17,052
edits
Changes
Jump to navigation
Jump to search
Insert journal reference
|DOI=10.5402/2012/707329
|accessdate=2019-11-02
}}</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.
==== Manual stretching ====
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 boy himself should engage in stretching exercises, if needed with the aid of corticosteroid cream. Depending on the active substances, success rates of 80-90% have been documented.<ref>{{REFjournal
|last=Orsola
|first=A.
There are several different methods:
* Dorsal slit with transverse suturing: this technique places a single lengthwise cut into the stenotic ring which is then closed transversely.<ref>{{REFjournal |last=Cuckow |first=Peter M. |author-link= |etal=yes |title=Preputial plasty: a good alternative to circumcision |trans-title= |language= |journal=J Pediatr Surg |location= |date=1994-04 |volume=29 |issue=4 |pages=561-3 |url=http://www.cirp.org/library/treatment/phimosis/cuckow/ |quote= |pubmedID=8014816 |pubmedCID= |DOI=10.1016/0022-3468(94)90092-2 |accessdate=2019-11-24}}</ref>
* Lateral preputioplasty: this is a refinement of the dorsal slit with transverse suturing. It consists of two lateral, longitudinal incisions sutured transversely.
* Triple incision: this is a method of foreskin widening. It typically consists of three incisions across the tight ring. They are closed from side to side, thereby increasing the circumference of the tight ring relative to the length of the cuts. From an aesthetic view, it has results far superior to those of a dorsal slit, and usually yields a good cosmetic result.<ref>{{REFjournal
===Circumcision===
Circumcision is the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Circumcision ]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />
* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
* 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 [http://www.circumstitions.com/Restric/Botched9wd.html wound dehiscence]. Sexual and 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