PHIMOSIS
What is Phimosis?
Phimosis is a medical condition in which the foreskin of the penis of an uncircumcised male cannot be fully retracted. Phimosis is usually referred as male problem, but can also happen to women: women suffer from clitoral phimosis (in this article we will discus phimosis in men only). Phimosis can occur at any age, but the highest incidence is seen in infancy and adolescence ( approximately 1% of males older than 16 years suffers from phimosis)

The term
phimosis denotes both physiological stage of development
(it is not referred as disease), and a pathological
condition, when phimosis can cause problems for a
person. In most but not all infants phimosis is
physiological rather than pathological, whereas phimosis
in older children and adults is more often pathological
than physiological.
In the literature the true definition of phimosis has
been confused. Essentially, there are two entities, and
they are based on age and pathophysiology: congenital or
primary phimosis, and acquired or secondary phimosis (or
secondary phimosis of a lichenoid or fibrous type).
Both terms denote the inability to retract the distal
prepuce over the glans penis; however once the foreskin
can be retracted so that the glans penis partially
appears, a phimosis is no longer present.
Phimosis
is not a disease- phimosis is a condition.
Primary or congenital phimosis is the condition when
subject had phimosis ever since he can remember.
Treatment in this case usually includes gentle
stretching, since there is a reason to believe that
gentle stretching will mobilise the elastic capacity of
the skin tissue.
Secondary phimosis of a lichenoid or fibrous type is a
phimosis, when subject can remember developing phimotic
ring. In these cases such types of phimosis are prone to
degeneration and are generally difficult to stretch. In
some cases steroids may help, but recurrent problems
require surgery.
There is one more term we have to define: paraphimosis.
Paraphimosis is the entrapment of a retracted foreskin
behind the coronal sulcus, and the condition occurs in
the incorrectly circumcised or uncircumcised penis.
While primary and secondary phimosis denotes aggravated
o impossible retraction of foreskin over the glans
penis, typical of paraphimosis is edema, tenderness, and
erythema of the glans or of the distal foreskin
Primary or congenital phimosis occurs on young children:
infants and it is normal to have it into the
teenage years. Primary or congenital phimosis is
physiologic, but does not cause any side problems, such
as urinary obstruction, hematuria, or preputial pain. It
is possible child suffers from congenital phimosis
because of history of recent catheterization or of
parents forcibly retracting the foreskin in an attempt
to clean the glans.
Secondary or acquired phimosis also has several possibe
causes: it most often occurs because of a history of
poor hygiene, chronic balanoposthitis, but forceful
retraction of a primary phimosis is also possible.
Secondary or acquired phimosis is often followed by
hematuria or preputial pain. Acquired phimosis is
typical for both children and adults.
Secondary or acquired phimosis, caused by poor hygiene
and/or chronic balanoposthitis can eventually lead to
paraphimosis.
Typical of paraphimosis is pain and edema of the
uncircumcised or improperly circumcised penis. Even
vigorous sexual activity has been reported to predispose
one to paraphimosis.
Foreskin Contraction (phimosis)
How the Foreskin Develops in the First Couple of Years
The foreskin of a newborn boy is always closely
contracted around the penis head (glans). Only a small
passage allows the urine to pass through. In the first
months the foreskin is stuck to the glans and cannot be
pulled back and one should not attempt to do so.
During the first couple of years, the foreskin will
become gradually looser and in many boys it can in time
be pulled back without trouble. Half of all
three-year-olds can pull back their foreskin.
It is not advisable to try pulling the foreskin back
using force, since this may cause small cuts in the
foreskin with scars which could finally cause a regular
foreskin contraction.
Who Can Help?
A health visitor or GP will be able to give advice. If
the foreskin is very contracted and stays so, causing
recurrent infections and problems when urinating, then
it may be necessary to operate.
Which Problems may follow Foreskin Contraction?
Foreskin contraction - also called phimosis - can last
throughout life and not cause any trouble at all. It is
a voluntary decision whether to have an operation or
not. If any problems do arise they happen after puberty.
The contraction may occur for the first time as an adult
and usually requires an operation (circumcision).
