Phimosis - what is it?
Phimosis is the inability to completely or partially remove the skin fold (foreskin) from the head of the penis. It is a common phenomenon among newborns. It can occur even in 90% of cases. However, it should disappear in the first years of life. When the spontaneous disappearance of phimosis does not occur, contact a urologist and start treatment. Although phimosis mainly affects newborns, it also occurs in adults, but the incidence is around 1%. Due to the occurrence in certain age groups, phimosis is divided into two types:
- physiological - for patients up to 4 years of age,
- pathological - concerning elderly patients.
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Symptoms of phimosis
The basic, most characteristic symptom of phimosis is the aforementioned problem with the complete or partial removal of the foreskin from the head of the penis. Very often, in the case of the disease in question, redness is observed around the mouth of the urethra. The consequence is itching and inflammation of the glans penis. They mainly affect elderly patients who develop phimosis after reaching the age of 3.
The causes of phimosis
The foreskin is primarily protective. It is a mechanical barrier to the delicate structures of the penis. It is very important in the case of newborns, as it allows protection against abrasions, bacteria and other unfavorable factors. In summary, phimosis in young children is a normal phenomenon that increases protection against pathologies of the penis and the genitourinary system. However, it is a problem as it does not disappear with age. Systematic, gentle sliding of the foreskin in children during hygienic procedures prevents phimosis. A history of diseases affecting the genitourinary system increases the risk of phimosis in adulthood. These are the most common: inflammation of the glans and inflammation of the foreskin. As a result of inflammatory processes, permanent changes in the penile tissues may occur, which may predispose to the occurrence of the ailment in question. Mechanical injuries can be other causes. Diabetes is a common cause of phimosis in middle-aged and elderly patients.
Consequences of phimosis
Problems urinating are the most common discomfort resulting from phimosis. The inability to slide the foreskin off makes it difficult to maintain proper hygiene in the area of the glans penis. This increases the risk of bacterial infections within it, which can also cause infections in other structures of the genitourinary system, e.g. epididymis or bladder. Painful erections make sexual activity more difficult, which may adversely affect the patient's well-being. Independent, forceful attempts to remove the foreskin are often the cause of its mechanical damage. In extreme cases, it can lead to the so-called parapet. This phenomenon is defined as a situation in which the foreskin has been pushed beyond the glans and it is impossible to return it to its original position. As a result, the structures of the penis are swollen, reducing blood circulation within its apical structures, which may lead to their necrosis. Paraphimosis is a condition that requires urgent surgical intervention.
Treatment of phimosis
In the case of younger patients, observation is advisable, because in the early years this phenomenon is common and in the vast majority of cases it disappears with age. Taking care of the regular removal of the foreskin and daily hygiene significantly reduces the risk of pathological foreskin formation.
In the case of the presence of the disease, the use of ointments with corticosteroids may bring positive effects, as their use may increase the elasticity of the skin of the foreskin. In some cases, a surgical procedure called circumcision is necessary. There are two types of treatment:
complete - involves surgical removal of the entire foreskin
partial - only a part of the skin fold surrounding the glans is surgically removed.
This procedure is performed under local or general anesthesia (usually for children). The procedure is considered safe and possible complications are very rare. It has been proven on the basis of many studies that the circumcision procedure has no negative impact on the patient's sexual life.
The treatment strategy is selected by the urologist and is individual for each patient.
Phimosis in children is normal and shouldn't be worried. However, if it does not disappear with age, a urological consultation is recommended to diagnose the problem. Early intervention and relieving the ailments will increase the patient's quality of life and avoid unpleasant consequences in the future. Diagnostic methods and treatments are safe for the patient and should not be feared. The treatment strategy is selected by the urologist based on the patient's condition.
Source:
- Phymosis – overview, Informed health, Institute for Quality and Efficiency in Health Care, 2015.
- Mc Gregor TB. Pathologic and physiologic phimosis. Approach to the phimotic foreskin, 2007.
- McGregor TB, Pike JG, Leonard MP. Phimosis - a diagnostic dilemma. Can J Urol. 2005;12(2):2598–602.
- Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction? - A systematic review. J Sex Med 2013; 10(11): 2644-2657
