The head of men does not open why. What is phimosis and how to get rid of it. I heard that the operation should be done with a laser

A common disease is phimosis in men, which affects their reproductive organ. With this pathology the foreskin narrows and this causes problems with the opening of the glans penis during erection. Phimosis is considered a rather dangerous disease, and it is impossible to get rid of it with effective treatment. The choice of one or another method of therapy is determined by the stage of the disease, and most often medical and surgical treatment is used. Pathology is insidious in that the risk of developing various complications that can lead to the death of the patient is too great. It is for this reason that men should know what is phimosis in men, how to open the head without circumcision and massage the foreskin.

Characteristics of the disease phimosis in men

Phimosis is a disease that can develop in a man for various reasons. In order to understand how to treat phimosis in men at home, it is necessary to find out the etiology of the disease. A common reason for the development of such a pathology is considered to be a low level in the male body of the elastic element of the connective tissue. Various injuries can provoke an ailment of the male organ, which are accompanied by the formation of scars on the foreskin. Such a pathological condition leads to the disruption of the normal functioning of the skin on the genitals.

In men, scarring is possible on the foreskin as a consequence of various inflammatory and infectious pathologies of the genital area, which can lead to phimosis. In addition, uneven development of the foreskin in boys during puberty can cause the disease.

The following factors can provoke the development of pathology in men:

• detection of balanoposthitis in a patient, which is directly related to inflammation of the skin of the penis;
• a genetic feature, that is, the development of phimosis is caused by a weakly elastic connective tissue of the body;
• injuries of the genital organs and, as a result, narrowing of the foreskin due to the accumulation of scar tissue in large quantities;
• rapid growth during puberty can cause the penis and foreskin to develop unevenly.

Causes of phimosis in adult men may be different, and if a narrow foreskin is detected, only a doctor prescribes treatment. Such a pathology often occurs as a result of an infectious process suffered by a man, but the congenital form is predominantly diagnosed. In newborn boys, you can see the so-called congenital phimosis, which is accompanied by the appearance of certain symptoms.

The clinical picture of phimosis in adults is as follows:

• the foreskin is not completely displaced;
• the head of the penis is not exposed enough.

Usually, such a pathological condition resolves on its own without special treatment until the boy is 3 years old. In the absence of effective therapy for phimosis, the following complications may develop:

• severe inflammatory processes affecting the genitals;
• splicing of the foreskin;
• violation of the physiological process of excretion of urine from the body;
• education in the genital area of ​​scars and adhesions;
• pain in the penis;
• staining of the penis in blue and severe itching;
• accumulation of purulent exudate in the foreskin;
• the appearance of an unpleasant odor from the genitals.

In its development phimosis can go through several stages and each of them is accompanied by the appearance of a certain clinical picture.

Why treat phimosis?

In boys of preschool and school age, phimosis may disappear without special therapy, but adult patients will need to make some efforts to eliminate the disease. Patients with this disease are at risk for infections of the genitourinary system and this is due to the fact that without exposing the head of the penis, problems with intimate hygiene appear. This ends with the accumulation of smegma under the foreskin, which becomes an ideal place for the reproduction of pathogenic microorganisms. With poor hygiene of the genital organs, over time, lumps of dense consistency form from smegma, which are called smegmolites.

How to treat phimosis in men at home, and in what cases is such a method completely excluded? The elimination of the pathology helps to prevent the constant accumulation of smegma under the foreskin, which is considered one of the effective preventive measures against a bacterial infection. The narrowing of the foreskin can become a serious obstacle to a full-fledged sexual life, because its delay is accompanied by increased tension and its breaks are possible. A man complains of pain during intercourse, and permanent injuries further aggravate the course of the disease.

Some patients complain of severe discomfort during the retraction of the foreskin, and upon the onset of an erection. Constant pain can cause impotence, and complete squeezing of the head of the penis by the skin makes it difficult to remove urine from the body. The consequence of such a pathological condition may be stagnation of urine in the bladder. The choice of method of dealing with the disease is determined by the degree of phimosis and the cause that provoked its progression. At phimosis men to take a photo of the organ and learn about treatment at home you need an experienced professional.