-
There might be trouble urinating.
-
Infections may occur under the foreskin.
-
When infections are recurrent under the foreskin, a
GP or health visitor should be consulted.
-
In many cases an infection can be avoided by
cleaning regularly under the foreskin with lukewarm
water.
-
At erection, a contracted foreskin may cause trouble
by hurting when an attempt is made to pull the
foreskin back. It may not go back over the glans
before the penis is limp again.
-
Men may be able to have intercourse with a
contracted foreskin but would probably manage better
without this condition.
-
Very rarely, a malignant growth can occur in a
long-standing foreskin contraction.
How is a Contracted Foreskin Treated?
Many boys can be treated with a cream that contains a
weak corticosteroid.
-
A GP can provide this treatment. The tip of the
penis should be treated with the cream two to three
times a day for two to three weeks at a time.
-
The foreskin must be pulled as far back as possible
without using force before the cream is put on.
-
If this treatment does not work, an operation can
help.
The operation for phimosis is usually done under general
anaesthesia without any serious problems. The doctors
may try to retain the foreskin in the operation where
often a small cut is enough to loosen it up sufficiently
for it to be pulled back without trouble.
An actual circumcision where the foreskin is removed
completely is more often required in adults where the
foreskin is thickened and scarred.
Check your Symptoms
We want to make sure that you are definitely suffering
from a tight foreskin and that the Homecure Program is
going to be suitable for you.
Please compare yourself to the symptoms below to confirm
that you suffer from tight foreskin/phimosis and to
assess the severity of your symptoms:
Unable to completely pull back foreskin when flaccid
and/or erect
Pain when pulling back or attempting to pull back
foreskin when flaccid and/or erect
Foreskin dry, red, slightly swollen and/or tender
Foreskin is infected
If your symptoms are simliar or identical to those mentioned above not including the red then you will be able to cure yourself using the Homecure Program. The Homecure Program contains everything you need to know in order to cure yourself quickly, painlessly and discreetly from home. It is explained in great detail with annetations and photographs where appropriate. As customer satisfaction is our highest priority all customers receive free support via email for any questions that may arise and you are also protected by our 100% moneyback guarantee in the unlikely event you do not see results
What You Should Know?
If the foreskin of the penis is so tight that it can't
be pulled back, the condition is known as phimosis (fim-O-sis).
It is seen most frequently in children.
Care
If the boy is unable to urinate, seek medical attention
at once. The doctor may need to thread a tube (catheter)
into the tip of the penis, through the urinary canal
(urethra), and into the bladder to drain the urine. If
the boy can urinate, he may not need treatment right
away. The usual remedy is circumcision to remove the
foreskin.
What You Should Do?
Click Here
-
Do NOT use force to pull the foreskin back. This can
cause scarring and make the condition worse. Clean
under the foreskin regularly if possible.
-
In uncircumcised babies, the foreskin is normally
tight. It usually doesn't start to loosen enough to
be pulled back until the baby is at least 18 months
old. Until then, leave the foreskin alone. Later,
you may gently pull back the foreskin during
bathing.
Call Your Doctor If...
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There is redness, swelling, or drainage from the
foreskin. These are signs of infection.
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The boy has pain when urinating.
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The boy gets a high temperature.
Seek Care Immediately If...
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The boy has not urinated in 24 hours.
Treatment of Phimosis
Some men accept the chronic irritation and the red,
swollen foreskin. They sometimes complain of phimosis
and visit the doctor only when there is pain or an
odorous discharge.
Antibiotics may control the infection. Hot soaks may
help separate the foreskin from the glans. If they fail,
a small incision is made to release it. Circumcision is
generally advised when the inflammation clears.
For some pliant, unscarred foreskins, a preputial
stretch may be used. This can even be done under local
anesthesia with, for example, EMLA cream. Some surgeons
may perform a preputioplasty, with the aim of increasing
the diameter of the preputial ring but without excising
the prepuce (foreskin).
