Phimosis: when, how and why

9 Jul 2020

More common in boys, it can also affect men in adolescence and adulthood. What signs should encourage you to consult? When to have an operation?

The foreskin combines the skin and the mucous membrane that covers the glans. The foreskin should slide easily over the penis, allowing unclogging. The person suffering from phimosis experiences a difficulty or the impossibility of discovering the end of the penis, a situation that corresponds to the impossibility of decalcifying.

Causes of phimosis

A distinction must be made between constitutional phimosis, which is very rare, and secondary phimosis. 96% of newborns are considered to be born with phimosis. Most of the time it disappears with spontaneous erections, toilet. At 3 years, only 11% of children have phimosis and only 1% of men. 18 year olds have a constitutional phimosis. We don’t talk about phimosis before 3 years old.

Very often, phimosis is secondary. In childhood, phimosis can be related to forced uncovering, inflammation, cracks. It is a sclerotic phimosis. The preputial ring is thick, very narrow and fibrous.

Phimosis can appear more rarely in adults. Phimosis can be linked to diabetes or a sclero-atrophic lichen.

Symptoms of phimosis

The symptom of phimosis is the inability to retract the foreskin on the glans. In children, more often, phimosis does not cause symptoms “but it can cause local inflammation or even infection due to the retention of smegma (secreted by the preputial glands) that cannot escape in the child as in adults. In adolescents and adults Phimosis can also cause discomfort or even erection pain.

Beware of the risk of infection

There are complications if phimosis is not treated, in particular the risk of infection in the glans, called balanitis: in this case, the penis is painful, hot, sometimes increases in volume and spontaneous whitish discharge or pressure from the penis may appear.

The other potential consequence of phimosis is paraphimosis: if you force the uncap, the foreskin ring can lock on the penis at the base of the glans and strangle it, causing pain and swelling.

Phimosis diagnosis

The diagnosis of phimosis is clinical. It is suspected by the naked eye and confirmed by the examiner’s inability to uncover it. We can help ourselves with pictures of the erect penis in adolescents when it comes to functional phimosis with an erection constriction ring.

Treatments: it all depends on age

For babies and young children, in whom phimosis is often natural, it is only intervened in case of complications (infection, paraphimosis). The preputial adhesions gradually rise during the first years of life. Uncovering young children is not advisable. The more the uncovering is forced, the more we risk creating sclerosus phimosis.

In older children with phimosis, medical treatment consisting of applying a corticosteroid ointment twice a day is preferred. According to studies, there are 67 to 95% good results with this treatment. In case of failure, if the phimosis is bothersome, a surgical intervention is proposed.

In adults, the treatment of phimosis is usually surgical.

The operation

Surgical intervention is quick and does not require hospitalization. General anesthesia is more common in children. The healing lasts from 2 to 4 weeks. The resumption of sexual activity for adults takes place after 4 weeks.

Paraphimosis rarely requires emergency hospitalization. The application of an anesthetic gel improves pain. The need to quickly verify the foreskin by a professional is essential. Consultation with a urologist should be considered immediately.