What is phimosis?
By phimosis, we mean the narrowing of the foreskin, that is, of the skin that covers the glans of the penis.
What causes phimosis?
In general, phimosis is congenital, although children and adults can manifest this condition at any time in their lives. In the case of children, it could be due to incorrect intimate hygiene.
At times, parents lower the foreskin too much to wash the child’s penis, thus forming rings and tissues called preputial adhesions that cause the appearance of phimosis.
The child, from birth, often has mucous adhesions between the foreskin and glans, which are more or less tenacious. These adhesions must be detached to allow the foreskin to slide back until the glans is uncovered. The maneuver is used to maintain the daily hygiene of the glans and to prevent the stagnation of urine and secretions from causing urinary infections.
The dissolution of these adhesions (often performed by the mother during bath time) can cause small lacerations that heal with consequent scars that, if multiple, can lead to the rigidity of the foreskin (acquired phimosis).
In adults, phimosis is often the consequence of repeated bacterial or fungal infections (usually in a diabetic patient) or caused by skin disease (lichen sclerosus).
What are the consequences?
The principal symptom of phimosis is great difficulty in sliding back the foreskin
Failure to push back the foreskin can cause pain during erection, which is often blocked or causing pain during intercourse (dyspareunia). In other cases, the foreskin is edematous, painful and inflamed.
It is also common to confuse phimosis with the short frenulum. The frenulum is a thin strip of skin that joins the posterior part of the glans to the foreskin. When the frenulum is very short, it is impossible to leave the glans wholly exposed, but one cannot speak of phimosis. The best thing to do is to contact a specialist to examine the organ in question and make a correct diagnosis.
Types and degrees of phimosis
There are two main types of phimosis: physiological and pathological. The difference consists of the origin, evolution, and treatment of the condition itself. Let’s see it in detail –
Physiological phimosis – It is the most common form of phimosis, in fact, it affects most newborns. Over time, the foreskin becomes more elastic and widens, so the problem disappears spontaneously. If it has not yet occurred when the child is 10 years old, contact a specialist.
Pathological phimosis – It may occur at any age, following an infection or a trauma. It involves more complications and must be treated promptly.
Penile phimosis is a condition that can have varying degrees of severity. The scale is based on the opening or obstruction level of the foreskin. In total there are five degrees –
- First degree: the foreskin cannot be retracted, and the glans is not visible.
- Second degree: the foreskin retracts slightly, and only the urinary orifice is seen.
- Third degree: the foreskin is lowered to the middle of the glans.
- Fourth grade: the foreskin retracts above the glans crown.
- Fifth grade: the foreskin retracts completely but causes pain, and a phimotic ring appears.
It is an inflammation of the glans which arises when the foreskin retracts to the base of the glans, but then does not return to its normal position.
What is circumcision?
It is the intervention that resolves phimosis. It consists of removing the skin of the rigid and narrow foreskin to allow the sliding of the remaining skin.
Circumcision is a surgical method which consists in the total or partial removal of the foreskin, the piece of sliding skin that covers the glans.
There is no doubt that circumcision dramatically reduces the incidence of chronic glans infections and penile head cancer.
It is recommended, afterward, not to practice sports and not have sexual relations for a week.
Circumcision is a very minor operation that requires local anesthesia and can be easily performed as an outpatient procedure with no hospital stay necessary.
It is performed at every hospital in India. The operation usually requires the expertise of a general surgeon or a urologist and takes at most an hour. The cost is low even at private hospitals and is not more than INR 30,000 or USD 410 at the most expensive facility. At state-run facilities, the charge is no more than INR 5,000 or USD 70.