Phimosis can be of two different kinds:
- Physiological Phimosis: When children are born with a tight foreskin and separation takes time. Normal for uncircumcised infant / children.
- Pathological Phimosis: Phimosis that occurs due to scarring, infection, or inflammation. Forceful retraction of the foreskin can lead to bleeding, scarring, and physiological trauma for the child. A doctor must be consulted, especially if there is a ballooning of the foreskin during urination or difficulty in urination or any or any other infection.
Phimosis is not really a problem unless it causes redness, soreness, swelling, difficulty in passing urine, and infection and pus discharge which is known as Balanoposthitis. Uncircumcised boys may have a tight foreskin that would not be easy to retract. Never ever force it to retract as it may cause severe pain, irritation, and even damage the foreskin in the process.
Retraction is a progressive process. In the first few years of life, gentle retraction for cleansing underneath the foreskin is sufficient during diaper changes or bathing. It will result in progressive retraction over time. Once the child grows older, he will himself learn how to retract the skin, clean the inside region of the penis, and pull it back.
In this process, smegma (a collection of skin cells from the glans penis and inner foreskin that is often noted with retraction of the foreskin) is also cleaned.
Physiological Phimosis is a common, non-life threatening occurrence that causes cysts related to smegma production and transient painless ballooning of the foreskin during urination. Such problems generally get resolved on their own.
However, pathological Phimosis can cause complications like penile irritation or bleeding, 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 other urinary tract infections.
To avoid these problems, Pathological Phimosis must be brought to the doctor’s attention immediately and treated. Some of the common treatments are:
- Topical corticosteroid therapy – Involves using topical steroid ointment which helps soften the tight foreskin around the penis, so that it can be easily retracted. Later the ointment can be discontinued and manual daily retraction (during warm baths and urination for the potty trained child) will prevent phimosis from reoccurring.
- Gentle daily manual retraction – Must be done carefully and with utmost caution to avoid irritation and any harm to the infant’s foreskin.
- Circumcision – Refers to the surgical removal of the foreskin. Often seen as the last resort to remedy Phimosis. A paediatric urologist may recommend circumcision due to the failure of steroid ointment, or in cases of pathologic phimosis, paraphimosis, recurrent urinary tract infections, or severe Balanoposthitis.