Phimosis is defined as the inability to retract the skin covering the head of the penis. Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction.
This condition is a normal occurrence in the newborn boy, and usually resolves around 5-7 years of age. By age 17, almost all males will be able to completely retract their foreskin.
Phimosis can also occur due to scarring, infection (often referred to as balanitis by physicians) or inflammation. Forceful foreskin retraction can lead to bleeding, scarring and psychological trauma for the child. If there is ballooning of the foreskin during urination, difficulty with urination or infection, then treatment may be warranted.
How is phimosis diagnosed and evaluated?
Non-life threatening conditions may occur that are common in uncircumcised males, including cysts related to smegma production/trapping and transient painless ballooning of the foreskin during urination. These are considered normal variations that usually resolve with daily gentle retraction.
Phimosis that does not resolve naturally or causes other complications, including penile irritation or bleeding, ballooning of the foreskin with urination resulting in forceful/difficult urination, urinary retention, painful urination (dysuria), painful erections, recurrent infections of the foreskin (balanoposthitis), paraphimosis (foreskin stuck in the retracted position behind the head of the penis), or urinary tract infections all may require further treatment. Your medical provider will refer your child to a pediatric urologist for further evaluation.
How is phimosis treated?
Treatments for phimosis vary depending on the child and severity of phimosis. Treatments may include gentle daily manual retraction, topical corticosteroid ointment application or circumcision. Surgery for foreskin preservation can be offered for some children.
Topical steroid therapy
Your provider may recommend topical steroid ointment application. This is an effective treatment in most boys. The topical ointment is used to help soften the tight foreskin around the penis, so the foreskin may be easily retracted. During the appointment your provider will demonstrate how to apply the ointment to the tight ring of foreskin and/or head of the penis. The ointment is massaged into the affected areas twice daily for 6-8 weeks along with retraction twice daily. Once the foreskin can be fully retracted, the ointment is discontinued and manual daily retraction (during warm baths and urination for the potty-trained child) will prevent phimosis from reoccurring.
Circumcision is the surgical removal of the distal foreskin. It is performed for a variety of reasons, including cultural or religious reasons.
Circumcision is often not required for treatment of phimosis. In rare cases, your pediatric urologist may recommend circumcision due to failure of steroid ointment, paraphimosis (foreskin stuck in the retracted position behind the head of the penis), recurrent urinary tract infections or severe/recurrent balanitis. Circumcision is also recommended to reduce the risk of urinary tract infections in boys with severe abnormalities of their urinary tract.
Alternatives to circumcision
Foreskin-preserving surgery to repair a non-retractable foreskin (a surgical procedure where the foreskin released but not removed called prepucioplasty).