Phimosis Treatment

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

Causes

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.  

Treatment

Some men simply 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.
However, the treatment of phimosis depends on the type of phimosis. 
Congenital phimosis should be left alone: only the usual cleaning without any forceful retraction is recommended. Proper foreskin hygiene is also suggested to patients with acquired phimosis. Use of of steroid creams as a noninvasive effective treatment for acquired phimosis is recommended (treatment for repeated phimosis may involve application of a steroid cream to the foreskin up to three times a day for about a month to loosen the adhesive ring) or the use of nonsteroidal ointments has also been reported to be of benefit in the treatment of acquired phimosis. 
If a phimosis is causing urinary obstruction, seek for medical attention from specialist (urologist). In cases like this it is often necessary to perform circumcision or other plastic surgical technique to enlarge the opening without actually removing tissue. As said: either antibiotics may control the infection,sometimes hot soaks may help separate the foreskin from the glans, but if they fail, a small incision is made to release it.
In some cases circumcision is advised, which is done when the inflammation clears. Circumcision is 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 then a dressing is applied. The patient usually goes home the same day. Pain is present until the healing is complete, but it can be controlled with painkillers. After the circumcision, the     patient may find that the appearance of the penis has changed considerably. All causes of potential infection must be kept away (for example urine). Urination may also be painful. For couple of days also avoid tight clothes or any excessive movement, especially sexual activity. After few days there should be no more pain and stitches should be healing. 
In paraphimosis, after emergent reduction, referral to a urologist for eventual circumcision is obligatory since the condition is likely to recur.
Treatment for paraphimosis may involve lubricating the foreskin and tip of the penis and then gently squeezing the tip of the penis while pulling the foreskin forward. If this shows to be ineffective, a small incision to relieve the tension may be performed. However, generally the circumcision is performed. Of course, complications (gangrene of the glans, inflammation of the prepuce) are possible, but if appropriate treatment is followed they are not likely to occur.