Phimosis in children

April 30, 2020 By Dr. Ashish Prasad

Phimosis in children

A common complaint for which parents have anxiety about their boys is ‘Phimosis’. It is a condition in which the prepuce or foreskin (which is a normal covering over the glans and the tip of the penis) does not retract ie the parents are unable to withdraw it backwards. There is lot of misinformation regarding this and this leads to unnecessary surgical interventions in the form of circumcision. It is very important to differentiate between Physiological phimosisie is a normal entity and Pathological 'phimosis' which actually require surgical intervention (required in only 10-15% cases).

More than 90 % males at birth have a nonretractile foreskin which is due to the naturally occurring adhesions between the foreskin and the glans. This is known as Physiological phimosis. The foreskin gradually becomes retractable over a period of time, which varies in different children. It has been seen that more than 90% become retractile by 10-12 years of age as the secretions from the glans increases and also is helped by the erections of the penis. It usually is asymptomatic, although it might cause ballooning of the prepuce while passing urine in some children. It is important to differentiate it from Pathological phimosis, where the foreskin becomes whitish and scarred and is non-pliant to handling. In physiological phimosis the foreskin is healthy and as long as the urinary opening is visible and it is not causing any trouble, it does not require any management. The only thing that is required is to keep the foreskin clean. This can be done with gentle traction over the foreskin and washing with mild soap and lukewarm water. The prepuce will get retractile over a period of time. Under no circumstances should a forceful retraction be done as it will lead to tearing of the gentle skin and will lead to scarring and ultimately form a pathological phimosis.In older children in case the phimosis is hampering with the hygiene then a course of topical steroids can be given to aid in the retraction process. In contrast pathological phimosis almost always requires some intervention as the foreskin becomes scarred and causes repeated infections and this becomes a vicious cycle. The treatment for this is a circumcision. In this procedure the unhealthy foreskin is removed. The procedure is done under anesthesia and is a day care procedure. There is no dressing and wound care is simple sitz bath and application of topical antibacterial cream. The patient is called after a week for follow up.