phimosis


Also found in: Dictionary, Thesaurus, Encyclopedia, Wikipedia.
Related to phimosis: smegma

Phimosis

 

Definition

A tightening of the foreskin of the penis that may close the opening of the penis.

Description

The foreskin of a newborn boy is always closely contracted around the penis head (glans). Only a small passage allows the urine to pass through. In the first months the foreskin is stuck to the glans and cannot be pulled back and one should not attempt to do so. During the first couple of years, the foreskin will become gradually looser and in many boys it can in time be pulled back without trouble. Half of all three-year-olds can pull back their foreskin. It is not advisable to try pulling the foreskin back using force, since this may cause small cuts in the foreskin with scars which could finally cause a regular foreskin contraction.
Foreskin contraction, called phimosis, can last throughout life and not cause any trouble at all. It is a voluntary decision whether to have a circumcision operation or not. If any problems do arise, they happen after puberty. The contraction may occur for the first time as an adult and usually requires circumcision, the surgical removal of the foreskin.

Causes & symptoms

Phimosis is caused by the inability of the foreskin to retract from around the opening of the penis. In adults, phimosis can lead to chronic inflammation and cancer.

Diagnosis

A physician usually diagnoses phimosis when there are persistent problems urinating, when there are recurrent infections under the foreskin, or when the opening to the penis is completely blocked by the foreskin. Phimosis is a tight ring of foreskin often made of scar tissue preventing retraction of the foreskin. It may be primary, or secondary to recurrent infection. It may produce urinary obstruction with ballooning of the foreskin. Phimosis is different than having a non-retractable foreskin, which is normal in many boys.

Treatment

If the foreskin cannot be pulled back into place treatment should be sought. If the blood flow to the penis is restricted then emergency treatment is required and if the foreskin cannot be pulled back a surgical cut to the trapped foreskin may be required. Failure to seek treatment can result in permanent damage to the penis. Once phimosis is diagnosed, the available treatments include topical corticosteroids, manual stretching, foreskin surgical repair or plastic surgery, and circumcision. Conservative treatments should be tried in the first instance and surgery used as the treatment of last resort.
A number of studies show that phimosis can be safely and effectively treated by the application of topical steroids in 80-90% of cases. Betamethasone cream 0.05% should be applied to the exterior and interior of the tip of the foreskin two or three times a day. The treatment should be discontinued as ineffective after three months if the foreskin has not become retractile during this time.
A number of corrections are available for the adult or adolescent non-retractable foreskin. These include surgery to repair the foreskin, in which an incision is made through the constrictive band of the foreskin. The underlying tissue is spread with forceps to expose the Buck's fascia (the deep, connective tissue of the penis) and the incision is closed with absorbable sutures. This procedure has less risk of disease and infection than circumcision, and allows the foreskin to be retained.
Circumcision is very traumatic to a child. It is essentially irreversible and should be the treatment of last resort. Phimosis due to balanitis xerotica obliterans (BXO), a chronic, progressive, hardening skin inflammation of the penis, has been considered the one common absolute indication for circumcision.

Alternative treatment

There are no alternative medicine treatments for phimosis.

Prognosis

In most men, phimosis is not a serious problem and will not require treatment. However, it is not expected to improve on its own. With treatment, phimosis in most males can be managed or corrected.

Prevention

Proper hygiene is the most important preventative measure. The American Academy of Pediatrics recommends that the immature foreskin of boys not be forced back for cleaning. The only person who should clean and retract the foreskin is the boy himself. Bubble bath products and other chemical irritants can cause the foreskin to tighten and it is recommended they should be avoided by males with foreskins.

Key terms

Balanitis xerotica obliterans (BXO) — A chronic, progressive, hardening skin inflammation of the penis.
Buck's fascia — The deep connective tissue of the penis.
Circumcision — The removal of all or part of the foreskin from the penis.
Corticosteroids — A synthetic drug similar or identical to a natural corticosteroid, used to reduce inflammation.
Glans — The head of the penis.
Paraphimosis — The entrapment of a retracted foreskin behind the coronal sulcus, a groove that separates the shaft and head of the penis.

