Changes

'''Phimosis''' (''fɪˈmoʊsɨs'' or ''faɪˈmoʊsɨs'', from the Greek ''phimos'' (φῑμός "muzzle"), in adults is a condition natural variant of the [[penis]] where the [[foreskin]] cannot be fully retracted over the [[glans penis]]that occurs in about five percent of [[foreskinned]] adult males.<ref>{{URLwikipedia|Phimosis|Phimosis|2019-09-25}}</ref> Phimosis is classed as [[physiological phimosis]] or [[pathological phimosis]]. The physiological phimosis condition in adults is a conditionnatural variant, not a disease, so it does not threaten health. Phimosis Men may elect to treat it or may not require treatmenttreat it. Some men live their entire lives with a non-retractile foreskin. [[Sex with phimosis| They are able to have sexual intercourse and father children]].==Positive aspects of phimosis==Artificial intelligence produced this list of advantages:

* <b>Increased Sensitivity:</b> Some people report heightened sensitivity due to the [[foreskin]] covering the [[glans]], which may enhance pleasure. * <b>Natural Protection:</b> The [[foreskin]] acts as a barrier, potentially reducing exposure to irritants and infections. * <b>Reduced Risk of Certain Conditions:</b> Some studies suggest that [[intact]] foreskin may help maintain moisture and prevent dryness-related issues. * <b>Alternative Intimacy Experiences:</b> Individuals with phimosis sometimes develop unique approaches to intimacy that focus on broader sensual experiences rather than conventional techniques.==Physiologic phimosis==[[Michel Beaugé| Beaugé ]] (1997) states that adult phimosis is caused by persists when the individual uses unusual methods of [[masturbation]] that fail to stretch the narrow foreskin of [[https://en.intactiwiki.org/wiki/Foreskin#Foreskin_in_infancy_and_childhood| childhood]].<ref name="beauge1997">{{REFjournal

}}</ref> The condition may be treated by changing one's method of [[masturbation ]] according to Beaugé.

* The inner surface of the foreskin is fused or adherent by a [[synechia]] to the [[glans penis]].

 === Non-retractable foreskin of infancy and childhood ===

Boys are almost always born with non-retractable [[foreskin]].<ref name="gairdner1949">{{GairdnerDM 1949}}</ref> The inner surface of the foreskin of a newborn baby is fused by a [[synechia]] to the surface of the glans penis so that is non-retractable.<ref>{{REFjournal

}}</ref> Moreover the tip of the [[foreskin]] at birth is usually too tight to permit any retraction.<ref name="gairdner1949"/> Thus normal, natural childhood non-retractable foreskin, which must be distinguished from pathological phimosis,<ref name="shahid2012" /> has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults.<ref name="shahid2012" />

[[Physiological phimosis can be divided into three main categories - symptom-free]] is a normal, in need healthy stage of therapy, and in need of surgerydevelopment that does not require treatment.

From a medical standpoint, an otherwise symptom-free [[phimosis]], even after dissolution of preputial adhesions, does not require any treatment before the child enters [[puberty]]. The widespread notion that full retractability has to be achieved by a certain age, derives from obsolete assumptions and studies which only covered children's development until they entered school, but not beyond that point.

Even though the data from [[Jakob Øster]]'s studies have been known for 54 yearsmore than half a century,<ref name="Øster1968">{{OesterJ 1968}}</ref> some check lists for school doctors‘ examinations still erroneously refer to [[physiological phimosis ]] as an abnormality.

By age 10.4 years, about 50 percent of [[intact]] boys have a retractable [[foreskin]].<ref name="Øster1968"/><ref name-"thorvaldsen2005">{{REFjournal

}}</ref> Most of the rest develop a retractable [[foreskin ]] in their teenage years.<ref name="Øster1968"/> About An estimated two percent to 5 percent of adult males live with a non-retractable [[foreskin]].,<ref name="shahid2012" />in which retraction did not spontaneously develop, which is a normal variant.

If treatment is deemed necessaryelected, the application of topical steroid ointment to assist manual [[stretching ]] is the most cost-effective treatment.<ref name="vanhowe1998">{{REFjournal

Non-retractile or tight foreskin is a condition, not a disease. It is not life threatening. One may elect to remain as one is, without treatment. Many men do not have an issue with non-retractile [[foreskin]]. There may be some variation in the acceptance of phimosis. Other nationalities may be more accepting of phimosis than Americans<ref>{{REFweb |url= https://www.reddit.com/r/uncircumcised_talk/comments/1iy44ba/uncircumcised_asians_and_foreskin_retraction/ |title=Uncircumcised Asians and foreskin retraction |publisher=Reddit |date=2025-02-25 |accessdate=2025-02-25}}</ref> Some men seem to prefer the protection and sensation that the non-retractile foreskin provides.

Many men can have sex, father children, and live happily with a non-retractile foreskin.<refname="young">{{REFweb

=== Fingers ===The growth and hormonal surge during [[puberty ]] alter both the size and size ratio of the [[penis]] and [[penile skin]] significantly. Also, the first [[masturbation]] aids in the process of [[stretching]] of the [[skin]] and detachment of any remaining childhood fusion. Manual [[stretching ]] causes [[tissue expansion]] and a wider, retractable foreskin.

