Narrowing of the foreskin that prevents the glans from being exposed. This can compromise hygiene and cause discomfort during sexual intercourse. It is common in children but sometimes bothers older men as well.
Phimosis (from the Greek phimos) is the narrowing of the foreskin that prevents the glans from being exposed.
The foreskin develops as a small layer of epithelium surrounding the glans, beginning around the twelfth week of gestation. At birth, it completely covers the glans and is tightly attached to it. Over the first four to five years of life, the foreskin gradually separates through intermittent erections and the accumulation of shed skin cells.
Phimosis is quite common, especially in children before adolescence. It is estimated that less than 2% of 17-year-old boys have phimosis. In 95% of newborns, foreskin retraction is difficult. By 6 months, only 20% of foreskins are retractable; by one year, 50% are retractable; and by three years, 90% are retractable.
Phimosis is believed to be congenital, but it can also result from forced retraction of the foreskin in infants during hygiene by their parents, which creates fibrous rings in the foreskin and balanopreputial adhesions. In adults, the causes of phimosis are usually varied, including chronic or recurrent balanoposthitis, especially in diabetics, balanitis xerotica obliterans or lichen sclerosus et atrophicus, and trauma (direct, violent sexual acts, urological manipulations).
It is necessary to differentiate between phimosis and... paraphimosisPenile effusion, a urological emergency caused by inflammation or edema of the foreskin, prevents the glans from being covered after forced retraction. This leads to constriction or strangulation of the glans by the retracted foreskin ring, with the risk of glans necrosis, which can result in its loss. It is relatively common in adults with urinary catheters and in children after their first penile manipulations.
Complications or symptoms
- Painful intercourse: due to the lack of sliding of the foreskin over the glans and penis
- BalanitisIt is an infection of the penis, due to the accumulation of smegma in the balanopreputial space.
- Urine infections
- Urination problems: ranging from dysuria to recurrent acute urinary retention requiring urinary catheterization
- Balanopreputial adhesions: this is the union of the foreskin with the glans, which further complicates phimosis and can be present in the absence of phimosis.
- Cancer of the penisIt is a very rare complication, with an incidence of less than 1/100.000 males per year, which may be due to the persistence of phimosis after puberty.
- Paraphimosis
Before resorting to circumcision, treatment with topical corticosteroids prescribed by a pediatric urologist from the age of three for about two or three months, along with gentle retractions, can resolve phimosis.
Phimosis is usually treated by circumcision, performed by a urologist under aseptic conditions and with the necessary surgical material.
It is also possible to solve some cases through a frenuloplasty or elongation of bridle, or the combination of this with a foreskin plasty, which allows the foreskin to be preserved, but without phimosis.
