Is Phimosis Really A Problem?

Phimosis is a condition of the penis that occurs in children and adults who are unable to retract the foreskin or prepuce which covers the glans of the penis. 

It is subdivided into physiologic and pathologic.

Physiologic: Is associated with childhood and usually resolves as the age increase. 

Pathologic: Is an associated condition called balanitis xerotica obliterans (BXO) 

Balanitis xerotica obliterans (BXO) or penile lichen is a progressive sclerosing inflammatory dermatosis of the foreskin penis glans. Its appearance affects the skin, causing abnormally dry, white and thickened plaques.

What are the causes of phimosis? 

If a patient has pathologic phimosis, there are some reasons that might develop such as: 

  • poor hygiene 
  • skin condition: eczema, psoriasis, lichen plans and lichen sclerosus (BXO) 
  • preputial adhesion or scar tissue that keeps the foreskin attached to the tip of the penis 
  • traumatic injury 
  • infection, sexually transmitted disease 

The issue of phimosis: results in impaired urinary and sexual function 

Symptoms of phimosis: 

  • redness or discoloration 
  • Swelling 
  • Soreness 
  • Pain upon urination (dysuria) 
  • Pain during sexual intercourse (dyspareunia) 

Diagnosis 

Physiologic phimosis condition that commonly in uncircumcised males, including cysts related to smegma production (white pearls underneath foreskin) 

Pathologic phimosis condition that commonly does not resolve naturally and causes other complications such as penile irritation or bleeding, ballooning of foreskin with urination causing forceful and difficult urination, urinary retention, painful erection and recurrent infection of the foreskin, paraphimosis and also urinary tract infection. 

The severity of phimosis:  

Score 1: full retraction of the foreskin, tight behind the glans 

Score 2: partial exposure of glans, prepuce (not congenital adhesions) limiting factor 

Score 3: partial retraction, meatus just visible 

Score 4: slight retraction, but some distance between tip and glans neither meatus nor glans can be exposed 

Score 5: absolutely no retraction of the foreskin 

Suggested test if it is possible bacterial infection: 

  • Urine culture and sensitivity 
  • Swab culture and sensitivity if there is a discharge over the infection site 
  • C- reactive protein 
  • Full blood count to determine the white blood count (indicate bacteria infection) 

Treatment of phimosis:

Depending on the child and the severity of phimosis 

  • Physiological treatment 
  • Gentle daily manual retraction 
  • Pharmacological treatment 
    • Topical corticosteroid therapy: it helps to tighten the foreskin around the penis, so that the foreskin may be easily retracted, applies the ointment to the tight ring of the foreskin twice daily for 6-8 weeks 
    • Topical antibiotics therapy: it helps to eliminate the bacteria if there is swelling and also discharge from the foreskin and the glans of penis 
    • Oral antibiotics: if the patient indicated the sign of infection like fever, sharp pain and also discharge from the foreskin example sexually transmitted disease and urinary tract infection
  • Surgical treatment 
  • Circumcision – surgical removal of the foreskin
    • Example circumcision anastomotic stapler- a disposable medical instrument that have been used for rapid, safe and efficient removal of the foreskin 
  • Preputioplasty
    • As known as a limited dorsal slit with transverse closure which is a plastic surgical operation on the prepuce or foreskin of the penis. This procedure is to widen a narrow non-retractile foreskin that cannot comfortably be drawn back off the head of penis in erection because of a constriction that has not expanded after adolescence. 

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