Phimosis in Children and Adults

Phimosis is a condition characterized by the foreskin of the penis not being completely detached from the head of the penis. Actually the foreskin will fall off on its own as the child gets older. Don't try to remove it yourself, because you risk causing a condition known as paraphimosis.

Paraphimosis occurs when the retracted foreskin becomes stuck and cannot return to its original position. Paraphimosis is an emergency medical condition that must be treated immediately because it can block blood flow to the head of the penis.

One of the things you need to know is that there is smegma on the foreskin of the penis. Smegma is a collection of dead skin cells that sits between the head of the penis and the white foreskin, and helps separate the foreskin from the head of the penis. Smegma itself is easy to clean.

Phimosis Symptoms

Phimosis in uncircumcised children is a normal condition caused by the attachment of the foreskin to the head of the penis. The foreskin of the child's penis will stretch by itself with age. The foreskin will be completely detached generally by the age of 17 years.
Although generally phimosis in children is a normal condition, there are conditions that need to be watched out for in a child's penis, namely when the foreskin that has been detached but is reattached or the head of the penis becomes inflamed and is known as balanitis.
Phimosis may be normal for uncircumcised boys. However, phimosis has the risk of causing balanitis which can be characterized by the following symptoms:

• The head of the penis feels sore, and looks swollen and red.

• Thick discharge from the foreskin

• A white line is formed around the head of the penis that resembles a

• There is blood in the urine.

• Burning or pain when urinating.

• Lower pelvic pain.

If these conditions arise, immediately consult with your child's doctor to get the right treatment, because the pediatrician will also monitor the child's health condition, as well as the condition of your child's growth and development including the condition of the development of organs, one of which is the child's penis.

Causes of Phimosis

Phimosis is a normal condition in uncircumcised children, especially children under 3 years of age. After that, the foreskin will loosen by itself so that it can be moved or pulled behind the head of the penis.
In addition to children, phimosis can also occur in adults who have not been circumcised. Unlike children, phimosis in adults is an abnormal condition and can be caused by:

• Inflammation of the head of the penis
  

• Penile head infection

• Lichen sclerosus

• Eczema

• Psoriasis

• Diabetes

Phimosis Diagnosis

Phimosis will appear from the symptoms that appear, namely the foreskin of the penis attached to the head of the penis. This condition is normal in children, especially in children under 3 years of age. However, if there are symptoms that need to be watched out for, immediately consult a doctor.
When consulting with a doctor, the doctor will ask about the symptoms felt by the patient, then the doctor will perform a physical examination, especially on the penis. After that, the doctor will determine the steps of treatment to be undertaken, without the need for additional examinations.

Phimosis Treatment

Most cases of phimosis are not serious and do not require special treatment. For parents whose children have phimosis, never forcibly pull the foreskin of the penis. This action can trigger irritation or infection, and even lead to dangerous paraphimosis.
Doctors will provide treatment steps if phimosis causes symptoms that interfere with daily activities. The type of treatment given will be adjusted to the age and severity of the patient's phimosis.
The following are the types of treatment that your doctor may suggest:

Drugs

Doctors can give drugs to relieve phimosis. One of the drugs that can be used is topical corticosteroids in the form of creams, gels, or ointments. Corticosteroid medications can help loosen the foreskin, making it easier to pull out.
Doctors can also give other drugs according to the cause of phimosis. If the patient has a yeast infection, the patient will be given an antifungal cream. If the patient has a bacterial infection, the patient will be given an antibiotic cream.
Phimosis in adults can interfere with sexual activity because it causes discomfort or pain. To overcome this, the doctor may recommend the use of condoms and lubricants when having intercourse.

Circumcision

The doctor will advise the patient to undergo circumcision if the patient has recurrent balanitis or inflammation of the glans, or recurrent urinary tract infections. Circumcision can also be performed if the foreskin is attached very tightly.

Complications of Phimosis

Although phimosis in children is a normal condition, phimosis can cause complications such as penile infection. If it occurs in adults, phimosis can cause complications such as the following:

• Posthitis or inflammation of the foreskin.

• Necrosis or decay of the head tissue of the penis.

• Autoamputation of the head of the penis due to tissue decay.

Phimosis Prevention

Phimosis is a normal condition in children. Preventive measures are needed to prevent penile infections in children.
In the first few years of life, gently pulling the foreskin and regular cleanings such as bathing or changing diapers greatly affects the condition of the foreskin, making it easier to clean and over time it will loosen on its own. For this reason, parents need to teach their children to always clean and dry the penis regularly.
While in adults, cleaning the penis is done to prevent the occurrence or recurrence of phimosis. The steps that can be taken to clean the penis are:

• Wash the penis every day with water when bathing. This also needs to be done on men who have been circumcised.

• Use soap that does not contain perfume and avoid using deodorant on the penis to reduce the risk of irritation.

• Gently pull on the foreskin to clean the skin under the foreskin, but don't pull the foreskin hard as this can cause pain and sores.

If your little one experiences similar symptoms, immediately consult a Surgeon at Hermina Pasteur Hospital

To find out the practice schedule of dr. Samuel Onedes Siregar, Sp.B and registering can be done via:
1. Hermina Hospital website
2. Hermina Mobile Application "PT Medikaloka Hermina Tbk" (available on Playstore/Appstore)
3. Call Center 1500488

 

Reference
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Hayashi, et al. (2010). Prepuce: Phimosis, Paraphimosis, and Circumcision. ScientificWorldJournal., 11, pp. 289–301.
Lucile Packard Children's Hospital. Stanford Children's Health. Phimosis and Paraphimosis in Children.
MSD Manuals (2019). Phimosis and Paraphimosis.
NHS UK (2018). Health A-Z. Tight Foreskin (Phimosis and Paraphimosis).
Drugs (2018). Phimosis and Paraphimosis.
Balentine, J. MedicineNet (2017). Phimosis vs. Paraphimosis: Symptoms, Causes, and Treatments.
Ghory, H. Medscape (2017). Phimosis and Paraphimosis.
WebMD. 2 Penis Disorders: Phimosis and Paraphimosis.