Stages of pathology and symptoms

Phimosis in men can be divided into 4 stages and the treatment of each of them is carried out using certain methods.

1. Mild stage of phimosis in men accompanied by a full opening of the penis head in a calm state. During an erection, a man may feel slight pain and discomfort in the foreskin area. At the initial stage of the development of the disease, with narrowing of the foreskin in men, treatment at home is carried out without surgical intervention.
2. At pathology of moderate severity during the opening of the head of the penis in a calm state, discomfort may appear. In the normal state, the head is displayed quite problematic and you have to make some efforts. In the event that an erection occurs, then it is possible to do this with great difficulty. If the patient does not have any complications, treatment of phimosis at home is carried out with the help of drug therapy.
3. During the transition phimosis to a severe degree the head of the penis does not open even at rest. In the event that the patient is in a state of erection, then there is a strong pain syndrome and even bleeding. In addition, such symptoms are supplemented by the progression of the inflammatory process, but there are no problems with urination. With this pathological condition, the treatment of phimosis is carried out by small surgical intervention.
4. The fourth degree of pathology is considered the most difficult and it is absolutely impossible to expose the head of the penis. As a result, there are difficulties with the process of urination, that is, urine is excreted in the form of a thin stream or by drip. In addition, the foreskin can swell quite strongly and resemble a bag in its appearance. Upon careful examination of the patient, it is possible to notice an increase in the lymph nodes in the inguinal zone, and the body temperature rises. Treatment of the fourth stage of phimosis is carried out by performing an emergency surgical intervention.

It is possible to avoid surgical intervention and maintain a full sexual life with timely treatment of phimosis. It is for this reason that the fight against the disease must begin immediately after the diagnosis is made.

Video about the symptoms and treatment of phimosis in adult men and children.

Non-drug treatment

One of the directions treatment of phimosis in adults is a non-pharmacological way to eliminate the disease, when gradual stretching of the foreskin. This technique requires compliance with certain rules:

• before carrying out such treatment, it is necessary to consult with a specialist and is under his constant supervision;
• observe the principle of gradual exposure and stretching;
• carry out the procedure systematically.

Medical practice shows that some patients with the initial stages of the disease successfully cope with the problem in just a few months. To do this, a man needs to know how to stretch the foreskin and how to treat phimosis at home. This method involves pulling the foreskin over the head of the penis in the morning while the man takes a shower. In addition, such a manipulation must be done every time after the act of urination until the first pain occurs.

Before starting the procedure for stretching the flesh, it is necessary to treat the hands with an antiseptic without alcohol, and soften the epidermis in the treatment area. One of the effective ways to soften the skin is a hot bath with essential oils, which should be taken for 30 minutes. After that, the foreskin is lubricated with a hypoallergenic baby cream, which softens it even more and helps to avoid unnecessary friction.

The stretching method has been successfully used in the treatment of childhood phimosis. a, and the duration of such manipulations is determined by the stage of the disease. Usually, therapeutic therapy is carried out for no more than 4 months when a diagnosis such as proboscis phimosis in boys is made. In some cases, resort to stretching with the fingers, when they are introduced into the preputial cavity and gradually diluted.

Preparation for the procedure

Before starting the procedure, it is recommended to lubricate the foreskin with a nourishing cream, which will further soften the skin and facilitate treatment. Stretching can be done with your hands and with the use of such a special device as the Glansha device. This procedure is considered the most effective in eliminating phimosis in men only in the initial stages.

It must be understood that the stretching procedure does not give an instant result, therefore, it may take a long time for a positive effect to appear. It is not allowed to use force and try to stretch the foreskin in one procedure. It is necessary to carry out the procedure gradually, gradually pulling the skin down the head of the penis. In the event that discomfort, pain or microcracks appear, it is necessary to immediately stop treatment. Otherwise, instead of the expected effect, the patient's condition can be further aggravated.

How to treat phimosis in men at home, And what method is considered the most effective? With a slight narrowing, it is allowed to use another method for performing such a procedure, in which 2 fingers are inserted into the preputial sac and parted in different directions. Conduct such phimosis treatment at home should be done with extreme caution, slowly increasing the distance with each subsequent procedure. The duration of such stretching is approximately 20 minutes and it must be performed every day. If time permits, then treat phimosis at home conditions in this way it is allowed several times a day, but after taking a bath and following all hygiene procedures.

