Phimosis

In a phimosis, the foreskin of the penis can not or hardly push back over the glans. Read all important information about phimosis!

Phimosis

The phimosis is a narrowing of the foreskin of the penis. It prevents or hampers a retraction of the foreskin. This can be normal until preschool age. However, if the foreskin does not loosen in the course of growth, later narrows or causes problems, treatment may be necessary. A foreskin stenosis can be treated with cortisone ointment or by circumcision. Read all important information about symptoms, diagnostics and therapy of phimosis!

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. N47

Product Overview

phimosis

  • description

  • paraphimosis

  • symptoms

  • Causes and risk factors

  • Examinations and diagnosis

  • treatment

  • Phimosis: surgery

  • Disease course and prognosis

Phimosis: description

Phimosis is the narrowing or a trunk-like extension of the foreskin (prepuce). As a result, it can only be pulled back behind the glans (glans penis) of the penis with pain and with the risk of injury or even not at all. The foreskin constriction is usually congenital, so it mainly occurs in children. In contrast, adult phimosis is rare. As a result of local inflammation or injury may also come to an acquired phimosis.

Depending on the extent, two main forms of phimosis can be distinguished:

  • absolute (complete) phimosis: The foreskin can not be pushed back either in the relaxed or stiff (erect) penis.
  • Incomplete (relative) phimosis: The foreskin can not be stretched back only when the penis is stiff.

To delimit from the foreskin narrowing is a shortening of the Vorhautbändchens (Frenulum breve), which can be treated in the simplest case by the transection of the running down the penis connective tissue band.

paraphimosis

An absolute emergency is the so-called paraphimosis. Read more in the article Paraphimosis!

The phimosis in children is normal

In neonatal and infancy it is perfectly normal that the foreskin can not be displaced. The reason is that the inner foreskin layer (inner foreskin) is glued to the glans. Thus, the very sensitive skin of the glans is protected from contact with urine and feces. Over time, this bonding usually dissolves: Through recurring (involuntary) erections and a reinforcement (keratinization) of the foreskin, the process of dissolution of the foreskin is driven by the underlying glans.

From the age of three, the foreskin is mobile in 80 percent of the boys and should at least be movable from the age of five at the latest. For many five-year-olds, however, the foreskin is not yet completely retractable. Among the six- to seven-year-old boys, five to seven percent are affected by a foreskin constriction; among the 16 to 18-year-olds, around one percent shows phimosis. Adults are less affected.

Prolonged phimosis increases the risk of inflammation and urinary tract infections, which can justify the initiation of therapy.

Phimosis: symptoms

The main symptom of phimosis is that the foreskin can not or hardly push back over the glans. In mild cases, this results in no complaints. But it can also cause pain and itching. In addition, the phimosis promotes inflammation and infections in the foreskin.

With a pronounced foreskin narrowing, urination is also more difficult: the urinary stream is very thin and toned. The direction of the urinary stream may also deviate to the side. In addition, too tight foreskin may urinate due to the backflow of urine inflating like a balloon (ballooning).

In adults, phimosis can also impede erection and ejaculation. Sex with foreskin can therefore be painful.

Phimosis: causes and risk factors

One distinguishes the primary from the secondary phimosis.

Toddler phimosis is almost always primary, this means innate, The foreskin constriction then exists from birth and does not regress as normal during the course of growth. The causes are unknown.

A acquired (secondary) phimosis develops during the course of life, especially as a result of scarring as a result of local inflammations and injuries. In probably 80 percent of the cases, the secondary foreskin narrowing is based on the so-called lichen sclerosus (also called balanitis xerotica obliterans). Lichen sclerosus is an inflammatory skin disease that leads to hardening of the skin - in this case the foreskin. The cause of this disease are probably immune cells whose activity is directed against the body's own tissue (autoimmune reaction). Why a lichen sclerosus develops is not known. Probably many factors are responsible, including genetic.

