Changes

'''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 classed as [[physiological phimosis]] or [[pathological phimosis]]. The physiological phimosis condition in adults 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]] 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.

}}</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.

}}</ref> Some men seem to prefer the protection and sensation that the non-retractile foreskin provides.

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 (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" />

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) == 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. There are 3 surgical variants:<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref> * Frenectomy, the complete removal of the frenulum* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient.==Pathologic Pathological phimosis==

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  == Short frenulum (frenulum breve) ==[[Frenulum breve]] may prevent retraction and may be mis-diagnosed as phimosis below 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. There are 3 surgical variants:<ref>{{URLwikipedia|Frenulum_breve|Frenulum breve|2019-09-25}}</ref> * Frenectomy, the complete removal of the frenulum* Frenuloplasty, where the frenulum is cut horizontally, and sewed together vertically* 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 an attractive fee from performing a circumcision, so may be quick to recommend inappropriate and unnecessary injurious [[circumcision]] to an unwary patient. 

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