Phimosis is a general and rather inprecise term that refers to a condition in which the foreskin cannot be retracted. The word, phimosis, is derived from the Greek word, phimos or φῑμός, which means “muzzled”. Phimosis is a condition, not a disease. Phimosis rarely requires treatment.
Causes of non-retractile foreskin.
Non-retractile foreskin (phimosis) has three possible causes:
1. The opening at the tip of the foreskin is too narrow to permit retraction.
2.The inner surface of the foreskin is fused with the underlying glans penis, which is frequently and improperly confused with_adhesions_that are pathological in nature. Fusion is a normal condition in infants, which will dissolve over time, but an adhesion will not dissolve and must be surgically lysed. Adhesions may occur when the foreskin of a child is prematurely forcibly retracted.
3. The frenulum of the foreskin is too short to permit complete retraction (frenulum breve).
Non-retractile foreskin in childhood.
Newborn boys are almost invariably born with non-retractile foreskin.1 _The inner surface is fused with the glans penis.2 Also, the opening at the tip is too narrow to permit retraction. This is a normal condition. Non-retractile foreskin (phimosis) is not a disease. It is simply a condition. Non-retractile foreskin does not normally require any sort of treatment.Non-retractile foreskin in children is not harmful in any way. A non-retractile foreskin actuallyis beneficial because it protects the glans penis from the ammonia in diapers, so prevents meatitis, meatal ulcer, and meatal stenosis.3-5 Non-retractile foreskin also keeps feces away from the urethra while the infant is in diapers (nappies) and helps to prevent urinnary tract infections.
Development of retractile foreskin in boys is very gradual and occurs over a period of years.6,7_The membrane that fuses the foreskin and the glans penis spontaneously disintegrates and the foreskin separates from the glans penis.2_Also, the opening at the tip becomes wider with increasing maturity. According to a Danish study, the average age of first foreskin retraction was found to be 10.4 years.8_Separation of the foreskin and development of retraction occurs rapidly in adolescence.9_With rare exception, as Sir James Spence, the eminent British consultant paediatrician, said in 1950, “What looks like a pin point opening at 7 months will become a wide channel of communication at 17.”10
A few youths, who have longer foreskins in relation to the length of the shaft of the penis, do not stretch the tip of the foreskin when erections occur and do not spontaneously develop a retractile foreskin.These adolescents may develop a wider opening by manual stretching, if desired.11,12
There is a stage of human development, after the foreskin has separated from the glans penis and before the tip widens, during which many boys experience ballooning of the foreskin during urination. This is a temporary condition that resolves when the tip widens. It is harmless and not a matter for concern. It does not require treatment of any sort.13,14
Poorly trained doctors.
Most doctors are poorly trained regarding non-retractile foreskin.15-17 _Consequently, they are unable to distinguish between the normal, healthy non-retractile foreskin of childhood and pathologic phimosis.14,15-17 _Patients frequently receive very poor advice from medical doctors regarding non-retractile foreskin. Such doctors are likely to recommend circumcision when, in fact, the foreskin is normal, healthy, and no treatment is needed.15-18
The foreskin is an important organ, with many physiological functions,19_so it should not be excised without very good reason, and then only after less invasive therapies have been exhausted.
Non-retractile foreskin in adulthood.
Although a retractile foreskin is considered normal in adult males, a few men never spontaneously develop retractile foreskin, which is normal and non-problematic for them.
Adult onset of non-retractile foreskin.
Edema of the foreskin may cause the foreskin to become non-retractable.
A more common cause of non-retractile foreskin is the disease called_balanitis xerotica_obliterans_(BXO), also known as_lichen sclerosus, a disease of unknown origin.20 _This disease is distinguished by a ring of whitish tissue near the tip of the foreskin.21,22 _This condition may sometimes be treated by application of topical steroid ointment,23-25 _but in severe cases, circumcision may be required.18
Making the non-retractile foreskin retractable.
The foreskin almost always becomes retractable by the end of adolescence (18-25 years).6,10 In almost all cases, no treatment is necessary. Watchful waiting for nature to take its course is all that is necessary.
If treatment is deemed necessary, application of topical steroid ointment is effective in most cases.26-28_More than thirty studies have demonstrated its effectiveness. Application of topical steroid ointment is a cost-effective treatment.29
Preputioplasty, surgery to widen the tip of the foreskin, is another effective method of making the foreskin retractable. Preputioplasty has been perfected by European surgeons.30-33_It is minimally invasive and preserves the functions of the foreskin.
Manual stretching to produce_tissue expansion_also is effective and may be accomplished by the individual without medical help or expense.11,12,34
_How to Fix Phimosis and Tight Foreskins, Solutions That Work_is a website where information and advice on manual stretching to relieve narrow foreskin, phimosis, and frenulum breve may be obtained.
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