Phimosis

Subject: Midwifery III (Theory)

Overview

Phimosis is a penile condition in which the foreskin cannot be fully retracted over the glans penis. The term may also refer to clitoral phimosis in women, a condition in which the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis. At birth, the inner layer of the foreskin is sealed to the glans penis. This attachment forms "early in fetal development and provides a protective cocoon for the delicate developing glans." The foreskin is usually non-retractable in infancy and early childhood, but it can be as late as 18 years old.

Phimosis is a penis condition in which the foreskin cannot be fully retracted over the glans penis. The term can also refer to clitoral phimosis in women, a condition in which the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis.

The foreskin is fused to the glans at birth and is not retractable. According to Huntley and colleagues, "non-retractability can be considered normal for males up to and including adolescence."

Signs and symptoms:

The inner layer of the foreskin is sealed to the glans penis at birth. "Early in fetal development, this attachment forms and provides a protective cocoon for the delicate developing glans." In infancy and early childhood, the foreskin is usually non-retractable, but it can be as late as the age of 18.

In order to avoid scarring, medical associations advise against retracting an infant's foreskin. Some claim that non-retractability is "normal for males up to and including adolescence." According to Hill, full retractability of the foreskin may not occur until late childhood or early adulthood. According to a Danish survey, the average age of first foreskin retraction is 10.4 years.

According to Rickwood and other authors, true phimosis is over-diagnosed due to a failure to distinguish between normal developmental non-retractability and a pathological condition. Some authors use the terms "physiologic" and "pathologic" to differentiate these types of phimosis; others use the term "non-retractile foreskin" to differentiate this developmental condition from pathologic phimosis.

If an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort, the cause may not be clear in some cases, or it may be difficult to distinguish physiological phimosis from pathological phimosis. Ballooning, on the other hand, does not indicate a urinary obstruction.

Causes:

Other types of chronic inflammation (such as balanoposthitis), repeated catheterization, or forcible foreskin retraction can all lead to phimosis.
Phimosis can also occur in untreated diabetics due to the presence of glucose in their urine, which causes infection of the foreskin.
The severity of phimosis in older children and adults varies, with some able to retract their foreskin partially (relative phimosis) and others completely unable to retract their foreskin even when the penis is flaccid (full phimosis).

Treatment:

Physiologic phimosis, which is common in males aged 10 and under, is normal and does not require treatment. During puberty, the non-retractile foreskin usually becomes retractable.
Nonsurgical measures may be effective if phimosis in older children or adults is not causing acute or severe problems. The choice of treatment is frequently determined by whether circumcision is viewed as a last resort to be avoided or as the preferred course of action.

Things to remember

Phimosis is a penis condition in which the foreskin cannot be fully retracted over the glans penis.
In women, the term may also refer to clitoral phimosis, a condition in which the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis.
The inner layer of the foreskin is sealed to the glans penis at birth.
Early in fetal development, this attachment forms and provides a protective cocoon for the delicate developing glans.
In infancy and early childhood, the foreskin is usually non-retractable, but it can be as late as the age of 18.
If an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort, the cause may not be clear in some cases, or it may be difficult to distinguish physiological phimosis from pathological phimosis.
Physiologic phimosis, which is common in males aged 10 and under, is normal and does not require treatment. During puberty, the non-retractile foreskin usually becomes retractable.
Non-retractile foreskin usually becomes retractable during the course of puberty.

Questions and Answers

Define Phimosis ?

A disorder of the penis called phimosis prevents the foreskin from entirely retracting over the glans penis. The condition, known as clitoral phimosis in females, prevents the clitoral hood from retracting, reducing the amount of the glans clitoridis that can be exposed.

What are the causes of phimosis ?

Phimosis may develop as a result of recurrent catheterization, forced foreskin retraction, or other forms of persistent inflammation (such balanoposthitis). Untreated diabetics may also develop phimosis because glucose in their urine can cause an infection of the foreskin. Older children and adults who have phimosis can have varying degrees of severity, with some only being able to partially retract their foreskin (relative phimosis) and others being completely unable to do so even when their penis is in the flaccid state.