In newborns, this procedure can be completed in a clinic with local pain relief and no form of sedation or anesthesia.
How to prevent phimosis
- Ensure proper foreskin care to prevent pathological phimosis.
- The foreskin will naturally retract at different ages, depending on the child; this may start as early as three years of age or as late as pubertal age. Regular retraction is NOT recommended prior to the age that this happens naturally.
- Never forcefully retract the foreskin, as it can worsen phimosis or result in paraphimosis.
How to clean the foreskin and penis
Before the foreskin can naturally retract
- Clean your child’s foreskin and penis with soap and warm water during bath time. Mild soap works well. There is no need for special cleansers or cotton swabs. Do not try to pull back the foreskin.
- Pat the area completely dry with a towel.
After the foreskin can naturally retract
- Gently pull the foreskin back. Never retract it forcibly. Forcing the foreskin to retract before it is ready may harm the penis, causing pain, bleeding, and tears in the skin.
- Clean under the foreskin with soap and water during bath or shower time. Mild soap works well. There is no need for special cleansers or cotton swabs.
- Rinse and dry beneath the foreskin thoroughly.
- Gently pull the foreskin back over the head of the penis. The foreskin should NOT be left in the retracted position.
As your child gets older, encourage them to continue to care for their foreskin. Proper care is part of healthy hygiene.
When to seek medical attention
Bring your child to see a health-care provider if:
- They have burning or pain when they urinate
- They are unable to urinate for several hours
- They are only able to dribble urine (unable to form a normal stream of urine)
- There is abnormal white or cloudy discharge from the penis
- There is swelling of the head of the penis
- There is an inability to pull the foreskin over the penis head after it has been stretched back (paraphimosis)
References
Informed Health.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Phimosis: Overview. 2015 Oct 7 [Updated 2018 Oct 31]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK326437/.