When to Treat Phimosis

The decision to circumcise your baby boy is a very personal one. It is affected by religious and cultural influences as well as a desire to do what is best for your child. Many parents that are initially opposed to circumcision eventually have their sons circumcised after noticing that the foreskin of the penis will not fully retract, a condition called phimosis. What some parents don't realize is that infantile phimosis is a normal condition that usually resolves without treatment. It can be confusing, however, to know when phimosis is a cause for concern.

As many as 95% of all male infants are born with some degree if phimosis. Most doctors now recommend gentle cleansing instead of the forcible retraction that used to be common. Retraction of the foreskin during cleaning can actually cause small tears that can develop into a more severe condition. Circumcision is only medically indicated for neonatal phimosis when the foreskin causes urinary obstruction or pain. By the age of three, phimosis is rare. If the foreskin is unable to be retracted by this age, treatment is usually initiated. Conservative treatments include steroid creams, but in some rare cases, circumcision may be necessary.

If phimosis recurs after it was initially cleared up, it can be a more serious condition, acquired or pathological phimosis. As many as 8% of uncircumcised males develop this condition, which can cause pain, difficult urinating and sexual dysfunction. The most common cause of pathological phimosis is poor hygiene.

Traditional treatment for pathological phimosis is full circumcision. This procedure is covered by most insurances and is extremely effective. If the full foreskin is removed, phimosis will not recur. More conservative measures include preputioplasty, a procedure where the physician makes a small slit in the foreskin. This relieves the pressure, is less painful than traditional circumcisions while leaving the foreskin intact. Other treatments include the application of a topical cream with gentle foreskin retraction. Less common conditions include manual stretching of the foreskin and ballooning of the foreskin done under local anesthesia.

Pathological phimosis can be prevented by fully pulling back the foreskin and cleaning it thoroughly while bathing. Failure to replace the foreskin after cleaning can result in a more serious condition called paraphimosis. Paraphimosis can cause serious pain and in some extreme cases, the tip of the penis can be lost. If you son is unable to replace the foreskin over the head of the penis and is bothered by swelling and pain, a visit to the emergency room is necessary to prevent serious complications.