Phimosis

What is Phimosis?

Phimosis is a medical condition wherein the foreskin of the penis is too tight and cannot be pulled back over the glans. This causes discomfort and pain to the patient besides creating conditions for infection of the urinary tract due to poor hygiene practices.

It is a commonly occurring condition in uncircumcised male babies. Occasionally skin ailments that result in scarring may also cause Phimosis. Such a possibility is high in older children.

This may cause slight pain while passing urine as the head is covered and the urethra is not exposed. Forcefully pulling back the foreskin before it is detached is not recommended because it is not only painful but would also result in damage to the foreskin.

Awareness of the available options for patients with Phimosis, particularly in young children, is the need of the hour. Both parents and doctors need to be informed about the available options as well as the advantages of these new techniques.

Phimosis rarely causes complications or serious health issues. The health problems are limited to painful and difficult urination or soreness and swelling of the glans. Over the last two decades, medics are treating cases of phimosis with topical steroids, since the results of this non-surgical approach are highly positive.

What is the Medical Definition of Phimosis?

Medically Phimosis is defined as being unable to retract the prepuce or foreskin that covers the penis head or glans.

What Causes Phimosis?

It may be a natural occurrence at birth or caused by skin ailments like Eczema, Lichen planus, Psoriasis, and Lichen sclerosus. Phimosis may be the result of a sexually transmitted infection or be the outcome of infections by fungi or bacteria.

Older Boys may get affected by Phimosis if they have repeated UTIs, Foreskin Trauma, infection of the foreskin, or handling the foreskin roughly every time.

What are the Symptoms of Phimosis?

Sore and inflamed glans can also lead to Balanitis in children. In some cases, thick discharge is seen beneath the foreskin. Such a condition when both the foreskin and the glans are having an inflammation is referred to as Balanoposthitis.

What are the Types of Phimosis?

There are two types of Phimosis- pathologic and psychologic. Phimosis seen in uncircumcised male infants is called Psychologic Phimosis. If the condition is caused by inflammation, scarring, or infection it is called Pathologic Phimosis.

What are the Complications that Patients with Phimosis need to be aware of?

Do not use a cotton swab or Q-tip to clean the areas between the glands and the foreskin as it might cause damage to the sensitive skin in the area.

Inability to pass urine, and constant pains during urination are usually sufficient causes to recommend surgery.

Circumcision though recommended as a last resort may lead to post-operative infection and bleeding if adequate precautions are not taken.

Non-surgical Adhesiolysis, wherein the foreskin is separated from the places it is attached to the glans without actually removing it is a new age approach that is being recommended of late. This approach is seen to be safe, effective, and reasonably priced when compared to surgery.

The latest medical and surgical treatments are safer, highly effective, and conservative. These non-invasive options are seen to give better results with negligible side effects.

How is this Condition Diagnosed?

Clinical Diagnosis is sufficient to diagnose this condition and there is no need for the patients to undergo any imaging studies or laboratory tests. Phimosis is easily diagnosed as it presents itself at the tip of the penis and prevents full retraction. The foreskin appears like a rubber band similar to a tight ring around the tip of the penis.

It is important to check the cause of Phimosis, and identify if it is pathologic or psychologic. Severe Phimosis tends to prevent patients from completely clearing their bladder and some amount of residual urine tends to remain behind. The patient thus feels like urinating and makes frequent trips to the washroom.

The cases of Phimosis observed in uncircumcised babies are not pathologic and do not need aggressive treatment. However, parents tend to be apprehensive and they need to be reassured that such cases are normal and quite common in young males till they reach the age of 2-6 years when it gets rectified naturally.

What is the Recommended Line of Treatment for Phimosis?

Studies done with data available with the NIH show that 0.6 percent of boys are affected by cases of pathological phimosis by the time they are 15 years. This means 2 in every 5000 boys are affected in this age category.

The recommended line of treatment for physiological phimosis is more conservative, while surgery is recommended in cases of pathological phimosis.

Circumcision is carried out under local anaesthesia and the patient may have slight pain for the first 2 days due to the bruises and swelling of the penis. In young children, the surgeons prefer using general anaesthesia. Circumcision is not extremely painful and is usually relieved by pain killers like ibuprofen that are easily available and can be purchased without prescriptions at any pharmacy.

The line of treatment would vary from case to case and depends on the severity of the situation as well as the patient’s age and resilience. In most cases doctors adopt the wait and watch policy, to see if the condition will be rectified naturally.

Data available with the NIH shows that moisturising is not effective in treating this condition and thus not recommended at all.

It is recommended that the penis should be gently retracted and the area under the foreskin must be cleaned regularly. In children, this should be done with each diaper change. As he grows older, the child must be taught to do this on his own as part of his personal hygiene.

Occasionally, steroid creams are prescribed to help in the reduction of pain by artificially stretching the foreskin. This is the most commonly recommended and used line of treatment. It is expected that with regular stretching of the foreskin, the condition will get corrected without surgical intervention.

Although there have not been any identifiable side effects when using the ointment, the treatment procedure may need to be repeated at regular intervals. Doctors recommend surgery only in cases of failure to get expected results subsequent to the use of steroid-based ointments for local application.

Especially in those rare cases wherein the patient experiences severe pain, or if the condition has been diagnosed as Pathological Phimosis thereby necessitating surgical intervention. It is also recommended if the patient has recently suffered from a recurring UTI (Urinary Tract Infection) or suffers from repeated or severe instances of Balanoposthitis.

Immediate surgical treatment is recommended if the difficulty in passing urine is too acute. Circumcision is recommended if the patient’s condition is severe and he continues to suffer from constant pain due to Balanoposthitis or Balanitis.

Circumcision is carried out under local anaesthesia and the patient may have slight pain for the first 2 days due to the bruises and swelling of the penis. In young children, the surgeons prefer using general anaesthesia. Circumcision is not extremely painful and is usually relieved by pain killers like ibuprofen that are easily available and can be purchased without prescriptions at any pharmacy.

Alternatively, some patients prefer to only surgically detach a part of the foreskin that is attached to the glans, while leaving the rest as it is. Though less painful, there is no assurance that the problem would not re-occur at a later date.

In all other cases, the root cause is identified and treated. For instance, if the patient is suffering from Balanoposthitis, ensuring correct hygienic practices like maintaining personal hygiene suffices.

This includes washing the penis at regular intervals using clean water and mild soap followed by the use of moisturiser to keep the skin hydrated. On the other hand, if the patient is suffering from Balanitis, then the line of treatment includes the use of ointments and creams while making sure that the penis does not come into contact with irritants and good personal hygiene.

What are the Precautions to be Taken When Caring for Patients with Phimosis?

Maintain personal hygiene, by daily washing the genitals in warm water while bathing. Ensure that the area beneath the foreskin is cleaned thoroughly in case of adults or older children. Avoid the use of irritants like harsh soaps in the area. Avoid deodorants and talcum powders as they may irritate the skin in the area.

The foreskin must not be forcibly pulled back especially for young children. It is also recommended to apply a local analgesic to reduce the infection and irritation on the glans and the foreskin if diagnosed with Phimosis.

It is essential that parents and caregivers are made aware of the commonality of Phimosis in the various age categories. It is also important that they are taught and guided in ensuring proper hygiene and care of patients affected by Phimosis so that they keep the foreskin and its surrounding areas, including the under-surface areas clean and hydrated at all times.

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