What is phimosis or adhesions on the foreskin?

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Phimosis is a fairly common problem, especially in children. It is estimated that about 2% of 17-year-olds suffer from this abnormality in the penis.

Phimosis is a congenital anomaly that occurs in men in which the foreskin is too narrow to allow the head of the penis or glans to be exposed.

Newborn boys have an adhesion between the foreskin and the glans that can be maintained during childhood.

Urology experts, explain that it is usual to be able to retract the foreskin in a flaccid state as an erection between the ages of twelve and fourteen. If this is not possible, we would speak of phimosis.

Phimosis is quite common, especially in children before adolescence. It is estimated that about 2% of 17-year-olds suffer from phimosis.

Preputial retraction is difficult in 95% of newborns. At 6 months only 20% of the foreskins are retractable. After a year, 50% already are, increasing the value of the percentage to 90% at 3 years.

Causes of phimosis

The cause of phimosis is believed to be congenital, but it can also be due to forced retractions of the foreskin of babies during their hygiene by the parents. These forced movements favor the creation of fibrous rings in the foreskin and balanopreputial adhesions. However, adults can also have this abnormality. It may be due to a series of predisposing factors, among which are:

  • Lack of hygiene.
  • Balanitis.
  • Dermatological diseases.
  • Tumors.

In this way, the elasticity of the skin in this area decreases, aggravating the clinical situation of the patient. However, this problem in adults can also be caused as a result of childhood phimosis that has not been treated in time.

What are the complications of phimosis?

There are a series of processes inherent to keeping the preputial cap intact, generally the consequence of improper handling of it.

In general, these are benign conditions, easy to treat and without significant consequences. Among them we find:

  • Balanoposthitis: it is one of the most frequent complications in children with an intact foreskin. Treatment ranges from the application of chamomile infusion and cleaning of the penis and secretions, in the mildest cases, to the introduction of topical or systemic antibiotic treatment and drainage of secretions.
  • Smegma: it is a consequence of the desquamation products of the glans mucosa and the preputial skin. In some patients, they accumulate in the form of whitish nodules or pearls. It does not require specific treatment.
  • Paraphimosis: consists of the entrapment of the preputial skin by a constrictive cutaneous ring that is forcibly retracted, without adequate previous dilation. It is a urological emergency  that requires prompt and adequate care to avoid major complications.
  • Xero-obliterating balanitis: it is a chronic atrophic dermatitis, of unknown etiology, characterized by the presence of atrophic whitish plaques on the foreskin and glans skin. Once diagnosed, the treatment is circumcision.
  • Recurrent urinary tract infections: the existence of a higher risk of suffering urinary infections has been described in uncircumcised boys compared to those who are. In cases of recurrent urinary tract infections, circumcision should be considered.

Circumcision: surgery to reverse phimosis

Circumcision is the surgical procedure by which the steonic preputial ring and, to a greater or lesser degree, the preputial skin is removed. The goal of surgery is to allow adequate retraction of the remaining skin and full exposure of the glans.

There is a medical indication for circumcision in those cases in which conservative treatment, through repeated and progressive retractions, together with topical treatment with a corticosteroid cream, has not been effective in solving the problem.

Normally, it is done around 5-6 years. However, along with the medical indication, there are sociocultural and religious factors that are added to the medical factors, giving rise to different practices depending on the social context.

For example, in Jewish tradition, children must undergo this surgery on the eighth day of life. And in the Muslim religion, circumcision must also be performed systematically during childhood.

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