Also, infections and other processes of inflammation of the foreskin can lead to scarring and thus to phimosis. These are common reasons for a foreskin narrowing in old age.

Scarring often occurs when too much and too much effort has been made to push back the foreskin. These so-called retraction attempts are responsible for around 20 percent of cases of secondary foreskin narrowing. Adults should therefore be very careful with their children and themselves when manipulating the foreskin!

Phimosis: examinations and diagnosis

The specialist in the examination and treatment of phimosis is the urologist. He deals with the organs responsible for urine production and urine diversion, as well as with the male genitalia.

In a first conversation with the patient or (in children) with the parents, the urologist raises the medical history (anamnese). Among other things, he asks the following questions:

  • Did the foreskin ever go back?
  • Are there any problems with urination (such as an inflation of the foreskin)?
  • Are there frequent infections of the urinary tract or on the penis?
  • Have you ever had an operation on the penis?
  • Is a violation of the penis known?
  • Will the penis harden during erection (erection)?

The conversation closes the physical examination at. Especially important are the glans, the foreskin and the foreskin band. First, the doctor checks whether the foreskin can not be pushed back, because it is still glued to the underlying skin of the glans, or whether it is actually too tight. In case of a foreskin narrowing, the foreskin is examined with regard to the narrowest point, shape, condition and retractability. This is very important for a possible therapy. Scarring can sometimes be seen on a white ring around the foreskin opening.

If the doctor Secretion or inflammation (Balanitis = glansitis) noticeable, he will make a smear. This allows any infections to be detected or excluded. Frequently, however, such inflammation is caused by residual urine and thus usually a pure chemical irritation.

After that, the doctor should do that urination to assess the strength and deviation of the urinary stream. Also, any existing flatulence of the foreskin may show up during urination.

Phimosis: treatment

An early treatment of phimosis in the first years of life is only necessary if the foreskin narrowing causes symptoms. So first of all, you can wait and see in many cases. The phimosis treatment is then usually started in preschool age; with repeated inflammations already from the third year of life. The therapy aims to normalize urination and enable sexual function. Important in a phimosis is also a good genital hygiene.

Local cortisone ointments

A non-surgical treatment of foreskin constriction and also adhesions is the local application of cortisone ointments. It should be tried especially for an unclear or borderline only phimosis.

For up to eight weeks, the ointment should be applied twice a day to the foreskin. After two weeks, try to push back the foreskin carefully. However, tears and injuries must be avoided!

Around three quarters of all patients show a marked improvement in phimosis due to cortisone therapy. The problem is, however, that the foreskin narrowing occurs very often afterwards.

The often dreaded side effects of cortisone therapy are not expected with a topical ointment.

Phimosis: surgery

In many cases circumcision is offered by the doctors. Read all important information about the phimosis-op!

Notes for parents!

Parents should only retract the foreskin of their child if this is easily possible. But never the foreskin should be mobilized by force! If a push back is not possible, adults should not be worried: Before puberty, the foreskin must not be stripped back!

If the foreskin is mobile, then it can be pushed back for urination and bathing. It should be cleaned regularly as well as the penis, but not too intense and not with soap. After cleaning it is important to ensure that the foreskin slides back to its original position, so that no paraphimosis persists.

Even if the foreskin is not mobile, the penis should be washed regularly.

If parents notice a sore or reddened foreskin, they should explain to the child that shaking and drying the foreskin after washing and using the toilet is important.

Phimosis: disease course and prognosis

In children, phimosis can often "grow out". For this reason, the therapy can often be maintained even without great risks.

However, untreated phimosis may obstruct the outflow of foreskin secretions, inflammation, urethral obstruction, and injury.Patients who are more likely to suffer from infections and inflammation of the glans and foreskin also have an increased risk of getting penile carcinoma. For circumcised men, this risk is lower. In addition, they have a reduced risk of HIV infection because there are many HIV-sensitive immune cells in the foreskin. Also, the risk of cervical cancer (cervix cancer) is lowered in partners of circumcised men.

