What is phimosis?
Phimosis is the inability of the glans to exit through the foreskin because the foreskin is narrow and does not dilate sufficiently. The inability to retract the foreskin is not always due to phimosis, it also happens because of the existence of adhesions between the foreskin and the glans, which we call: banana-preputial adhesions. Phimosis is a disease that requires medical intervention and specific treatment. On the other hand, adhesions are physiological, therefore, they disappear with time, usually during puberty, and do not need to be treated or removed by the “pulling” technique, which was very common in the past.
We should not force the foreskin to facilitate the exit of the glans penis because it can cause wounds and edema, i.e. scarring and swelling, causing paraphimosis.
Most young boys still have an inelastic foreskin, so they can actually be diagnosed with phimosis, but during the first four years of age phimosis can disappear because the skin becomes naturally elastic. That is why it is said that phimosis is physiological until 4-5 years of age and we tend to wait until that age before operating.
Treatments for phimosis
If after four or five years the phimosis and the impossibility of retracting the foreskin remain, then there are different treatments that can be carried out. In no case should we force the skin of the foreskin to facilitate the exit of the glans. This can cause paraphimosis, as well as pain and cracks in the skin.
Phimosis can be treated medically or surgically. Medical (non-surgical) treatment consists of the application of a corticosteroid cream for one or two months. The application of the cream should be accompanied by small tractions so that the area acquires elasticity. Many children, especially the youngest, cure their phimosis in this way.
There are two types of surgical treatment: foreskin plasty and circumcision. These interventions are performed, in children, under general anesthesia.
- Foreskin plasty: in this technique the foreskin, the skin covering the glans penis, is not removed. The position of the skin is modified and the narrower area is widened. In this way, the foreskin continues to cover the glans after the operation. The disadvantage of this technique is that the result is sometimes not very esthetic.
- Circumcision: this is the usual technique and consists of removing the foreskin so that the glans is now uncovered.