Circumcision is typically performed under general
anesthesia. The foreskin is pulled back as far as it
will go. It is slit along its upper surface and then all
around so that it can be removed. The raw edges of the
inner and outer layers are stitched, and a dressing is
applied. The patient usually goes home the same day.
Immediately after circumcision, the patient may find
that the appearance of the penis has changed
considerably. Until healing is complete, there will be
some pain but this can be controlled by painkillers.
Urination may be painful and the urine should be kept
away from the incision.
For some days, walking or any movement is discouraged
that may cause penile contact with clothes or thighs
while the previously very sensitive glans loses some of
its sensitivity through constant exposure to air. At the
end of that time, however, there should be no pain, the
stitches should be healing, and interest in sex will
have been re-established. While healing is taking place,
there is very little risk of the stitches splitting or
pulling out because of an erection. The good blood
supply to the area also means the chance of infection is
rare.
Although it is in generally- a common condition- not too
many people have heard about the condition called
phimosis. What exactly is phimosis? Well, it is defined
as the inability of the prepuce, also called -the
foreskin, to be retracted behind the glans penis. Of
course- we are talking about uncircumcised males. What’s
also interesting-a great majority of all males are born
with congenital phimosis but this represents a benign
condition that resolves in the great percentage of
infants in their early childhood. It is also extremely
important to point out that the phimosis in most infants
is physiological rather than pathological, whereas
phimosis in older children and adults is more often
pathological than physiological. Although, it is mostly
a condition that affects the males, women can also
suffer from a similar condition called the clitoral
phimosis. The most common symptoms are:
·
inability to retract foreskin
·
straining during urination
·
thin stream of urine
·
recurrent urinary infections
Good thing is that uncomplicated pathologic phimosis is
usually acceptable to conservative medical treatment but
patients should know that every failure of medical
treatment is a secure indication for surgical
intervention, usually in the traditional form of a
circumcision or preputioplasty.
Relevant Anatomy
Everyone should know that the foreskin or prepuce is an
integral, normal part of the penis. It normally forms an
anatomical covering over the glans. It is interesting
that the sensory receptors of the ridged band of the
preputial mucosa may form part of the afferent limb of
the ejaculatory reflex and that’s why it is important
that all of these structures are fully functional. Like
it was been told- the development of the prepuce is
incomplete in the newborn male child. Separation from
the glans and foreskin retractability occurs at a
variable age.
Incidence of the Condition
Important thing to point out is that a commonly
incidence statistic for pathological phimosis is 1% of
uncircumcised males. Others have described incidences in
adolescents and adults as high as 50%. Several
researches done in the past have showed that only 4% of
infants had a fully retractable foreskin at birth but
that 90% did by age 3 years. This means that this
condition could be, in certain occasions and age,
considered to be physiological. Beside this, primary
type- experts are saying that adult phimosis may also
occur secondary to poor hygiene or an underlying medical
condition.
Types of Phimosis & Possible Treatments
1.
Infantile or Congenital Phimosis
Like it was already mentioned- this infantile phimosis
has been widely recognized by the general practitioners
for most of the last century. It is extremely important
to point out that this foreskin cannot be easily
retracted. There are several approaches to this type of
phimosis and the most famous one where foreskin is being
repeatedly retracted to free it from the glans. If this
isn’t being done- later in life, a boy could experience
pathological phimosis and urinary problems. Poor hygiene
was thought to predispose to pathological phimosis.
Oppositely to this approach- there are some experts that
claim that forceful retraction that results in
inflammation may actually contribute to pathological
phimosis at an older age.
Another approach is presented in some physicians is
based on routine neonatal circumcision. How come? Well,
the fact is that circumcision really does prevent
phimosis, although by some incidence statistics, at
least 10 to 20 infants must be circumcised to prevent
each case of potential phimosis. Although, so far, this
infantile phimosis is mentioned only as physiological,
the thing is that this isn’t the only case because not
all infantile phimosis is simply physiological. Possible
causes of these, pathological congenital phimosis, are:
¨
balanitis (inflammation of the glans penis)
¨
preputial stenosis or narrowness that prevents
retraction
¨
a condition called- Frenulum breve
There are several management approaches to infant
phimosis and some of the most common are topical steroid
ointments and several other surgical techniques.