Medical therapy

Drug treatment of phimosis at home in adults involves the following activities:

• stretching of the skin of the foreskin;
• the use of hydrocortisone ointments for phimosis.

Such special tools help to quickly cure phimosis and have the following effect:

• reduce the risk of developing inflammatory processes in the genital organs and their irritation;
• increase the elasticity of the epidermis and soften it for subsequent procedures.

Medical practice shows that thanks to the complex treatment of phimosis at home, it is possible to quickly and effectively get rid of the disease. Corticosteroid ointments help speed up the healing of microcracks and minimize pain.

What ointments are suitable for home treatment of phimosis in men? The fight against the disease at home can be carried out using:

• Prednisolone;
• Hydrocortisone;
• Diprosalik;
• Betamethasone;
• Clobetasol.

Good effect on phimosis treatment without surgery gives the use of ointments in combination with the procedure for stretching the foreskin. In this case, the tissues of the head of the penis and the foreskin are treated with a drug. Treatment at home phimosis in men with ointments allows you to achieve the following results:

• the inflammatory processes occurring in the genital organ slow down;
• increases the elasticity of the skin;
• eliminates irritation and itching;
• accelerates the healing of microcracks in the area of ​​damage;
• pain syndrome is relieved.

Stretch the foreskin with ointments for phimosis in men recommended for boys in adolescence, since it is during this period that they are especially effective in eliminating pathological phimosis.

Despite the high effectiveness of complex treatment, in some cases it will have to be abandoned. Drug therapy using a corticosteroid ointment for phimosis is prohibited if a patient has a bacterial, viral or fungal infection that occurs in an acute or chronic form.

It is important to remember that too long use of corticosteroid ointments for phimosis may be accompanied by the development of side effects. A common complication after using an ointment against phimosis is a violation of the structure of the vessels located on the surface of the skin, as well as hyperpigmentation and thinning of the epidermis layer. It is for this reason that it is necessary to use hormonal ointments for the treatment of phimosis as prescribed by a doctor and under his control.

Discover, how to treat phimosis in adults at home, follows from a specialist. Various ointments for phimosis have a cooling effect, cause vasoconstriction and soften the skin. Good effect on treatment of cicatricial phimosis without surgery in adults give the following drugs:

• Contractubex helps to soften the dermis and thus facilitates the process of massage;
• Bepanthen is used in situations where it is necessary to eliminate a slight swelling;
• Desyatin helps to stop the pain syndrome that occurs with phimosis.

Traditional Therapy phimosis without surgery gives positive results in the detection of pathology in children and adolescents, so it is mainly carried out at this age. At the same time, the child's body is characterized by increased sensitivity to drugs and a high risk of side effects. It is for this reason that with phimosis in boys, it is necessary to start treatment after a thorough examination and consultation with a specialist.

Phimosis in men treatment at home

Many patients with phimosis do not rush to seek help from a specialist, but prefer folk remedies. In fact, when phimosis is detected in men, treatment at home with the help of alternative therapy is unlikely to help get rid of such a pathology forever, but it can alleviate the condition of a man. Thanks to them, it is possible to get rid of the pain syndrome, stop the inflammatory process and relieve itching.

In the event that phimosis in men is accompanied by a strong inflammatory process, then treatment of phimosis without surgery in adults at home can be carried out using freshly squeezed agave juice. It is drawn into a syringe and injected into the preputial sac. It is recommended to do this procedure 1 time per knock before going to bed, and after a day you can notice a significant relief in the condition of the man.

With phimosis, treatment without surgery at home can be carried out using herbal infusions. To stop the inflammatory process and heal microtraumas, you can use a compress based on calendula infusion. To prepare it, 10 grams of vegetable raw materials are poured into 200 ml of boiling water and infused for half an hour. After that, the resulting solution is filtered and a compress is made from it.

A good result in the fight against phimosis in men is given by baths with herbal preparations.. For their preparation, 10 grams of plants such as chamomile, string, calendula and thyme are poured into the container. All ingredients are mixed together and 1 tablespoon of this mixture is poured into 200 ml of boiling water. The resulting mixture is left to infuse for 15–20 minutes, after which it is filtered and used to prepare baths. In order to enhance the effect of such a folk remedy, it is recommended to add ½ teaspoon of soda to the solution.

