Phimosis is characterized by the impossibility of rolling up the skin of the foreskin at the level of the penis or “capping”. More common in children, phimosis also exists in adolescents and adults. Treatment, scheme: understanding phimosis.
The capping problems Where phimosis of the foreskin are more common in children but also affect adults. Definition, symptoms and operation.
Definition: what is phimosis?
“Phimosis is theinability to roll up the skin of the foreskin over the glans penis beyond the balano-preputial furrow. It is related to thetightness of the foreskin” informs Dr. Christian Castagnola, urological surgeon, Deputy Vice-President for Communication of the French Association of Urology (AFU). The foreskin includes the skin and mucous membrane that covers the glans. The foreskin should slide easily over the penis allowing capping. The person with phimosis experiences a difficulty or impossibility in discovering the end of the penisa situation corresponding toimpossibility of unraveling. Phimosis can give rise to paraphimosis. “The foreskin retracted but it remained in this position, swelled and created a ring of stricture around the penis with the impossibility of recoiling” explains Dr. Castagnola.
Phimosis at birth
“We consider that 96% of newborns are born with phimosis. This usually disappears with spontaneous erections, washing. At 3 years, only 11% of children have phimosis and only 1% of men over 18 have constitutional phimosis. So we don’t talk about phimosis before the age of 3.” indicates the urological surgeon.
What are the symptoms of phimosis?
“The symptom of phimosis is the‘impossibility of retracting the foreskin over the glans’ says Dr. Castagnola. In children, most often, phimosis does not cause symptoms “But it can cause a local inflammation even an infection due to the retention of smegma (secreted by the preputial glands) which cannot be evacuated in children as in adults. In adolescents and adults, phimosis can also lead to discomfort or even pain with erection” inform the urological surgeon.
“The diagnosis of phimosis is clinical“ informs Dr. Castagnola. It is suspected with the naked eye and confirmed by the impossibility for the examiner to retract. “We can help photographs of the erect penis in adolescents when it is a functional phimosis with an erection restriction ring” inform the specialist. Paraphimosis is also seen visually.
For infants and toddlers, in which phimosis is often natural, we intervene only in the event of complications (infection, paraphimosis). Prepucial adhesions are gradually lifted over the first years of life. ” He is not recommended to recap little boys. The more we force the decalottage, the more we risk creating a sclerotic phimosis “ emphasizes Dr. Castagnola.
Creams. In the older child with phimosis the medical treatment is privileged. “This is theapplication of corticosteroid ointment twice a day. According to studies, there are 67 to 95% good results with this treatment” describes Dr. Castagnola. In case of failure, if the phimosis is bothersome, a surgical intervention is proposed. “It’s about a posthectomy, medically justified removal of the foreskin” inform the urological surgeon. “There is an alternative, foreskin plasty (Duhamel plasty), which consists of cutting the preputial ring and suturing it in order to widen it but this technique can give an unsightly aspect to the penis” he completes.
In adultsthe treatment of phimosis is most often surgical (posthectomy or circumcision). When the phimosis is not very pronounced, a Duhamel plasty can be considered. “In some cases of lichen, local corticosteroid therapy can be effective” specifies the urological surgeon.
How is the operation of a phimosis of the foreskin carried out?
The surgery is quick and does not require hospitalization. Two types of operations are possible: posthectomy or circumcision which consists in removing the skin corresponding to the foreskin; or the Duhamel plasty which consists of cutting the preputial ring and suturing it in order to widen it. A General anaesthesia is most common in children. “What is important is the management of pain” emphasizes Dr. Castagnola. Healing lasts for 2 to 4 weeks. The resumption of sexual activity for adults takes place after 4 weeks. Paraphimosis rarely requires emergency hospitalization. The application of an anesthetic gel improves the pain. The need to quickly recap the foreskin by a professional is essential. The consultation of a urologist should be considered quickly.
What are the risks of infection in case of phimosis?
There are complications if phimosis is not treated, including risk of infection in the glans, called balanites : in this case, the penis is painful, hot, sometimes increased in volume, and a whitish discharge may appear spontaneously or on pressure from the penis. The other potential consequence of phimosis is the paraphimosis : if the scalping is forced, the ring of the foreskin can remain blocked on the penis at the base of the glans and strangle it, causing pain and swelling.
Thank you to Dr. Christian Castagnola, urological surgeon, Deputy Vice-President for Communication of the French Association of Urology (AFU).