If, after that, the [[foreskin]] still remains too tight, resulting in pain during sexual activities, and making genital hygiene difficult, treatment is indicated. The individual should engage in [[stretching ]] exercises, if needed with the aid of corticosteroid cream, which is available by prescription. Depending on the active substances, success rates of 80-90% have been documented.<ref>{{REFjournal

Should those therapies not yield the desired outcomes, there is a surgical option, namely a [[preputioplasty]].<ref name="milos2022-09-19" />

Circumcision (partial penile amputation) once was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Neurotomy]] is a feature of every circumcision and causes severe loss of [[erogenous sensation of the foreskin]]. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />

* Circumcision exposes the patient to the surgical risks of [[bleeding]], [[infection]], and surgical misadventure, which rarely can include loss of the [[glans penis]], loss of the [[penis]] or [[death]]. * Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its [[Foreskin#Physiological_functions| multiple protective, immunological, sensory, and sexual physiological functions]] are destroyed and has many [[risks and complications]]. The sensitive head of the [[penis]] will be permanently exposed so the [[Glans penis| head]] will rub against clothing. Many men find this to be very painful. * Most men report a permanent substantial loss of [[Sexual sensation of the foreskin| sexual sensation]]. * Circumcision results in a permanent, usually two-toned, [[circumcision scar]]. * Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision [[lymphoedema]] caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing [[wound dehiscence]]. Sexual and [[Psychological issues of male circumcision| psychological]] issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and [[infection]]. Loss of the penis and [[death]] are known.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal

* Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its multiple protective, immunological, sensory, and sexual physiological functions are destroyed and has many [[risks and complications]]is irreverible amputation. The sensitive head of the [[penis]] will Circumcision cannot be permanently exposed so the head will rub against clothingundone. Many men find this to be very painful.* Most men report a permanent loss of sexual sensation.* Circumcision results in a permanent [[circumcision scarRegret men]]are common.

<b><u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u></b>

Kumar et al. (2017) graded phimosis from 0 to 5. They argue claimed that [[adult circumcision ]] is necessary to treat grades 4 and 5.,<ref name="kumar2017">{{REFjournal

}}</ref>however that is not certain. Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]]. Circumcision is usually an elective surgical amputation. Men who elect to be [[circumcised]] can only blame themself if they do not like the results. [[Regret men]] are common.

Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for example, a cream that contains [https://www.webmd.com/drugs/2/drug-4316/clotrimazole-topical/details Clotrimazole].<ref name="milos2022-09-19" />

Lichen Scleroses, formerly called [[balanitis xerotica obliterans]] when it occurs in males, hardens the [[foreskin]] and makes it non-retractable.<ref name="milos2022-09-19" />

In [[pathological phimosis]], the foreskin cannot be retracted over the glans without injury, due to a lack of elasticity caused by scarring or hardening.

[[Pathological phimosis ]] usually requires treatment.

A [[Adolescent and adult circumcision| circumcision]] may be indicated in severe cases of pathological phimosis, where neither non-surgical methods with corticosteroid cream nor foreskin-preserving [[preputioplasty]] are promising (for example with chronic [[balanitis xerotica obliterans]]) or have failed in previous attempts.==Pathological phimosis==Pathologic phimosis is phimosis caused by lichen sclerosis et atrophicrus (LSA), formerly known as [[balanitis xerotica obliterans]] (BXO), on the [[foreskin]].<ref name="rickwood1980">{{REFjournal |last=Rickwood |first= |init=AMK |author-link= |last2=Hemalatha |first2= |init2=V |author2-link= |last3=Batcup |first3= |init3=G |author3-link= |last4=Spitz |first4= |init4=L |author4-link= |etal=no |title=Phimosis in boys. |trans-title= |language= |journal=Brit J Urol |location= |date=1980 |volume=52 |pages=147-50 |url=https://www.cirp.org/library/treatment/phimosis/rickwood/ |archived= |quote= |pubmedID=7191744 |pubmedCID= |DOI=10.1111/j.1464-410x.1980.tb02945.x |doi= |accessdate=2024-01-13}}</ref> <ref name="milos2022-09-19">{{REFweb |url=https://intactamerica.org/ask-marilyn-can-a-tight-foreskin-be-treated-without-circumcision/ |title=Ask Marilyn—Can a Tight Foreskin be Treated without Circumcision? |last=Milos |first= |init=MF |author-link=Marilyn Fayre Milos |publisher=Intact America |date=2022-09-19 |accessdate=2024-10-24}}</ref> Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" />

If the [[frenulum]] is too short, it can hinder or even prohibit retraction of the [[foreskin]]. If the mechanical strain is too great, the frenulum can tear or rip apart. If the frenular artery, which runs within, is damaged in the process, it can lead to considerable and prolonged [[bleeding]]. When only small tears appear, it may heal spontaneously.

* [[Retraction of the foreskin]]* [[Foreskin#Physiological_Phimosis|Physiological Phimosisphimosis]], described in the [[Circumpendium]]* [[Foreskin#Pathological_Phimosis|Pathological Phimosisphimosis]], described in the [[Circumpendium]]

|last=Anonymous