Resources

Books

Icon Health Publications. Phimosis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References San Diego: Icon Health Publications, 2004.

Periodicals

"GP Registrar: Pictorial-Case Study (Diagnosis of Phimosis)." GP (February 11, 2005): 66.
Berk, David R. "Paraphimosis in a Middle-Aged Adult After Intercourse." American Family Physician (February 15, 2004): 807.
Choe, Dr. Jong M. "Paraphimosis: Current Treatment Options." American Family Physician (December 15, 2000): 2623-2627.

Organizations

American Foundation for Urologic Disease. 1000 Corporate Blvd., Suite 410, Linthicum, MD 21090. (410) 689-3990 or (800) 828-7866. http://www.afud.org.

Other

December 19, 2004. Circumcision Information and Resource Pages. Conservative Treatment of Phimosis: Alternatives to Radical Circumcision http://www.cirp.org/library/treatment/phimosis/ (Accessed March 31, 2005).

phimosis

 [fi-mo´sis]
constriction of the orifice of the prepuce so that it cannot be drawn back over the glans. adj., adj phimot´ic.

phi·mo·sis

, pl.

phi·mo·ses

(fī-mō'sis, -sēz),
Narrowness of the opening of the prepuce, preventing its being drawn back over the glans.
[G. a muzzling, fr. phimos, a muzzle]

phimosis

(fī-mō′sĭs, fĭ-)
n. pl. phimo·ses (-sēz)
An abnormal constriction of the foreskin that prevents it from being drawn back to uncover the glans penis.

phimosis

Urology A foreskin constriction that prevents its retraction over the glans penis. See Circumcision.

phimosis

Tightness of the FORESKIN (prepuce) of such degree as to prevent retraction. This may be congenital or the result of inflammation. Severe phimosis that interferes with urination is an indication for CIRCUMCISION. From the Greek phmoun , to gag or muzzle.
References in periodicals archive ?
In the present study, only 24% of children referred for phimosis and 36% for cryptorchidism were ultimately scheduled for surgical intervention.
history of phimosis. (178) Not only are penile cancers rare, most penile
Caption: FIGURE 1: Initial examination revealing phimosis with purulent drainage.
Caption: Figure 1: Tight phimosis with visible huge preputial stone (white arrow) seen within.
--Justice does not tolerate circumcision as the only therapeutic solution proposed by the medical profession in cases of phimosis;
A small ulcer on his foreskin was also noted, while the phimosis was still present.
The probe should be inserted into the distal part and obtain urine; vii) Verify the location of the catheter in the bladder--by the presence of urine--and inflate the balloon with 5 or 7 cc of distilled or sterile water, perform the traction for the probe softly anchor in the bladder neck and remove the sterile area with care not contaminating the distal portion of the probe; x) Hold the probe in the closed drainage system; xi) Remove the excess of antiseptic and put the foreskin to its original position to prevent phimosis that can occur when left retracted; xii) Hold the probe in the lower abdomen to prevent urethra injuries exerted by traction; xiii) Clean and dry the patient, cover and let comfortable.
Biricik, "Urethral dilatation, ectopic testis, hypoplasia penis, and phimosis in a kilis goat kid," Kafkas Universitesi Veteriner Fakultesi Dergisi, vol.
Penile cancer is a rare condition and its incidence was linked to lack of circumcision and hygiene, phimosis, HPV infection, and tobacco use [144-147].
More patients in the conventional group had phimosis. Table 1 lists the characteristics of all patients in this study.
Congenital megaprepuce (CMP) is considered as a congenital penile malformation, which includes phimosis and severe ballooning of the redundant inner prepuce, conferring the typical aspect of concealed penis, in which the whole attachment is hidden within subcutaneous tissue.