phimosis

Phimosis: description

Phimosis is the narrowing or a trunk-like extension of the foreskin (prepuce). As a result, it can be pulled back only under pain and with the risk of injury or even not at all behind the glans (glans penis) of the penis. The foreskin constriction is usually congenital, so it occurs mainly in children. In contrast, adult phimosis is rare. As a result of local inflammation or injury may also come to an acquired phimosis.

Depending on the extent, two main forms of phimosis can be distinguished:

• absolute (complete) phimosis: The foreskin can not be pushed back either on the relaxed or stiff (erect) penis.
• Incomplete (relative) phimosis: The foreskin can not be stretched back only when the penis is stiff.

To delimit from the foreskin narrowing is a shortening of the Vorhautbändchens (Frenulum breve), which can be treated in the simplest case by the transection of the running down the penis connective tissue band.

paraphimosis

An absolute emergency is the so-called paraphimosis. Read more in the article Paraphimosis!

Phimosis in children is normal

In neonatal and infancy it is perfectly normal that the foreskin can not be displaced. The reason is that the inner foreskin layer (inner foreskin) is glued to the glans. Thus, the very sensitive skin of the glans is protected from contact with urine and feces. Over time, this bonding usually dissolves: Through recurring (involuntary) erections and a reinforcement (keratinization) of the foreskin, the process of dissolution of the foreskin is driven by the underlying glans.

From the age of three, the foreskin is mobile in 80 percent of the boys and should at least be displaced by the age of five at the latest. For many five-year-olds, however, the foreskin is not yet fully retractable. Among the six- to seven-year-old boys, five to seven percent are affected by a foreskin constriction; among the 16 to 18-year-olds, around one percent shows phimosis. Adults are less affected.

Prolonged phimosis increases the risk of inflammation and urinary tract infections, which may justify starting therapy.

Phimosis: symptoms

The main symptom of phimosis is that the foreskin can not or hardly push back over the glans. In mild cases, this results in no complaints. But it can also cause pain and itching. In addition, the phimosis promotes inflammation and infections in the foreskin.

With a pronounced foreskin narrowing, urination is also more difficult: the urinary stream is very thin and toned. Also, the direction of the urinary stream may deviate to the side. In addition, too tight foreskin can inflate urine through the backflow of urine as a balloon (balloon).

In adults, phimosis can also impede erection and ejaculation. Sex with foreskin can therefore be painful.

Phimosis: causes and risk factors

One distinguishes the primary from the secondary phimosis.

Toddler phimosis is almost always primary, this means innate, The foreskin constriction then already exists from birth and does not reform as usual during the course of growth. The causes are unknown.

A acquired (secondary) phimosis develops during the course of life, especially due to scarring as a result of local inflammation and injuries. In probably 80 percent of the cases, the secondary foreskin narrowing is based on the so-called lichen sclerosus (also called balanitis xerotica obliterans). Lichen sclerosus is an inflammatory skin disease that leads to hardening of the skin – in this case the foreskin. The cause of this disease are probably immune cells whose activity is directed against the body’s own tissue (autoimmune reaction). Why a lichen sclerosus develops is not known. Presumably, many factors are responsible, including genetic.

Also infections and other processes of inflammation of the foreskin can lead to scarring and thus to phimosis. These are common reasons for a foreskin narrowing in old age.

Scarring often occurs when too much and too much effort has been made to push back the foreskin. These so-called retraction attempts are responsible for around 20 percent of cases of secondary foreskin narrowing. Adults should therefore be very careful with their children and themselves when manipulating the foreskin!

Phimosis: examinations and diagnosis

The specialist in the examination and treatment of phimosis is the urologist. He deals with the organs that are responsible for urine production and urine diversion, as well as with the male genitalia.

In a first conversation with the patient or (in children) with the parents, the urologist raises the medical history (anamnese). Among other things, he asks the following questions:

• Did the foreskin ever go back?
• Are there any problems with urination (such as a bloating of the foreskin)?
• Are there frequent infections of the urinary tract or on the penis?
• Have you ever had an operation on the penis?
• Is a violation of the penis known?
• Does the penis get hard during erection?

The conversation closes the physical examination at. Particularly important are the glans, the foreskin and the foreskin band. First, the doctor checks whether the foreskin can not be pushed back, because it is still glued to the underlying skin of the glans, or whether it is actually too tight. In a foreskin narrowing, the foreskin is examined for the narrowest point, shape, condition and retractability. This is very important for a possible therapy. Scarring can sometimes be seen on a white ring around the foreskin opening.

If the doctor Secretion or inflammation (Balanitis = glansitis) noticeable, he will make a smear. As a result, any infections can be detected or excluded. Frequently, however, such inflammation is caused by residual urine and thus usually a pure chemical irritation.

After that, the doctor should do that urination to assess the strength and deviation of the urinary stream. Also, any existing flatulence of the foreskin may show up during urination.

Phimosis: treatment

Early treatment of phimosis in the first few years of life is only required if the foreskin narrowing causes symptoms. So first of all, you can wait and see in many cases. The phimosis treatment is then usually started in preschool age; with repeated inflammations already from the third year of life. The therapy aims to normalize urination and enable sexual function. Important in a phimosis is also a good genital hygiene.

Local cortisone ointments

A non-surgical treatment of foreskin constriction and also adhesions is the local application of cortisone ointments. It should be tried especially with an unclear or borderline only phimosis.

For up to eight weeks, the ointment should be applied twice a day to the foreskin. After two weeks, try to push back the foreskin carefully. However, tears and injuries must be avoided!

Around three-quarters of all patients show a marked improvement in phimosis due to cortisone therapy. The problem is, however, that the foreskin narrowing occurs very often afterwards.

The often dreaded side effects of cortisone therapy are not expected with a topical ointment.

Phimosis: surgery

In many cases circumcision is offered by the doctors. Read all important information about the phimosis-op!

Notes for parents!

Parents should only peel back the foreskin of their child if this is easily possible. But never should the foreskin be mobilized by force! If a push back is not possible, adults should not be worried: Before puberty, the foreskin must not be stripped back!

If the foreskin is mobile, then it can be pushed back for urination and bathing. It should be cleaned regularly as well as the penis, but not too intense and not with soap. After cleaning, make sure that the foreskin slides back to its original position, so that no paraphimosis persists.

Even if the foreskin is not mobile, the penis should be washed regularly.

If parents notice a sore or reddened foreskin, they should explain to the child that shaking and drying the foreskin after washing and using the toilet is important.

Phimosis: disease course and prognosis

In children, phimosis can often “grow out”. For this reason, the therapy can often be maintained even without great risks.

However, untreated phimosis may obstruct the outflow of foreskin secretions, inflammation, urethral obstruction, and injury. Patients who are more likely to suffer from infections and inflammation of the glans and foreskin also have an increased risk of getting penile cancer. For circumcised men, this risk is lower. In addition, they have a reduced risk of HIV infection because there are many HIV-sensitive immune cells in the foreskin. Also, the risk of cervical cancer (cervical cancer) is lowered in partners of circumcised men.

In most cases, surgery is a successful and safe treatment option phimosiswhich does not cause any problems even in adult age, even of a sexual nature.