2. Acquired
Phimosis
Reasonably- not all phimosis are the same! They can vary
in severity, with some men able to retract their
foreskin partially, condition called relative phimosis,
and some completely unable to retract foreskin,
condition called full phimosis. Of course- this first
type- relative phimosis is more common, with estimates
of its frequency at approximately 8% of uncircumcised
men. Exact
medical graduation is next:
¨
Grade I - Fully retractable prepuce with stenotic ring
in the shaft
¨
Grade II - Partial retractability with partial exposure
of the glans
¨
Grade III - Partial retractability with exposure of the
meatus only
¨
Grade IV - No retractability

Potential Complications of Acquired Phimosis
It is reasonable that acquired phimosis, if left
untreated, can lead to several complications! Chronic
complications of acquired (pathological phimosis)
include: discomfort or pain during urination or sexual
intercourse. How come? Well, it is simple- the urinary
stream can be impeded, resulting in dribbling and
wetness after urination. During sexual intercourse, or
even during simple erection, patient could experience
strong pain because of over-extension of the foreskin!
Pain may occur when a partially retractable foreskin
retracts during intercourse and chokes the glans penis.
Although nothing of this is proven –the fact is that
there is some evidence that phimosis may be a risk
factor for penile cancer. Of course, all patients should
know that the worst acute complication is paraphimosis.
Paraphimosis is one acute condition characterized by the
glans swollenness and strong pain. During this condition
the foreskin is immobilized by the swelling in a
partially retracted position. The contraction may occur
for the first time as an adult and usually requires an
operation (circumcision).
Review of possible complications:
·
There might be trouble urinating
·
Problems and pain during intercourse
·
Infections may occur under the foreskin
·
Frequent and recurrent infections under the
foreskin which can be avoided by cleaning regularly
under the foreskin with lukewarm water
·
At erection, a contracted foreskin may cause
trouble by hurting when an attempt is made to pull the
foreskin back
·
Although very rarely, there is a chance that a
malignant growth can occur in a long-standing foreskin
contraction.
Circumcision – Health Benefits
Urinary Tract Infections
One of the most beneficial things about the circumcision
is the fact that it has been promoted as a means of
reducing the risk of urinary tract infections, which are
more common in uncircumcised males younger than 6
months. Several researches have proven
that the risk in circumcised kids is approximately 1 in
1000, while the risk in uncircumcised kids is about 1 in
100.
Sexually Transmitted Diseases
Another very serious indication for circumcision is
prevention of STDs. Although not too many people know
about this- the fact is that a large number of
case-control studies concerning the relationship between
the foreskin and HIV infection have confirmed the
present but not definite link. Another fact is that the
United States has one of the highest rates of STDs, HIV
infection, and male circumcision. Strange!
Penile Cancer
Timing of circumcision could also be amazingly
important! Although it may sound impossible- the fact is
that infant circumcision seems to decrease the risk of
penile cancer, while the same thing but only -done later
does not. Good thing is that penile cancer is a rare
disease in the United States, with an incidence of 1.5
per 100,000 people. Direct proof of this the fact that
the lowest incidence has been reported in Muslims and
Jews and we all know that both of these groups have high
rates of neonatal circumcision.
Diabetes Mellitus
Experts are claiming that this condition may be a
presenting symptom of early diabetes mellitus. Where is
the connection between these two conditions? Well, it is
simple- when the residual urine of a patient with
diabetes mellitus becomes trapped under the foreskin,
the combination of a moist environment and glucose in
the urine may lead to a proliferation of bacteria which
can then progress to phimosis.
Circumcision & Sex
Experts today know that the presence of the foreskin
actually enhances the sexual experience for men because
it constantly moves over the head of the penis causing
more friction and pleasure. Therefore, it is logical to
assume that men will also lose much sensitivity to the
glans if circumcised. Not only that- it is also proven
that circumcised men will have to deal with discomfort
and dry glans. The foreskin has many needed functions:
protective, erogenous, sensory, and sexual physiologic.
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