What is phimosis? What are the symptoms of phimosis? How can it be treated?

Author: Yuan Yifeng, deputy chief physician of the First Affiliated Hospital of Hunan University of Chinese Medicine

Reviewer: Peng Jing, Chief Physician, Peking University First Hospital

Some three or four-year-old boys always urinate a thin line, and some even have a bulge in front of the penis. Doctors say this is phimosis.

So, will phimosis have a negative impact on the growth and development of boys? How can it be treated?

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1. Phimosis and its main symptoms

Phimosis refers to the narrowness of the foreskin opening or the adhesion of the foreskin to the glans penis, which makes it impossible to turn the foreskin up and expose the glans penis. Phimosis is divided into physiological phimosis and pathological phimosis.

Physiological phimosis refers to the situation in which the inner layer of the foreskin is tightly fused with the skin of the glans penis during infancy, so that the glans penis cannot be fully exposed. This is also called "primary phimosis". Generally, physiological phimosis will heal on its own as the boy grows older.

Pathological phimosis is often secondary to balanoposthitis and damage to the foreskin and glans. Scars form at the foreskin opening, which loses its elasticity, causing contracture and loss of expansion ability. The foreskin cannot retract upwards, and is often accompanied by urethral stenosis. This type of phimosis cannot heal itself.

It can be seen from this that when a newborn baby boy urinates, only a thin stream of urine can be seen without the glans penis exposed. On the surface, it seems to be "phimosis", but in fact it is the foreskin that is covering and protecting the glans penis, which is a normal physiological phenomenon.

However, if a boy is still unable to turn up his foreskin after the age of 4 to 5, and there is a bulging phenomenon when urinating, it may be pathological phimosis and require surgery.

When bathing a boy, parents can gently pull up his foreskin, but do not use too much force, so that the child does not feel obvious pain. This is not only conducive to early diagnosis of whether the boy has phimosis, but also can clean the penis and avoid the accumulation of smegma.

If a boy aged 5 to 6 still has bulging when urinating and the glans penis cannot be exposed, circumcision can be considered.

2. Treatment of phimosis

Phimosis and excessive foreskin can cause balanitis, which can cause swelling, redness, itching and other discomforts. Repeated attacks of balanitis can also lead to stenosis of the foreskin opening and even stenosis of the external urethral opening, causing urination difficulties. Therefore, phimosis requires early intervention and treatment.

The treatment of phimosis can be divided into non-surgical treatment and surgical treatment. In non-surgical treatment, the doctor can apply local anesthetics such as lidocaine ointment to appropriately expand the foreskin opening, allowing the foreskin to be turned outward and the glans penis to be exposed.

Surgical treatment is for those who have difficulty with external eversion. The doctor can cut the foreskin from the back, enlarge the foreskin opening or perform a direct circumcision.

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It is worth noting that although circumcision is the most effective way to solve phimosis, doctors still need to decide whether to perform the operation based on the boy's age and his degree of cooperation.

3. What should patients with phimosis pay attention to?

Studies have shown that phimosis will hinder the development of the penis to a certain extent, and will also have a certain impact on the degree of penis development and sexual function of adult men. Therefore, patients with phimosis should receive treatment as soon as possible to promote penis development and improve sexual function. During this period, the following matters should be noted:

1. For children's physiological phimosis, parents should use warm water to clean their children's external genitalia more often, but there is no need to deliberately pull up the foreskin for cleaning.

2. If the patient has undergone circumcision, he should get enough rest after the operation. Eat more nutritious food, such as meat, eggs, etc., and eat less spicy food. This will help the incision grow quickly and heal as soon as possible.

3. Whether it is physiological phimosis or pathological phimosis, men should maintain good local hygiene of the external genitalia in daily life, keep it dry, and avoid other diseases caused by foreskin balanitis.

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If phimosis is not treated in time, it is easy to form smegma, which will form smegma stones after accumulation, and long-term stimulation may also induce cancer. However, due to the influence of traditional concepts and people's lack of knowledge about reproductive health, secondary infections caused by phimosis and excessive foreskin often occur.

Therefore, as parents, we should strengthen our knowledge of reproductive health so that our children can grow up more healthily; and as men, we should pay attention to enhancing our self-protection and health-care capabilities for reproductive health.

References

[1] Chinese Medical Association, Andrology Branch. Chinese expert consensus on phimosis, prepuce hyperplasia and foreskin-related diseases[J]. Chinese Journal of Andrology, 2021, 27(9): 845-852.

[2] Zhang Jingti, Ma Yunyun, Li Penglong. Authoritative answers to boys' phimosis and cryptorchidism are here: one of the health care issues for boys that young parents should know [J]. Children and Health, 2021(7):4-5.