Are there real and fake phimosis? Do children with phimosis need treatment?

Author: Zhang Weiping, Chief Physician, Beijing Children's Hospital, Capital Medical University

Chairman of the Pediatric Surgery Branch of the Chinese Medical Association

Reviewer: Zhang Kai, Chief Physician, Peking University First Hospital

Some people divide phimosis into true phimosis and false phimosis.

In fact, there are two types of phimosis in medicine, one is phimosis and the other is foreskin is too long, and there is a big difference between the two.

Phimosis refers to a condition in which the foreskin opening is very small and the glans penis is wrapped inside and cannot be exposed. This is the so-called true phimosis.

Phimosis means that the foreskin can cover the glans penis, but the glans penis can be exposed by pushing the foreskin back with the hand, which is what people call pseudophimosis.

Figure 1 Original copyright image, no permission to reprint

Generally, pseudophimosis, that is, the foreskin is too long, does not need to be treated. Just push the foreskin behind the glans penis until the glans penis is completely exposed. Although some foreskin openings are not narrow, the inner plate of the foreskin and the glans penis are adhered, which is called foreskin adhesion. There will be some yellow smegma hidden in the adhered foreskin, which needs to be cleaned. In the later stage, just pay attention to regular cleaning.

True phimosis usually requires correct guidance or treatment based on the specific circumstances.

True phimosis is particularly common in children, some of which are congenital and some of which are acquired.

1. Is congenital phimosis in children a disease?

Congenital phimosis in children is not a disease.

If a child's penis head is exposed when he is born and the foreskin does not cover the penis head, this is actually a disease. For example, common diseases such as hypospadias or epispadias will have such symptoms.

For congenital true phimosis, if the child does not have any symptoms such as dysuria or infection before the age of five or school age, he or she can be observed and no treatment is needed for the time being. When the child reaches school age, the foreskin opening will slowly open, and it is best if it can heal on its own. If the infection recurs during this period, or if the foreskin is still very narrow and shows no signs of improvement when the child reaches school age, he or she needs to go to the hospital for treatment.

There are two types of treatment. The first is to use some glucocorticoid ointments, such as Elocon ointment, under the guidance of a doctor, and apply it manually. The other is surgical treatment. The doctor will choose the treatment method according to the specific situation of the child.

Acquired phimosis is also called scar phimosis.

Most cases of scar phimosis are caused by repeated infection of the foreskin. The narrow foreskin opening will affect the child's urination. When urinating, the foreskin sac will be inflated like a small light bulb, and the urine will come out of the foreskin opening with a very thin urine stream. In addition, there will be smegma inside the phimosis. If the smegma cannot come out, it will repeatedly stimulate the glans penis, which will cause balanoposthitis.

After the foreskin is infected, the child's penis will appear red and swollen, and the swelling will be severe. Yellow secretions will flow out of the foreskin. The child will feel extremely itchy and painful, and the stimulation of urine during urination will aggravate the pain. In severe cases, the child will be unable to urinate, leading to urinary retention.

If long-term urine irritation or repeated infection is not treated in time, a scar-like narrow ring will slowly form at the foreskin opening, which is called scar-like phimosis. In this case, the glans penis cannot be exposed without surgical treatment. Surgery is the only option.

2. If phimosis in children causes foreskin infection, how should parents take care of them?

The first method: prepare some warm water, add some topical medicine, and soak the child's penis in the water. The soaking time does not need to be too long, 5-10 minutes is enough, soak 2-3 times a day. If the child is relatively young, you can use a clean basin, put some warm water, and let the child sit in it to soak.

Another method is: after soaking and washing the penis, apply some antibiotic ointment, such as chloramphenicol or erythromycin eye ointment, on the red and swollen foreskin, which will usually heal in about a week.

3. If a child has congenital phimosis, can parents manually separate the foreskin?

Small congenital phimosis can be pushed away by manipulation, but the technique must be correct. It is best to go to the hospital and have the doctor guide the parents on how to do it.

The most important thing about manual separation of the foreskin is that after turning the foreskin up, you must push it back, otherwise the consequences will be serious.

Some parents forget to put their children's foreskin back in place after turning it out, resulting in incarcerated phimosis, which will cause great pain to the children.

Figure 2 Original copyright image, no permission to reprint

In this case, you must go to the hospital immediately. In the early stages of incarcerated phimosis, it can be repositioned through manipulation. If it is too late, it may even lead to foreskin necrosis and can only be solved through surgery.