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Phimosis and How It Is Treated

Anastasios D. Kalantzis, Surgeon Urologist-Andrologist


Phimosis is a condition in which the glans penis cannot be revealed due to preputial stenosis (stenosis or narrowness of the foreskin) that prevents retraction. Usually, this condition is considered a congenital anomaly in boys. Normally, the glans penis should be able to be revealed during the second or the third year of age. In case of phimosis, the children are in danger of developing either balanoposthitis caused by the inability to clear away the sebum, or urinary tract infections.


In adults, the most usual cause of the condition is the chronic infection of the glans penis and the prepuce due to poor local hygiene, and can occur at any age. Also, people suffering from diabetes mellitus are likely to develop chronic balanoposthitis which will eventually result in phimosis.


The condition may cause problems with urination, pain during sexual intercourse, premature ejaculation, short erection, paraphimosis (inability to retract the foreskin in position over the head of the penis). Due to the symptoms, many times men confuse phimosis with short frenulum.


Adult phimosis is a serious condition, because, further to the numerous dangers of penile carcinomas development, it can also result to paraphimosis, where, during erection, the narrowed skin is pulled down towards the coronary sulcus of the glans penis and, due to edema, retraction is almost impossible. This may result in penile necrosis, if the condition is left untreated.


The most usual method for phimosis restoration is circumcision. Circumcision has been common practice since antiquity because man has always wanted to be sexually active. Hippocrates describes in detail the circumcision technique in his scripts. Muslims circumcise their children on the day they are baptized, at the age of 7-8 years approximately, and the Jewish on the day the child goes home from maternity hospital.


With this surgical operation, (the overhang) part of the foreskin is removed, thus allowing the glans to be revealed. The glans is not fully revealed due to cicatricial occlusion of the foreskin. Many circumcision techniques–practices have been described over the years. In the commonest of them, the foreskin is cut off circularly, 1cm beyond the end of cicatricial pathology.


After careful haemostasis, the inner foreskin petal is compiled with the outer petal using very thin absorbable stitches. The operation does not last more than 35 minutes and is performed with light sedation or local anaesthesia, according to the patient's age. Full restoration is achieved after 7-10 days, when the patient can return to full sexual activity.


Furthermore, another phimosis restoration method is the foreskin plastic surgery, which allows easy revealing of the glans penis, while the foreskin is retained, for the protection of the glans penis.


The benefits of circumcision described in thousands of medical researches and studies include smaller number of urinary tract infections, especially in younger boys, elimination of local infections-balanoposthites, lower frequency of penile cancer as well as uterine cervix cancer of the sexual partner, reduced risk of AIDS virus transmission, and better sexual performance.