Phimosis: narrowing of the foreskin in children

What is phimosis?

Phimosis or narrowing of the foreskin is a pathological disproportion between the size of the glans and the opening of the foreskin of the penis. The foreskin, the so-called prepuce, can therefore only be pulled back over the glans with difficulty or not at all in the case of phimosis, which should normally be possible both when the penis is flaccid and when it is erect. Phimosis can lead to pain or inflammatory diseases.

There are differences between complete and relative narrowing of the foreskin. In the case of relative phimosis, the problem only occurs when the penis is erect; in the case of complete phimosis, the foreskin cannot be pulled back over the glans even when the member is flaccid.

Physiological phimosis in infants

In infants and small children it is perfectly normal that the foreskin cannot be pulled back over the glans. However, this is not actually a narrowing of the foreskin, since the foreskin is “glued” to the glans in the first few years of life to protect it.

Such a preputial adhesion is present in about 96 percent of newborn boys. It usually resolves itself within the first three to five years of life through natural development and growth. If the condition persists after the age of five, this can indicate a pathological phimosis. However, the physiological phimosis persists in about 8 percent of boys until they start school, and in about 1 percent of boys it is still present at the age of 16 to 18 years.

As long as there are no problems such as pain when urinating or frequent inflammation of the intimate area or the urinary tract, it is not called pathological phimosis and there is no medical indication to loosen the foreskin adhesions. Caution: Never try to push back your newborn or toddler’s foreskin as this can cause injury and scarring.

Causes of phimosis

A distinction is usually made between primary and secondary phimosis.

• In primary phimosis, the narrowing of the outer ring of the foreskin is congenital and therefore already manifests itself in the first years of life.
• In secondary phimosis, the foreskin is initially normal in width, but then narrows due to external influences. Acquired phimosis of this kind can be caused, for example, by repeated inflammation or small tears in the foreskin, which lead to scarring. Since scar tissue tends to shrink, this can narrow the opening of the foreskin and lead to phimosis. This form can occur in both childhood and adulthood.

detect phimosis

Symptoms of phimosis

The main feature of phimosis is usually the non-retractable foreskin. However, since this can also be due to other causes, such as a shortened foreskin frenulum, phimosis is usually only spoken of with certainty when other symptoms appear:

• frequent inflammation of the glans penis or foreskin
• frequent urinary tract infections
• distended foreskin when urinating
• Difficulty urinating because the stream of urine is obstructed or diverted through the tight foreskin
• Tension, pain or tears in the erection
• Whitish deposits, so-called smegma, on the glans, as intimate hygiene is more difficult

diagnosis of phimosis

The doctor treating you will make the diagnosis primarily based on these symptoms. However, it always depends on the extent of the problems, their combination and last but not least on the age and history of the patient whether the present symptoms are classified as signs of pathological phimosis or not.

In the case of children, a pathological condition is usually only spoken of if pain or problems frequently occurred in the first few years of life. In adults, a blood test to determine blood sugar levels can help because secondary phimosis is common in diabetics.

Phimosis: why treat?

If a pathological phimosis is not treated, it can lead to serious health problems.

• These include chronic inflammation of the foreskin and glans.
• The more difficult personal hygiene and the increased accumulation of smegma on the glans also increases the risk of developing penile cancer.
• In the worst case, acute urinary retention can occur in the case of a very pronounced phimosis, which severely impairs the flow of urine. This means that those affected are no longer able to empty their bladder spontaneously.

In order to prevent such problems, treatment of phimosis is urgently recommended in most cases. Note: In children, treatment is only recommended from the age of three and only if problems have repeatedly occurred in the first years of life. Earlier treatment is advisable only in exceptional cases, when massive problems arise.

Phimosis: how to treat?

The therapy for phimosis consists of dilating the narrowed foreskin or, if that is not sufficient, removing all or part of it. So there are different treatment methods.

If the phimosis is not very pronounced, treatment with a cortisone ointment may be sufficient. Such an ointment is usually applied to the tip of the penis twice a day for four to eight weeks. After about two weeks, the foreskin can then be gradually and carefully pushed back in order to stretch it. However, extreme care must be taken to ensure that the tissue does not tear and thus form scars, which could later develop into secondary phimosis or aggravate the existing phimosis. Such conservative treatment leads to a phimosis in about 50 to 75 percent of children Success.

When is an operation necessary for phimosis?

If conservative therapy using cortisone ointment does not work, an operation is necessary in most cases. In cases where scarring is present, paraphimosis is present, or urination is impeded by phimosis, surgery to remove the narrowing of the foreskin is unavoidable.

• Circumcision: In the so-called circumcision, better known as circumcision, the narrowed foreskin is either partially or completely removed. Partial circumcision leaves part of the foreskin intact, while radical circumcision leaves the glans completely exposed. The process usually only takes a few minutes and can easily be performed on adults under local anesthesia. General anesthesia is recommended for children.
• Plastibell method: Phimosis can also be remedied by pinching off part of the foreskin, especially in small children. To do this, the foreskin is cut a little and then tied off over a special plastic bell. The front part of the foreskin, which is therefore no longer supplied with blood, falls off together with the bell after a few days.
  Note: This method cannot be used if the foreskin tissue is severely scarred or if the foreskin frenulum is shortened.
• Extension plastic: Another alternative to circumcision is the so-called extension plastic. With this method, the narrowed foreskin opening is expanded using special cutting and suturing techniques. The foreskin itself is primarily “remodeled” in the process, but remains largely intact.

prevent phimosis

Since primary phimosis is already present at birth, it logically cannot be prevented. In order to prevent the development of secondary phimosis, however, observing a few points can be helpful:

• The foreskin should never be forcibly pulled back behind the glans as this can result in tears and subsequent scarring.
• Regular and conscientious intimate hygiene can prevent inflammation.
• Inflammation of the glans or foreskin and urinary tract infections should be treated early. This can also counteract scarring.