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Phimosis

Features

Phimosis is a condition where the male foreskin cannot be fully retracted over the head of the penis in uncircumcised males. The foreskin may be red, swollen, and tender. Difficulty in urinating and ballooning of the foreskin are the commonest reasons for clients to seek treatment, though recurrent bacterial infections may also occur.

Epidemiology

Phimosis can occur at any age, however, a higher incidence is seen in infancy and adolescence. According to studies done in the USA, phimosis affects more or less than 1% of men below the age of 16.

Causes

Phimosis is the result of repeated foreskin infections. It is linked to neglected hygiene. Germs breed under the foreskin. The delicate tissues undergo a process of partial healing/partial flare-up/partial healing again. Scar tissue keeps building up and breaking down. Eventually, the scar tissue becomes fibrous – hard, tough and inelastic. It contracts, pulling the infected foreskin tightly inwards. This adds to the spread of germs.

Treatment

  • Antibiotics may control the infection. Hot soaks may help separate the foreskin from the glans. If they fail, a small incision is made to release it. Full or partial circumcision is generally advised when the inflammation clears.
  • For some pliant, unscarred foreskins, a preputial stretch may be used. This can even be done under local anesthesia. Some surgeons may perform a preputioplasty, with the aim of increasing the diameter of the preputial ring but without excising the prepuce (foreskin).
  • Circumcision is typically performed under general anesthesia. The foreskin is pulled back as far as it will go. It is slit along its upper surface and then all around so that it can be removed. The raw edges of the inner and outer layers are stitched, and a dressing is applied. The patient usually goes home the same day.
  • Immediately after circumcision, the client may find that the appearance of the penis has changed considerably. Until healing is complete, there will be some pain but this can be controlled by painkillers. Urination may be painful and the urine should be kept away from the incision.