Phimosis: Difference between revisions
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* The [[frenulum]] is too short to permit retraction. The medical name for this condition is ''[[frenulum breve]]''. | * The [[frenulum]] is too short to permit retraction. The medical name for this condition is ''[[frenulum breve]]''. | ||
* The inner surface of the foreskin is fused or adherent by a [[synechia]] to the glans penis. | * 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">{{REFjournal | |||
Boys are almost always born with non-retractable foreskin | |||
|last=Gairdner | |last=Gairdner | ||
|first=Douglas | |first=Douglas | ||
| Line 32: | Line 27: | ||
|DOI=10.1136/bmj.2.4642.1433 | |DOI=10.1136/bmj.2.4642.1433 | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</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 | ||
|last=Deibart | |||
|first=G.A. | |||
|title=The separation of the prepuce in the human penis | |||
|journal=Anat Rec | |||
|date=1933 | |||
|volume=57 | |||
|issue= | |||
|pages=387-99 | |||
|url=http://www.cirp.org/library/anatomy/deibert/ | |||
|quote= | |||
|pubmedID= | |||
|pubmedCID= | |||
|DOI=https://doi.org/10.1002/ar.1090570409 | |||
|accessdate=2019-11-01 | |||
}}</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 has been given the name ''physiological phimosis'' to distinguish it from ''pathological phimosis'' in adults. | |||
Physiological phimosis can be divided into three main categories - symptom-free, in need of therapy, and in need of surgery. | Physiological phimosis can be divided into three main categories - symptom-free, in need of therapy, and in need of surgery. | ||
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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. | 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 | Even though the data from Jakob Øster's studies have been known for 51 years,<ref name="Øster1968">{{REFjournal | ||
|last= | |||
|first=Jakob | |||
|title=Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys | |||
|journal=Arch Dis Child | |||
|date=1968-04-01 | |||
|volume=43 | |||
|issue= | |||
|pages=200-3 | |||
|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2019851/pdf/archdisch01557-0066.pdf | |||
|quote= | |||
|pubmedID=5689532 | |||
|pubmedCID=2019851 | |||
|DOI=10.1136/adc.43.228.200 | |||
|accessdate=2019-11-01 | |||
}}</ref> some check lists for school doctors‘ examinations still erroneously refer to physiological phimosis as an abnormality. | |||
In most cases only watchful waiting is necessary, not surgery or other treatment. | |||
By age 10.4 years, about 50 percent of intact boys have a retractable foreskin.<ref name="Øster1968" /> <ref name-"thorvaldsen2005">{{REFjournal | |||
|last=Thorvaldsen | |||
|first=M.A. | |||
|last2=Meyhoff | |||
|first2=H.H. | |||
|title=Phimosis: pathological or physiological? | |||
|journal=Ugeskr Læge | |||
|date=2005 | |||
|volume=167 | |||
|issue=17 | |||
|pages=1858-62 | |||
|url=http://www.cirp.org/library/normal/thorvaldsen1/ | |||
|quote= | |||
|pubmedID=15929334 | |||
|pubmedCID= | |||
|DOI= | |||
|accessdate=2019-11-01 | |||
}}</ref> Most of the rest develop a retractable foreskin in their teenage years.<ref name="Øster1968" /> | |||
Teen boys with a non-retractable foreskin may benefit by manual stretching. | |||
==Medical indications and therapies== | |||
There is a group of typical conditions of the foreskin, that can occur in more or less distinct ways. | |||
==Treatment options== | ==Treatment options== | ||