Phimosis is the technical term for a narrowing of the foreskin on the penis, which thus can not be pushed back over the glans. In babies and toddlers a phimosis is a normal condition - usually the foreskin dissolves in kindergarten age by itself. Even in adults, such a foreskin narrowing can occur. Cause is then usually a scarring due to inflammation or injury to the penis.
In children, phimosis can often be treated with an ointment and careful stretching of the foreskin. Circumcision by surgery is usually not necessary until complications such as recurrent inflammation occur.
What is a phimosis?
A phimosis denotes a foreskin narrowing, through which the foreskin can not be withdrawn (absolute phimosis) or only incompletely or with difficulty (relative phimosis) over the glans.
Ninety-five percent of all male newborns are born with a phimosis, which in most cases grows to school age. Until the age of three to five years, a phimosis is considered physiological (not pathological).
Phimosis in children often
A phimosis is common in children: In the sixth year of age, eight percent of children have a foreskin narrowing, at 16 years, one percent of adolescents affected.
It is not known why the congenital foreskin narrowing is not resolved or delayed in some children.
Lichen sclerosus as a cause
If a phimosis occurs for the first time in school age, under certain circumstances a so-called lichen sclerosus can be the cause. Among other things, this chronic inflammatory skin disease can affect the genital area and lead to keratinization and hardening of the foreskin in boys and men.
Other signs of lichen sclerosus include whitish, hard skin elevations occurring on the back, neck and genitals. The disease can usually be treated with an ointment with cortisone.
Scarring as a cause in adults
A newly occurring phimosis in adulthood is often due to scars of the foreskin, which can arise from recurrent inflammation of the penis. Scarring can also be caused by injuries to the foreskin, such as violent withdrawal. Therefore, an extension of the foreskin should always be carried out very carefully.
Adults with phimosis should also be screened for diabetes mellitus, as diabetics are at an increased risk of infection, especially in the genital area, which promotes phimosis.
Signs of phimosis
The main symptom of a phimosis is a not or difficult retractable foreskin. In an absolute phimosis the glans and, if necessary, the urethral opening are then not visible.
In adolescents and adult men, this can sometimes lead to pain during erection, sexual intercourse or masturbation.
Complications: inflammation and urinary retention
Phimosis can cause urinary problems if the urine can not drain properly due to the narrow foreskin. Signs include a thin or distended urinary stream and a "bloated" foreskin under which the urine collects. In extreme cases, no or only droplet-wise urination is possible - with such an acute urinary retention then surgery is usually necessary.
By restricting urinary outflow, phimosis may promote urinary tract infections such as cystitis. In addition, a phimosis complicates the intimate hygiene: Under the foreskin, a mixture of glandular secretions and dead skin cells (so-called smegma) can accumulate, which forms an ideal breeding ground for bacteria. Thus, it can easily lead to inflammation of the glans and foreskin (Balanoposthitis).
If there are no symptoms or complications, phimosis must not be treated in infants: if the disease progresses smoothly, treatment can even be expected to reach primary school age.
At the age of seven to eight years, however, the start of therapy is recommended, since up to this age a non-operative (conservative) treatment is more successful than in older children. In addition, it makes sense to treat a phimosis before adolescence, since a narrowed foreskin can lead to discomfort with the onset of sexuality.
Treatment by ointment and stretching
In a child with uncomplicated course of the phimosis, conservative treatment can usually be attempted first. This is applied over four to eight weeks twice daily an ointment or cream with cortisone-like agents such as betamethasone on the foreskin ring.
After two weeks, parents can begin to carefully stretch the foreskin and try to push it back. In the case of stretching therapy, however, always avoid forceful withdrawal, as this can lead to tearing of the foreskin or, in the worst case, constriction of the glans through the narrowed foreskin (paraphimosis).
Phimosis: OP inevitable in some cases
If the conservative treatment does not succeed or if complications occur, surgery is usually necessary. As a rule, a phimosis should be operated in the following cases:
- Recurrent urinary tract infections or inflammation of the penis
- Malformations of the urinary tract with increased risk of urinary tract infections
- Obstruction of urination with "swelling" of the foreskin
- Lichen sclerosus
- Scarring on glans and foreskin
A certain age, from when one should operate a phimosis, does not exist. The decision for or against surgery is made individually according to symptoms and clinical picture. However, adults with phimosis are usually treated by surgery because they are usually caused by scars or lichen sclerosus.
Operation: circumcision or foreskinoplasty
There are a variety of procedures available for the operation of a phimosis: the most common procedure is circumcision, in which the foreskin is either completely or partially removed. If parts of the foreskin are preserved, phimosis may recur again (recurrence).
Another possibility with preservation of the foreskin is a so-called foreskinoplasty: Here, the foreskin is repeatedly cut longitudinally and sewn expanded. Here, however, there is an increased risk of recurrence due to scarring. The procedures are usually performed on children under a short general anesthetic - in an adult male, local anesthesia surgery is also possible.
A paraphimosis ("Spanish collar") refers to the constriction or entrapment of the glans in a phimosis. The cause is usually the violent retraction of the foreskin, which can not be pushed forward again by the narrowing. It forms a Schnürring that hinders the blood drain. This is expressed by a swollen, bluish-red penis tip and severe pain.
Paraphimosis is an emergency that must be treated promptly by a urologist, otherwise tissue damage may occur. The urologist will then try to remedy the paraphimosis by hand - in case of severe pain this may be anesthetic used in those affected. If the paraphimosis can not be resolved in this way, usually a small incision of the foreskin is performed.