Phimosis

Phimosis
Fimosis.jpg
An erect penis with a case of phimosis
Pronunciation
SpecialtyUrology
SymptomsUnable to pull the foreskin back past the glans[3]
ComplicationsBalanitis[3]
Usual onsetNormal at birth[3]
DurationTypically resolves by 3 years old[4]
CausesNormal, balanitis, balanitis xerotica obliterans[5]
Risk factorsDiaper rash, poor cleaning, diabetes[6]
Differential diagnosisHair tourniquet, lymphedema of the penis[6]
PreventionSteroid cream, stretching exercises, circumcision[4]

Phimosis is a condition in which the foreskin of the penis cannot be pulled back past the glans.[3] A balloon-like swelling under the foreskin may occur with urination.[3] In teenagers and adults, it may result in pain during an erection, but is otherwise not painful.[3] Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.[3]

In young children, it is normal not to be able to pull back the foreskin.[4] In more than 90% of cases, this inability resolves by the age of seven, and in 99% of cases by age 16.[4][5] Occasionally, phimosis may be caused by an underlying condition such as scarring due to balanitis or balanitis xerotica obliterans.[5] This can typically be diagnosed by seeing scarring of the opening of the foreskin.[5]

Typically, it resolves without treatment by the age of three.[4] Efforts to pull back the foreskin during the early years of a young male's life should not be attempted.[4] For those in whom the condition does not improve further time can be given or a steroid cream may be used to attempt to loosen the tight skin.[4] If this method, combined with stretching exercises, is not effective, then other treatments such as circumcision may be recommended.[4] A potential complication of phimosis is paraphimosis, where the tight foreskin becomes trapped behind the glans.[5] The word is from the Greek phimos (φῑμός), meaning "muzzle".[7]

Signs and symptoms

At birth, the inner layer of the foreskin is sealed to the glans penis. The foreskin is usually non-retractable in early childhood, and some males may reach the age of 18 before their foreskin can be fully retracted.[8]

Medical associations advise not to retract the foreskin of an infant, in order to prevent scarring.[9][10] Some argue that non-retractability may "be considered normal for males up to and including adolescence."[11][12] Hill states that full retractability of the foreskin may not be achieved until late childhood or early adulthood.[13] A Danish survey found that the mean age of first foreskin retraction is 10.4 years.[14]

Rickwood, as well as other authors, has suggested that true phimosis is over-diagnosed due to failure to distinguish between normal developmental non-retractability and a pathological condition.[15][16][17] Some authors use the terms "physiologic" and "pathologic" to distinguish between these types of phimosis;[18] others use the term "non-retractile foreskin" to distinguish this developmental condition from pathologic phimosis.[15]

In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological phimosis if an infant appears to have discomfort while urinating or demonstrates obvious ballooning of the foreskin. However, ballooning does not indicate urinary obstruction.[19]

In women, a comparable condition is known as "clitoral phimosis", whereby the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis.[20]

Severity

  • Score 1: full retraction of 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, i.e. neither meatus nor glans can be exposed.
  • Score 5: absolutely no retraction of the foreskin.[21]
Other Languages
العربية: شبم
asturianu: Fimosis
беларуская: Фімоз
català: Fimosi
čeština: Fimóza
Deutsch: Phimose
Ελληνικά: Φίμωση
español: Fimosis
Esperanto: Fimozo
euskara: Fimosi
فارسی: فیموزیس
français: Phimosis
한국어: 포경 (의학)
հայերեն: Ֆիմոզ
हिन्दी: फाइमोसिस
hrvatski: Fimoza
Bahasa Indonesia: Fimosis
italiano: Fimosi
עברית: פימוזיס
Кыргызча: Фимоз
македонски: Фимоза
मराठी: फायमॉसिस
Nederlands: Fimosis
日本語: 包茎
norsk: Fimose
ଓଡ଼ିଆ: ଫାଇମୋସିସ
Plattdüütsch: Phimoos
polski: Stulejka
português: Fimose
română: Fimoză
русский: Фимоз
sicilianu: Fimosi
slovenčina: Fimóza
српски / srpski: Фимоза
українська: Фімоз
Tiếng Việt: Hẹp bao quy đầu
中文: 包莖