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* [[Retraction of the foreskin]]
Wikify.
{{GraphicWarning}}
[[File:Phimosis.jpg|thumb|An erect penis with a case of phimosis]]
'''Phimosis''' (''fɪˈmoʊsɨs'' or ''faɪˈmoʊsɨs'', from the Greek ''phimos'' (φῑμός "muzzle"), is a condition of the [[penis]] where the [[foreskin]] cannot be fully retracted over the [[glans penis]].<ref>{{URLwikipedia|Phimosis|Phimosis|2019-09-25}}</ref> Phimosis is a condition, not a disease, so it does not threaten health. Phimosis Men may or may not require treatmentelect to 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]].==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 |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>
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. ==Physiologic phimosis==Beaugé (1997) states that adult phimosis is caused by unusual methods of [[masturbation ]] that fail to stretch the narrow foreskin of [[Foreskin#Foreskin_in_infancy_and_childhood| childhood]].<ref name="beauge1997">{{REFjournal
|last=Beaugé
|first=Michel
|url=http://www.cirp.org/library/treatment/phimosis/beauge2/
|accessdate=2020-04-20
}}</ref> The condition may be treated by changing one's method of [[masturbation ]] according to Beaugé.
There are three possible causes of non-retractile foreskin:<ref name='hill2012">{{REFweb |url=https://genitalwholeness.wordpress.com/article/phimosis-2y9nanfagw8nr-11/ |archived= |title=Phimosis: Non-retracticle foreskin |trans-title= |language=English |last=Hill |first=George |init=G |author-link=George Hill |publisher=genitalwholeness |website=wordpress |date=2012-05-28 |accessdate=2020-12-06 |format= |quote=Development of retractile foreskin in boys is very gradual and occurs over a period of years._The membrane that fuses the foreskin and the glans penis spontaneously disintegrates and the foreskin separates from the glans penis._Also, the opening at the tip becomes wider with increasing maturity.}}</ref>
* The tip of the foreskin is too narrow to pass over the [[glans penis]].
* The [[frenulum]] is too short to permit retraction. The medical name for this condition is ''[[frenulum breve]]''.
All may be conservatively treated without [[Adolescent and adult circumcision| circumcision]].<ref name='hill2012" /> === Non-retractable foreskin of infancy and childhood ===
[[File:Oester.jpg|frame|Percentage of boys with fused foreskin by age according to Øster]]
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
|last=Deibart
|init=GA
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 51 54 years,<ref name="Øster1968">{{OesterJ 1968}}</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. Parental reassurance is the only treatment required.<ref name="shahid2012" />
By age 10.4 years, about 50 percent of [[intact ]] boys have a retractable foreskin.<ref name="Øster1968"/><ref name-"thorvaldsen2005">{{REFjournal
|last=Thorvaldsen
|init=MA
|DOI=
|accessdate=2019-11-01
}}</ref> Most of the rest develop a retractable foreskin in their teenage years.<ref name="Øster1968"/> About two percent of adult males live with a non-retractable [[foreskin]].<ref name="shahid2012" />
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
|last=Van Howe
|first=Robert S.
}}</ref>
Teen [[intact ]] boys with a non-retractable [[foreskin ]] may benefit by manual [[stretching]].<ref name="beauge1997" />
==Treatment options==
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]].
Many men can have sex, father children, and live happily with a non-retractile foreskin.<refname="young">{{REFweb
|url=http://www.circumstitions.com/Restric/adult-non-retr.html#adult
|title=Adult non-retracting foreskin ("Phimosis")
|last=Young
|first=Hugh
|init=H |author-link=Hugh Young
|publisher=Circumstitions
|website=
}}</ref>
Adequate lubrication has been recommended when penetrating the [[vagina]] with a non-retractile foreskin covered [[penis]]. This option preserves the [[foreskin]], its appearance, and most of the protective, immunological, sensory, and sexual [[https://en.intactiwiki.org/wiki/Foreskin#Physiological_functions physiological functions]], but does not make the foreskin retractable. If desired, a non-retractile foreskin may be flushed out with warm water with the aid of a rubber-bulb ear syringe or a Water Pik.
==== 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 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
|last=Orsola
|init=A
|last=Carilli
|first=Marco
|init=M
|author-link=
|last2=Asimakopoulos
|first2=Anastasios D.
|init2=AD
|author2-link=
|last3=Pastore
|first3=Serena
|init3=S
|author3-link=
|last4=Germani
|first4=Stephani
|init4=S
|author4-link=
|etal=yes
==== Preputioplasty ====
Should those therapies not yield the desired outcomes, there is a surgical option, namely a [[preputioplasty]].
This surgical method preserves the [[foreskin]].<ref>{{REFjournal
|last=Hotonu
|first=Sesi
|init=S
|author-link=
|last2=Mohamed
|first2=Ahmed
|init2=A
|author2-link=
|last3=Rajimwale
|first3=Ashok
|init3=A
|author3-link=
|last4=Gopal
|first4=Milan
|init4=M
|author4-link=
|etal=no
|DOI=10.1016/j.surge.2019.08.004
|accessdate=2021-06-26
}}</ref> A good cosmetic result and total preservation of the [[foreskin ]] are achieved. The basic principle of most of those methods consists of making one or more small longitudinal incisions, and then suturing the wound or wounds transversely.