Home treatment relative phimosis folk remedies can be effective only with a slight narrowing of the foreskin.

How cure phimosis at home healing herbs, and which of them are considered the most effective? Get rid of phimosis without surgery succeeds thanks to the following plants:

1. Chamomile. The plant helps to soften and moisturize the skin, and also has a pronounced anti-inflammatory effect. To prepare a decoction, pour 10 grams of plant flowers with a glass of boiling water. The resulting mass should be left for several hours to infuse and boil on fire for no more than 15 minutes. On the basis of such a chamomile decoction, baths can be made in the treatment of phimosis adults at home, having previously filtered it.
2. Calendula. The plant has anti-inflammatory and antimicrobial effects and is widely used in the treatment of the disease. At home, you can prepare a healing infusion of calendula flowers by pouring a teaspoon of the dry mixture with 200 ml of boiling water. This mass should be insisted for about 1 hour, then strain into a jar. A decoction of calendula can be added to baths when treatment of phimosis in adults at home without surgery.
3. Barley decoction. Such a folk remedy helps to eliminate itching and irritation, relieve pain and soften the skin. To prepare a healing agent, you need to pour 50 grams of grain with 2-3 cups of boiling water and leave it all night. In the morning, barley broth should be boiled over low heat for 10-15 minutes and left to infuse for 1 hour. Such a non-native agent is recommended to be used for washing with treatment of phimosis 1 degrees at home.

Surgical treatment of phimosis

When a stage 3 or 4 narrowing of the foreskin is detected in men, treatment is carried out by surgical intervention. With this pathological condition, two types of surgery can be performed:

• complete removal of the foreskin;
• plastic correction of pathology.

The first treatment was called circumcision or circumcision., and lasts no more than 15-20 minutes. Many men prefer this method of treatment, since the patient does not require additional procedures for recovery. The specialist performs a complete removal of the foreskin and immediately after such a surgical intervention, the patient can return home.

The main task of plastic surgery is to preserve the natural appearance of the penis. During such treatment, the foreskin is not cut out, but it is only expanded, which allows the man to save such an important part of the body.

Phimosis is considered a disease that develops due to a genetic predisposition. It is possible to prevent the development of the disease by observing the rules of hygiene, therefore, from early childhood, it is necessary to teach boys to take care of their genitals. Treatment of pathology is carried out under the supervision of a doctor, and it is best to refuse the independent use of folk remedies. You can find out what phimosis is in men, how to stretch the foreskin at home and how to open the head without circumcision, you can contact your doctor.

Possible complications and prevention

Phimosis may be accompanied by the development of some complications:

• infringement of the head develops if a man tries to forcibly remove the head of the penis from the preputial cavity;
• urethritis, pyelonephritis and cystitis develops at an advanced stage of phimosis due to problems with urine outflow;
• increment of the foreskin to the head with a tight adjacency of the damaged areas to each other and healing with a single scar, which is not always possible to excise;
• balanoposthitis is accompanied by an inflammatory process in the foreskin and glans penis.

In order to prevent the development of such a pathology in men, it is recommended to follow some preventive measures. It is necessary to maintain hygiene of the genital organs, that is, wash the child every day and change diapers if necessary. In case of casual sexual intercourse, it is imperative to use a condom and treat the underlying pathologies that can provoke phimosis.

Conclusion

Unfortunately, treatment of phimosis 3 degrees at home unlikely to have a positive effect. When the pathology passes into a neglected form, only surgical intervention becomes the only effective method of dealing with the disease. It is for this reason that when men are asked, can phimosis be cured without surgery 3 and 4 degrees, the answer is unambiguously negative. Discover, how to treat phimosis at home can be obtained from a urologist.

Phimosis (from the Greek. "Contract") is a condition in which it is impossible to completely remove the head from the foreskin due to its narrowing. It occurs in 90% of boys before the onset of puberty and is a manifestation of the physiological maturation of the penis. Phimosis in men is a pathological condition. It develops in 2-3% of adults and leads to a number of serious complications, impoverishes the sensations of sexual intercourse. In the early stages, phimosis can be successfully treated with conservative methods, so it is important to notice the pathology in time and consult a doctor.

