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Although it is in generally regarded as a common condition, not too many people have heard about phimosis. What exactly is this condition?
A commonly quoted incidence statistic for pathological phimosis is 1% of uncircumcised males. Others have described incidences in adolescents and adults as high as 50%.[2]
Several types of research done in the fifties of the previous century have shown that only 4% of infants had a fully retractable foreskin at birth, but 90% did by age 3.[3] This means that this condition could be, on certain occasions and age, considered to be physiological. Besides this primary type, experts believe that secondary adult phimosis may also occur due to poor hygiene or an underlying medical condition. Balanitis can occur in babies and is a consequence of poor hygiene — a common occurrence among boys still wearing diapers.[4]
Types of phimosis and possible treatments
1. Infantile or congenital phimosis
As already mentioned, infantile phimosis has been widely recognized by the general practitioners for most of the last century. The foreskin cannot be easily retracted. There are several approaches to this type of phimosis, and the most commonly used is the one where the foreskin is being repeatedly and very gently retracted to free it from the glans. If this isn’t being done, a boy could experience pathological phimosis and urinary problems later in life. Opposing this approach, there are some experts that claim that forceful retraction that results in inflammation may actually contribute to pathological phimosis at an older age. Forceful retraction creats microtears at the preputial orifice, which may lead to scarring that might eventually cause formation of a phimotic ring. [4]
Another approach presented by some physicians is based on routine neonatal circumcision. Circumcision is known to prevent phimosis, although by some incidence statistics, at least 10 to 20 percent of all infants would have to be circumcised to prevent every case of potential phimosis. So far, infantile phimosis is mentioned only as physiological, but not all cases of congenital phimosis are simply physiological.
Although prior statements from the American Academy of Pediatrics recommended against circumcision, the most recent recommendation states that circumcision outweigh the risk and the procedure’s benefits justify it for families who want it. The greatest benefits included prevention of urinary tract infections, transmission of sexually transmitted infections such as human papilloma virus (HPV), and penile cancer. However, with improvements in daily hygiene and prevention strategies in sexually transmitted diseases, neonatal circumcision may not be critical for the prevention of penile cancer, especially in western countries.[5]
Possible causes of pathological congenital phimosis are:
- balanitis (inflammation of the glans penis)
- preputial stenosis or narrowness that prevents retraction
- a condition called Frenulum breve
There are several management approaches to infant phimosis: topical steroid ointments are commonly used, as well as several different surgical techniques.
2. Acquired phimosis
It stands to reason that not all phimosis are equal. They can vary in severity:
- some men are able to retract their foreskin partially (a condition called relative phimosis),
- some men are completely unable to retract the foreskin (full phimosis).
The former type is more common, with estimates of its frequency at approximately 8% of uncircumcised men.
Exact medical graduation is as follows:
- Grade I - Fully retractable prepuce with stenotic ring in the shaft
- Grade II - Partial retractability with partial exposure of the glans
- Grade III - Partial retractability with exposure of the meatus only
- Grade IV - No retractability
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