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Phimosis

What Is Phimosis?

Phimosis occurs when the foreskin of an uncircumcised penis cannot be retracted (pulled back) to expose the glans (head of the penis). This is a normal occurrence in newborn boys, called “physiologic phimosis,” but retraction should become possible as the child grows.

Over time, the soft inner adhesions that keep the foreskin attached to the head of the penis begin to separate. Most boys can pull back their foreskin to reveal the head of the penis by the time they are 5 years old, but the timing can vary. A child should be able to pull back the foreskin, completely, by age 10, or at least prior to puberty.

As the inner adhesions begin to break apart, you may notice a white, cheesy material, called “smegma,” emerging between the layers of skin. You also may see a white substance develop under the fused layers of the foreskin and the head of the penis. These are normal occurrences.

The foreskin should never be forcibly retracted, as it can cause pain and bleeding which can lead to scarring and adhesions. The foreskin should be retracted slowly and cleaned daily. Once potty trained, uncircumcised boys should retract their foreskin when they urinate and clean this area during bathing.

What Are the Signs and Symptoms of Phimosis?

  • Chronic irritation
  • Bleeding
  • Difficulty with urination
  • Ballooning of the foreskin during urination
  • Recurrent infections of the foreskin (balanitis)
  • Urinary tract infections
  • Painful erections

How Is Phimosis Treated?

Treatment depends on the severity of the phimosis. Typically, phimosis can be safely and effectively treated by using a topical steroid cream for 4 weeks. If the steroid cream does not resolve your child’s phimosis, or if the phimosis has caused excessive scarring, a circumcision may be necessary.

Please seek immediate medical attention if your child has paraphimosis. This is a condition where the foreskin retracts over the head of the penis and becomes stuck, leading to intense pain and swelling. This is an emergency and will need to be addressed quickly. Without medical treatment, the swelling can cut off blood supply to the head of the penis.