There are several different methods:
====Circumcision====
Circumcision is 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" />
* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
* 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 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
}}</ref>
* 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]]. The sensitive head of the [[penis]] will be permanently exposed so the head will rub against clothing. Many men find this to be very painful.
* Most men report a permanent loss of sexual sensation.
* Circumcision results in a permanent [[circumcision scar]].
<u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u>
Kumar et al. (2017) graded phimosis from 0 to 5. They reported argue that circumcision is necessary to treat grades 4 and 5.<ref name="kumar2017">{{REFjournal
|last=Kumar
|first=
|last2=Neeraj
|first2=G
|init2=G
|author2-link=
|last3=Rajesh
|first3=L
|init3=L
|author3-link=
|last4=Kumar
|DOI=
|accessdate=2021-01-14
}}</ref>Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]].
== Adult onset phimosis ==
Phimosis or tight foreskin may be caused by a yeast infection. The proper treatment is to use an anti-fungal drug such as, for examleexample, a cream that contains [https://www.webmd.com/drugs/2/drug-4316/clotrimazole-topical/details Clotrimazole].
Lichen SclerosisScleroses, formerly called [[balanitis xerotica obliterans]] when it occurs in males, hardens the [[foreskin ]] and makes it non-retractable.
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 is | 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) ==
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.
[[Frenulum breve]] is frequently confused with phimosis. To make a differential diagnosis, one may attempt to retract the foreskin when the penis is erect. Since the underside of the glans is attached to the inner foreskin by the [[frenulum]], if frenulum breve is present, the head of the penis will bend downwards due to the resulting tension when the foreskin is retracted.
To help the healing, lukewarm camomile baths or cremes containing panthenol can be applied. With a very short frenulum and previous large tears, surgical treatment is advised.
* Elongation of the frenulum with a [[skin]] graft.
Circumcision is not appropriate or necessary to treat [[frenulum breve]]. Patients must be careful when consulting a urologist, because urologists earn a nice an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecesary unnecessary injurious [[circumcision ]] to an unwary patient.==Video==<br><youtube>v=NPwFMSZjiII</youtube>
{{SEEALSO}}
* [[Adolescent and adult circumcision]]
* [[Development of retractable foreskin]]
* [[Foreskin]]
* [[Frenulum breve]]
* [[Issues with American urologists and the practice of male circumcision]]
* [[Mitosis]]
* [[Paraphimosis]]
* [[Preputial sac]]
* [[Regret men]]
* [[Sexual effects of circumcision]]
* [[Sex with phimosis]]
* [[Stretching]]
* [[Tissue expansion]]
* [[Foreskin#Physiological_Phimosis|Physiological Phimosis]], described in the [[Circumpendium]]
* [[Foreskin#Pathological_Phimosis|Pathological Phimosis]], described in the [[Circumpendium]]
* {{REFjournal
|last=Rickwood
|init=AMK
|author-link=
|last2=Hemalatha
|DOI=10.1111/j.1464-410x.1980.tb02945.x
}}
* {{REFwebREFjournal |last=Hodges |first=Frederick M. |init=FM |author-link=Frederick M. Hodges |etal=no |title=Phimosis in antiquity |trans-title= |language= |journal=World J Urol |location= |date=1999-06 |season= |volume=17 |issue=3 |article= |page= |pages=133-6 |url=httpshttp://genitalwholenesswww.wordpresscirp.comorg/articlelibrary/history/phimosis-2y9nanfagw8nr-11hodges1/
|archived=
|titlequote=Phimosis: Non-retracticle As demonstrated by their visual art, the Greeks highly esteemed the foreskinas a defining feature of the male body. |trans-titlepubmedID=10418085 |languagepubmedCID=English |lastDOI=Hill |first=George |author-link=George Hill |publisher=genitalwholeness |website=wordpress |date=2012-05-2810.1007/s003450050120 |accessdate=20202022-1206-06 |format= |quote=Development of retractile foreskin in boys is very gradual and occurs over a period of years._The membrane that fuses the foreskin and the glans penis spontaneously disintegrates and the foreskin separates from the glans penis._Also, the opening at the tip becomes wider with increasing maturity.16
}}
|url=http://www.cirp.org/library/treatment/phimosis/
|title=Conservative Treatment of Phimosis: Alternatives to Radical Circumcision
|last=Anonymous
|first=
|publisher=Circumcision Reference Library
|date=2006-07-12
|accessdate=2019-11-01
}}
* [https://www.wikihow.fitness/Do-Phimosis-Stretching How to Do Phimosis Stretching]
* {{REFweb
|title=Phimosis and Circumcision (Adult)
|url=https://www.coventryrugbygpgateway.nhs.uk/pages/phimosis-2/
|archived=
|trans-title=
|language=
|last=Blacker
|first=Anthony
|author-link=
|publisher=National Health Service - Coventry and Warwickshire
|website=
|date=2018-05-22
|accessdate=2022-06-24
|format=
|quote=Phimosis is a condition in where the foreskin of the penis is too tight to be pulled back to reveal the glans.
}}
* {{REFweb
|url=https://treatphimosis.com/
|title=treat phimosis
|last=
|first=
|init=
|publisher=
|date=
|accessdate=2023-11-01
}}
{{REF}}