phimosis

Phimosis is a condition in which the foreskin cannot be fully retracted over the glans penis. It is often described as physiological when present in infancy or early childhood, in which case it usually resolves with growth and development. Pathological phimosis is persistent or accompanied by scarring or disease and may require treatment.

Causes and risk factors include physiological phimosis common in newborns and young boys, which typically improves over time. Pathological phimosis can result from repeated infections such as balanitis, inflammation, trauma, or poor hygiene. Dermatologic conditions, notably lichen sclerosus (balanitis xerotica obliterans), can also lead to permanent narrowing of the foreskin. Paraphimosis, a slipping of the retracted foreskin that cannot be returned to its normal position, is a medical emergency.

Symptoms range from none in mild cases to difficulty retracting the foreskin, ballooning of the foreskin during urination, pain, itching, or recurrent infections. In adults, persistent phimosis can interfere with hygiene and urinary flow and may predispose to infections.

Diagnosis is typically clinical, based on examination of the foreskin and glans. In uncertain cases or when an underlying dermatologic condition is suspected, further evaluation or referral may be needed.

Treatment depends on age, severity, and cause. Physiological phimosis in children often requires no treatment beyond monitoring and good hygiene. For persistent phimosis, topical corticosteroids applied to the foreskin for several weeks, combined with gentle stretching, can improve retractility. If non-surgical measures fail or complications arise, surgical options include dorsal slit, preputioplasty, or circumcision. Treat underlying infections as indicated.

Prognosis is generally favorable with appropriate management. Complications to watch for include paraphimosis, recurrent infections, and, in chronic inflammatory conditions, potential long-term tissue changes.