With a normal anatomical structure, the skin that covers the penis forms a fold in the head area, it is called the "foreskin". A condition in which the opening of the foreskin narrows and its mobility is limited is called phimosis. What are the causes of phimosis and how can you fight it?

Phimosis is a fairly common phenomenon, which in most cases does not cause much concern to its "owners". Ninety-five percent of newborn boys have a congenital physiological pathology.

First signs

The main problem of patients with phimosis remains pain when trying to expose the head in the erectile state of the penis. In some cases, it is completely impossible to open it, regardless of whether an erection is present or not. In addition, there may be problems with urination, as well as the accumulation of sperm in the pouch and the classic hygienic inconvenience associated with limiting the possibility of cleaning the head. When the condition is neglected, doctors also detect inflammation of the extreme epithelium and urethra. The above symptoms are typical for both adolescents and men.

Species and types

Doctors distinguish 4 degrees of severity of phimosis:

• 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
• 2nd degree. During an erection, the head does not open at all, there are difficulties in its withdrawal in the normal state.
• 3rd degree. The head can be partially exposed only in the non-erect state of the penis.
• 4th degree. The head is not exposed at all, in the process of urination the stream does not flow freely, but inflates the preputial sac, and then flows out in rare drops or a very thin stream from the scarlet slit of the end of the penis. As a rule, in this case, there is chronic inflammation due to the impossibility of removing the secret from the head, and in some cases, smegmolites are formed - solid formations from stagnant smegma. Sometimes an infection of the urethra develops.

The main subspecies of phimosis include:

• Physiological phimosis. One of the most common types of problem, the vast majority occurs in children under three years of age. In fact, this phenomenon is an underdevelopment of the foreskin after the period of infancy: in the first year of life, in all male babies, the epithelium is practically closed and fits snugly against the head of the penis. After some time, it “opens”, therefore, until the age of three or four years, physiological phimosis can be considered a variation of the age norm, of course, if it does not cause severe inflammation, as well as pain during urination. By the age of five or six, this type of phimosis resolves on its own, and the head of the penis can open freely. If this event does not occur, then you need to contact a specialist.
• Hypertrophic. This type of phimosis is identified by the thickening of the epithelium of the foreskin, its protrusion beyond the head in the form of a "trunk". If there is no proper treatment, this phimosis flows into hypogonadism.
• atrophic. In this case, the foreskin is significantly thinned and even completely atrophied.
• Cicatricial. Here, along with the classic phimosis, there is the formation of scars of various sizes on the edges of the foreskin.

In this way, physiological phimosis IS NOT a pathology in children under 5-6 years old and there is no need to treat him.

Causes

There are no absolutely clear and clear causes of phimosis in the stronger sex. The most likely include:

1. Congenital genetic problems, which are the initial factor of systemic insufficiency of the elastic element of the connective tissue in the human body.
2. Inflammatory processes like balanoposthitis, which often lead to cicatricial phimosis.
3. Physical injury to the penis, head or epithelium.
4. Diseases of the circulatory system.
5. Age-related changes (aging and "sclerosis" of the skin).

Complications of phimosis

Phimosis can cause a number of negative consequences, some of which require urgent surgical intervention.

The consequence of the problem is regular inflammation under the foreskin, caused by stagnation of the secret. In addition, the above condition often leads to infection of the urethra due to improper excretion of urine and its backflow into the urinary canal.

The most dangerous consequence of phimosis is paraphimosis - a sharp infringement of the head of the penis, flesh. Paraphimosis usually occurs due to attempts to expose the head during intercourse or onanism. The foreskin at the same time blocks the blood flow of the end of the penis, which in turn leads to swelling of the organ, its blueness and other negative condition. If it is impossible to return the epithelium to its original state on its own, then an emergency surgical intervention will be required in the form of a longitudinal section of the epithelium or excision of its “leaves”.

Treatment of phimosis without surgery

In the vast majority of cases, it is rational to eliminate phimosis in an operative way, however, there are also non-operative methods, although they do not act immediately and in some cases do not have the proper effect.

