Phimosis

Phimosis is a condition where the foreskin cannot be pulled back over the glans. Smegma, a whitish substance containing various types of bacteria and their metabolic byproducts, mainly skatole and indole, accumulates under it. These substances are considered carcinogens and can lead to penile cancer over time.

In more than 90% of newborns, the foreskin cannot be freely pulled back over the glans because it is partially adhered to it. This is not phimosis, it is called conglutination, a condition where the inner layer of the foreskin and the glans remain adhered.

Up to 18 months of age, it is not necessary or correct to forcibly release the foreskin. This can repeatedly cause injuries, leading to small wounds that heal with scarring and may cause later phimosis.

In some boys, around 1.5 to 2 years old, we observe the release of the adhesion and the possibility of releasing the foreskin.

Another case is the persistence of a narrowed foreskin, which we call congenital phimosis. Phimosis can also occur secondarily in boys who previously had no difficulty retracting the foreskin. This usually happens due to inflammation of the foreskin (balanitis), but it can also result from forcibly retracting the foreskin before it is sufficiently mature. In both cases, the foreskin becomes scarred and does not allow retraction, known as sclerotic phimosis.

We also encounter so-called relative phimosis. This is a condition where the foreskin can be retracted under normal circumstances, but difficulties arise during an erection when the penis enlarges. Problems can also be caused by an excessively long foreskin.

What are the risks of these conditions?

The main risks are more frequent occurrences of foreskin inflammation, and in cases of tight narrowing, even difficulties with urination and urinary tract infections.

For patients with persistent phimosis after exhausting conservative treatment options, and for patients with recurrent foreskin inflammations leading to scarring, surgical treatment (circumcision) performed under general anesthesia is recommended.