Phimosis: Difference between revisions

'''Phimosis''' (''fɪˈmoʊsɨs'' or ''faɪˈmoʊsɨs'', from the Greek ''phimos'' (φῑμός "muzzle"), in adults is a 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 a natural variant, not a disease, so it does not threaten health. Men may elect to treat it or not treat 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]].

}}</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, in need of therapy, and in need of surgery.

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 more 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"/> An estimated two percent of adult males live with a non-retractable [[foreskin]].<ref name="shahid2012" />

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.

Circumcision once was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />

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.

 

== Short frenulum (frenulum breve) ==

 

 

 

 

 

 

==Pathologic 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

Some success has been shown with treatment by topical steroid cream, but other cases may be an indication for [[circumcision]].<ref name="rickwood1980" /> See section on adult onset phimosis below.

* [[Foreskin#Physiological_Phimosis|Physiological Phimosis]], described in the [[Circumpendium]]

* [[Foreskin#Pathological_Phimosis|Pathological Phimosis]], described in the  [[Circumpendium]]