In most cases, surgery is a successful and safe treatment option phimosiswhich does not cause any problems even in adult age, even of a sexual nature.

Phimosis

FAQ - 💬

❓ What is phimosis caused by?

👉 Inflammation or an infection of the foreskin or the head of the penis (glans) may cause phimosis in boys or men. Balanitis is an inflammation of the glans. It's sometimes the result of poor hygiene or an infection of the foreskin. One of the infections that can lead to balanitis is called lichen sclerosus.

❓ How do you fix phimosis?

👉 There are three treatment options: Continue to “wait and see” if the phimosis will go away on its own. Use a steroid cream to help stretch the foreskin. Have surgery to partially or completely remove the foreskin (circumcision).

❓ Why do men get phimosis?

👉 Causes of phimosis The foreskin and glans of the penis are fused together as they develop and gradually separate after birth. Scarring of the foreskin from injury, infection, inflammation or skin conditions like lichen sclerosis (balanitis xerotica obliterans), can lead to phimosis.

❓ How serious is phimosis?

👉 Risks. If you have phimosis, you are more likely to get penile cancer. If left untreated, it can lead to increased swelling, and in extreme cases, gangrene, and eventually the loss of your penis.

❓ How long can phimosis last?

👉 Physiologic phimosis: Children are born with tight foreskin at birth and separation occurs naturally over time. Phimosis is normal for the uncircumcised infant/child and usually resolves around 5-7 years of age, however the child may be older.

❓ At what age is phimosis a problem?

👉 If you or your child has a tight foreskin, it will be difficult to pull it back from the end of the penis. A tight foreskin is normal in babies and young boys. Most boys' foreskins do not pull back (retract) before the age of 5, but sometimes it's not possible until they're 10 or older.

❓ Can phimosis be left untreated?

👉 In most men, phimosis is not a serious problem and will not require treatment. However, it is not expected to improve on its own. As noted above, paraphimosis is sometimes a medical emergency, and the penis may become permanently damaged if you do not seek immediate medical attention.

❓ Can I use Vaseline for phimosis?

👉 What are the main treatments? A doctor can manually retract the foreskin under local or general anaesthesia. You may also be shown how to gradually retract the foreskin after a bath, using petroleum jelly (Vaseline) or some other form of lubrication. But if the problem persists, circumcision may be necessary.

❓ What phimosis looks like?

👉 What is Phimosis? Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction.

❓ Is pulling back foreskin necessary?

👉 You don't need to pull it back for cleaning. If your child does pull back the foreskin in the bath or shower, that's fine – but it's not needed. Once your child goes through puberty and can easily pull back the foreskin, it's good for your child to do this in the bath or shower for cleaning.

❓ Is it OK to have phimosis?

👉 It's normal for babies and young boys to have a tight foreskin (phimosis), but adults can also be affected. See a GP if your or your child's foreskin is sore or swollen.

❓ What is phimosis and how do you treat it?

👉 Phimosis is a condition in which the foreskin can’t be retracted (pulled back) from around the tip of the penis. A tight foreskin is common in baby boys who aren’t circumcised, but it usually stops being a problem by the age of 3. Phimosis can occur naturally or be the result of scarring.

❓ What is phimosis (muzzling)?

👉 Phimosis (from Greek φίμωσις phimōsis 'muzzling'. [9] [10] [11]) is a condition in which the ridged band of 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]

❓ What are the possible complications of phimosis?

👉 A potential complication of phimosis is paraphimosis, where the tight foreskin becomes trapped behind the glans. [5] At birth, the inner layer of the foreskin is sealed to the glans penis. The foreskin is usually non-retractable in early childhood, and some males may reach the age of 18 before their foreskin can be fully retracted. [12]

❓ How common is phimosis in boys?

👉 You have 3 more open access pages. Phimosis is the inability to retract the foreskin because of a narrow preputial ring. It affects about 1% of boys. (1) European Society for Paediatric Urology 2009.


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