Phimosis (fy-MOH-sis) is the inability to retract the foreskin (prepuce) covering the head of the penis (glans penis).
Phimosis is a condition where the foreskin is too tight to be pulled back over the head of the penis. It is only seen in uncircumcised * males. It may appear as a tight ring or “rubber band” of foreskin around the tip of the penis. In babies and toddlers this is normal. The foreskin naturally starts to separate from the penis around age two; it can take longer in some boys and most times will detach at a later time.
The majority of male babies in the United States are circumcised (55%–65%). Phimosis is only a concern for uncircumcised males and is the most commonly observed penile skin issue noted in children. Phimosis typically resolves on its own as the child gets older as evidenced by the observation that virtually all infants experience unretractable foreskin but less than 5 percent of males near puberty encounter this issue.
Phimosis is usually caused by adhesions or adherence between the prepuce (foreskin) and the glans penis (head of the penis). At birth, the prepuce is normally adhered to the glans penis. This adherence generally separates by five years of age. When it does not separate, it may interfere with urination or cause other problems.
In older boys and men, phimosis may be caused by an injury to the penis or prolonged irritation and inflammation * of the foreskin and the head of the penis.
Uncircumcised males are at risk for phimosis. Phimosis is often a problem in infants and young children that is identified by the parents who then seek information and treatment from the pediatrician, a physician who has specialized knowledge and experience in the care of children.
Phimosis appears as a tight ring of foreskin at the tip of the penis. The person is unable to retract the foreskin. People with pathologic phimosis may have pain, infection, or problems with urinating or sexual intercourse.
When the problem occurs in a child, the healthcare provider obtains a health history from the parents or caregivers. When the problem occurs in an older male, the man may report problems with sexual intercourse and urination. He may also report frequent urinary tract infections * or infection/inflammation of the foreskin and head of the penis. A physical examination of the person shows the penis with the foreskin that cannot be pulled back (retracted).
In most cases involving infants and toddlers, physiologic phimosis will resolve during the first few years of life. In those cases where phimosis presents a problem, such as recurrent infections at the site, there are two options for treatment:
It is important that good hygiene practices are taught to the child and used by the adult, especially those who are uncircumcised. The area of skin underneath the foreskin should be washed daily.
Phimosis can be prevented by circumcision, the surgical removal of the foreskin that covers the head of the penis. In many males it can also be treated by stretching of the prepuce and treatment with steroids.
See also Bacterial Infections • Pain • Puberty and Sexual Development
Castagnetti, Marco., et. al. “Benign Penile Abnormalities in Children: A Primer for Pediatricians.” World Journal of Pediatrics. March 9, 2015. 11(4): 316-23. www.wjpch.com/UploadFile/2015-316.pdf (accessed April 1, 2016).
KidsHealth. “A to Z: Phimosis.” http://kidshealth.org/parent/dictionary/p/az-phimosis.html (accessed April 1, 2016).
KidsHealth. “Circumcision.” http://kidshealth.org/parent/system/surgical/circumcision.html (accessed April 1, 2016).
PubMed Health. “What Are the Treatment Options for Phimosis?” U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079408/ (accessed May 12, 2016).
University of California, San Francisco—Department of Urology. “Phimosis.” https://urology.ucsf.edu/patient-care/children/phimosis (accessed April 1, 2016).
* uncircumcised is the way the penis looks at birth with the foreskin covering the head of the penis.
* inflammation (in-fla-MAY-shun) is the body's reaction to irritation, infection, or injury that often involves swelling, pain, redness, and warmth.
* urinary tract infection (YOOR-ihnair-e) (UTI) is an infection that occurs in any part of the urinary tract.
* steroid (STIR-oyd) is any of a group of substances related to sterols, including cholesterol, bile acids, and certain hormones. Includes corticosteroids that are used to treat inflammation.