Stretching of the foreskin

The main and fairly good method of non-operative disposal of phimosis. It consists in a periodic phased stretching of the foreskin. The easiest way is masturbation with the strongest retraction of the epithelium and the corresponding exposure of the head of the penis.

Gradual stretching must be done before the onset of a moderate pain syndrome and repeated in several approaches two to three times a day (10-15 minutes). In the process of expanding the passage, it is possible to increase the amplitude of translational movements, up to the complete exposure of the head. For greater efficiency, you can take a hot bath before the procedure and, when the skin becomes more elastic, perform an act of masturbation with maximum amplitude.

An alternative way to stretch is to insert two little fingers into the preputial sac and periodically spread them apart to stretch. This procedure is less traumatic than classical masturbation, but is less effective.

Medical treatment

The basis of drug therapy for phimosis is the application of corticosteroids in the form of ointments to the head of the penis - this type of drug gives elasticity to the epithelium, and also relieves inflammation and swelling.

The most effective ointment preparations for this task are considered to be clobetasol and betamethasone. They must be applied daily and once on the head of the penis, for two months. In this case, the method can be combined with the above-described stretching of the epithelium.

Treatment of phimosis with surgery

Surgery is still considered the most effective method of getting rid of phimosis. Surgical intervention usually consists in the formation of three zigzag-longitudinal incisions of the foreskin with their subsequent stitching.

In the treatment of phimosis in children, a more gentle method is used, based on the neutralization of adhesions at the head, using a special metal probe. However, if the foreskin is scarred, then a safer and more effective method would be to completely circumcise the epithelium in a circle. In rare cases, to preserve aesthetics, they use more expensive plastic surgery with preservation of the foreskin, however, in some cases, after this event, a recurrence of the problem may occur.

The effectiveness of surgical intervention for the treatment of phimosis approaches one hundred percent.

Postoperative period

Despite the high efficiency of surgical intervention, some doctors note the regular appearance of various complications in operated patients. Most often, these are small bleeding caused by not too accurate suturing, as well as meatitis and meatostenosis - the former are inflammation of the outer part of the urethra, while the latter are due to the narrowing of the canal of this component of the genitourinary system.

In order to avoid such problems in the first ten days, you must regularly take baths with potassium permanganate, use antibacterial creams approved by your doctor. In some cases, repeated surgery may be necessary, most often to eliminate defects in the appearance of the foreskin (plastic) or to restore the meatus - the correct contours of the urethra.

Useful video

Elena Malysheva in the program "Life is great!" about men's issues

Dr. Komarovsky on what will happen if phimosis in a child is not treated

Causes

The origin of the pathological process is still a controversial issue. Common causes of phimosis include the following:

• inflammatory process of the foreskin and glans penis, resulting in the formation of exudate;
• non-compliance with the rules of intimate hygiene;
• uneven development of the external genital organs;
• scleroderma of the penis;
• trauma to the penis with subsequent scarring;
• genetic deficiency of connective tissue, which is essentially an elastic component of our body. As a result, when the foreskin is stretched, microtears occur.

As practice shows, phimosis often develops along with other pathologies, namely:

• scoliosis;
• varicocele;
• flat feet;
• heart defects.

Obesity, diabetes mellitus, vitamin deficiency are predisposing factors for the development of the disease. The disease is congenital and acquired. If we talk about the congenital form, then with it the physiological phimosis is not eliminated on its own, and the glans penis never opens. Although the reasons for this have not been fully understood, doctors suggest that the provoking factor in the physiological form is the gluing of the foreskin to the glans penis.

Symptoms

The disease causes the following clinical manifestations, namely:

• discomfort and pain during intimacy;
• violation during urination, urine can be excreted in a small stream or even drop by drop, and all this is accompanied by severe pain;
• premature ejaculation;
• the sharpness of sexual sensations decreases, in particular, the difficulty in achieving orgasm and the decrease in the sensitivity of the penis;
• psychological discomfort;
• weakened potency.

Classification

The disease is divided into two types:

• hypertrophic. The foreskin, in this case overdeveloped, hangs down from the head of the penis, which resembles a proboscis;
• atrophic. The thinned foreskin tightly fits the head. There is also a pinhole that has hardened edges.

