Phimosis is a condition that describes the tightness of the foreskin opening for uncircumcised men and boys.
For men and boys with phimosis, the foreskin cannot be drawn back and over the penis’ tip; instead, it adheres to the skin. While phimosis is normal in newborn baby boys, it typically reduces over age with ~95% of boys able to retract the foreskin by age three. The foreskin will generally loosen with time and penile growth, and the skin will stop adhering to the tip of the penis.
Paraphimosis is a different type of condition also affecting the foreskin in uncircumcised men and boys. In this case, the foreskin is pulled back behind the tip of the penis and becomes stuck and can no longer be returned to its normal position. This can have severe consequences, as blood flow is restricted to the penis when the foreskin is held behind the head and the coronal groove. This is a serious medical emergency that requires prompt attention.
Causes of Phimosis & Paraphimosis
In some cases, phimosis occurs when the normal loosening of the foreskin that happens over time simply does not take place. In other cases, attempts to force the foreskin to retract before it is naturally ready can lead to the development of phimosis. Fibrous scar tissue can form in the area and cause the foreskin to remain stuck in place, preventing it from retracting. In some cases, infections can lead to phimosis. Careful, gentle washing can help to prevent phimosis. Paraphimosis has a number of different causes, including phimosis itself and previous foreskin infections.
Symptoms of Phimosis
Phimosis can have symptoms include the inflation or bulging of the foreskin during urination. This may be painful and boys have difficulty urinating. When the foreskin cannot be retracted comfortably as the child grows, this may also indicate the development of pathologic phimosis. Boys with phimosis may have penile and foreskin infection and possibly urinary tract infections. In some cases, they may develop a foreskin infection known as balanitis. Long-term phimosis can have significant impact and possibly lead to chronic scarring of the skin.
Symptoms of Paraphimosis
In addition to the inability to return the foreskin over the head of the penis, there are several signs of paraphimosis. Paraphimosis can be painful, and the tip of the penis will often swell. The tip of the penis may turn blue or dark red. Children showing signs of paraphimosis should receive urgent medical attention.
Treatment for Phimosis and Paraphimosis
A physician can diagnose phimosis or paraphimosis based on a physical examination. Boys with phimosis may be prescribed a steroid cream. This cream should be applied three to four times daily in order to help loosen the adhesive area connecting the foreskin to the penile tip. If the cream does not alleviate symptoms or improve the phimosis, a physician may recommend circumcision. Paraphimosis treatment may involve lubricating both the foreskin and the penis tip while squeezing them into place. The penis may be bandaged in order to reduce pain and swelling. In some cases, an incision in the foreskin can help to remove tension, and in more severe cases, an emergency circumcision may be necessary.
Circumcision in the Older Child
If a circumcision is indicated in the older child (unable to have an office procedure due to size), your child will be taken to the operating room with a brief general anesthetic. This procedure typically takes 30 minutes and your child should go home the same day. Your surgeon at UCI Pediatric Urology will review the after-care with you. Your child will likely have stitches in place, but these will not need to be removed as they are absorbable.