Phimosis in babies and children: what it is, how it is treated and when the operation is necessary
Phimosis is a narrowing of the foreskin, the skin that covers the glans penis. If there is phimosis, the foreskin does not descend, it does not retract, and the glans is not visible.
Typically, all newborns have phimosis; We therefore speak of physiological phimosis. But, up to what age is it considered normal to have phimosis? When should it be treated and how is it done?
Evolution of phimosis
As we have just commented, most newborns have phimosis, and it is normal; we call it physiological phimosis . In addition, they have balano-preputial adhesions, a fibrous tissue that joins the foreskin and glans. Progressively, both phimosis and adhesions disappear. This is due to the child’s growth, spontaneous erections and a substance that secretes and lubricates the area. Thus, at 4 years of age, only 10-20% still have phimosis and at 16 years of age, only 1% of adolescents cannot fully retract their foreskin.
Do I have to give a “pull”?
Traditionally, baby boys had their foreskin pulled back sharply on their first visits to the pediatrician to stop phimosis.
This is a practice that should be totally banned since phimosis will disappear spontaneously in most cases over time. But furthermore, far from being necessary or beneficial, it is painful and can cause wounds to appear that, when healed, leave fibrosis and produce a cicatricial phimosis.
When is phimosis a problem?
We have commented that phimosis is something normal that disappears as the child grows. However, in some cases complications may occur.
– Paraphimosis. The glans is trapped by the foreskin. It happens when there is a narrow phimotic ring, the foreskin retracts and cannot go back up. The more time you spend in this situation, the greater the inflammation of the foreskin and the more difficult it will be to solve the problem. In some cases, the blood supply to the glans may be compromised. Although it can usually be resolved by applying pressure to push the foreskin back into place, in more severe cases surgery may be necessary.
– Balanitis or balanoposthitis . Balanitis is the inflammation of the glans; when the foreskin (the skin that covers it) is also affected, we speak of balanoposthitis. It can appear due to lack of hygiene in the area, infections, irritants, traumatic retractions… It is treated with adequate hygiene, cleaning with physiological serum and, if necessary, antibiotic cream and corticosteroids.
When and how is phimosis treated?
We have commented that phimosis is physiological at birth and up to three years of life. If around the age of three or four, when sphincter control is achieved, the foreskin cannot be completely retracted, treatment with a corticosteroid cream can be prescribed .
This treatment, applied once or twice a day for several weeks (there is no single regimen that has been shown to be more effective than others, in general it is treated between 4 and 8 weeks) is effective in up to 80% of cases.
The cream is applied to the phimotic ring. After applying it, gentle preputial retractions must be carried out (no pulling) so that the skin of the foreskin gradually increases its elasticity and allows the glans to be visualized. It is important to return the skin to its initial position to avoid paraphimosis.
It is essential that after treatment with corticosteroids the child continues to retract the foreskin daily , for hygiene and so that phimosis does not reappear (something that can happen in approximately 15% of children). A good time can be during the bath or shower.
This topical corticosteroid treatment is safe and well tolerated , no significant side effects have been seen.
When medical treatment fails, if there are recurrent balanitis and/or recurrent urinary tract infections in children with genitourinary malformations, the child will need surgery. The phimosis operation is recommended from 3-4 years of age or earlier if there are symptoms.
What does the phimosis operation consist of?
There are two ways to surgically intervene a phimosis:
– Circumcision is the best known. It is a very old operation, there are data that indicate that in Egypt, in the year 2300-2400 BC it was already carried out. It consists of cutting the upper part of the foreskin, exposing the glans and suturing it around the entire circumference. This surgical technique can be used in all types of phimosis.
– In mild cases of phimosis, a preputioplasty can be performed . In this case, a cut is made in the upper part of the foreskin and it is sewn crosswise.
These surgeries have a good prognosis, but in some cases complications may appear, such as bleeding, wound infection or healing problems.
Is it advisable to operate on all phimosis children?
Although circumcision can prevent penile cancer, this procedure should not be recommended without medical reason. In some families, circumcision is performed on all males for religious or cultural reasons and it is essential that these interventions take place in a place suitable for it and are carried out by specific professionals.