Depending on the severity of the pathological process, experts distinguish four main stages:

1. In a calm state, the head of the penis opens freely, and during an erection - with difficulty, which is accompanied by pain;
2. At rest, exposing the head will require additional efforts, and during an erection this is not possible at all;

• The head does not open either in an excited or calm state;

1. All of the above symptoms are accompanied by a violation of urination. Stagnation of urine provokes the active reproduction of pathogens and, as a result, an inflammatory process develops.

What is dangerous phimosis

The disease can lead to the appearance of such complications that require specialized medical care:

• paraphimosis, the development of which can be triggered by masturbation. The essence of this complication lies in the fact that the foreskin, which extends beyond the head, is infringed. This leads to the appearance of such unpleasant symptoms: swelling and cyanosis of the penis, severe pain, and in the absence of qualified assistance, the head may become purple or even black;
• balanoposthitis, in which there is redness, pain, itching of the head of the penis, as well as the appearance of purulent discharge;
• stagnation of urine provokes the development of urethritis, cystitis, pyelonephritis;
• the foreskin and the head of the penis grow together.

Interestingly, in some nations, phimosis is not considered a problem at all, but is even a manifestation of beauty. Be that as it may, untreated phimosis can have serious consequences for men's health. Why is it possible to say so?

Everything becomes clear if you delve a little into physiology. The mucous membrane of the foreskin produces smegma - a substance that includes fats, bactericides, microorganisms, pheromones, etc. This is essentially a protective lubricant that protects against drying out. What happens with phimosis?

Smegma becomes a favorable environment for the active reproduction of pathogens. Stagnant processes eventually provoke the appearance of inflammatory and infectious diseases. In addition, there is scientific evidence that suggests that smegma stagnation leads to the appearance and accumulation of oncogenic substances. This can cause the development of oncology in the man himself and his partner.

Phimosis in boys

The narrowing of the foreskin, which prevents the exposure of the head, in newborns is called physiological phimosis and does not pose a health hazard. Boys under the age of five may experience the following symptoms:

• urination disorder, in which, in order to completely empty the bladder, the child needs to push hard. The newborn cannot explain to his parents what is bothering him, but you can pay attention to whims, anxiety and rare urination;
• it is impossible to bare the head with hands.

Treatment is carried out depending on the severity of the disease. A qualified specialist can give a correct assessment of the current situation.

Phimosis in men

Only about three percent of adults of the stronger sex are faced with such a problem as phimosis. If in newborns this disease is called physiological, then in adult men it is pathological. Men note a strong impact of the disease on the quality of sexual life.

The asymptomatic course of the disease leads to a long-term absence of rational treatment, which threatens the occurrence of complications and concomitant diseases.

Many men put off going to the doctor simply because they don't know who to turn to. Urologist or andrologist are those doctors who are engaged in the initial consultation, as well as the appointment of tests and effective treatment tactics.

Physiological phimosis

The cause of physiological phimosis in a newborn is that the foreskin and the head of the penis are interconnected. It is impossible to forcefully expose the head, as this can lead to the development of a serious inflammatory process. According to experts, it is for this reason that complications appear in boys.

If the child is not worried about the problem, it should not be corrected. Parents are required to wash their genitals daily with warm water and soap. In the future, the foreskin will separate and this does not require surgery.

Many are concerned about the question of up to what age phimosis is considered physiological. In fact, experts have not come to a consensus on this issue. Some say that up to three years, while others call a completely different age - seventeen years. As statistics show, in ninety percent of cases, the pathology resolves itself before the age of five.

Even if phimosis has not gone away in adolescence, experts do not recommend starting medical therapy, since by the age of twelve the level of male hormones rises, which positively affects the stretching and softening of the foreskin.

With regards to complications of the physiological form, they occur extremely rarely, but if this happens, then this is usually due to the following factors:

• predisposition to allergies;
• overheating;
• not following proper hygiene practices.

In the event that the symptoms are mild, you can fix the problems yourself as follows:

• in a ten-millimeter syringe, it is necessary to draw a warm solution of furacilin or ectericide;
• the skin should be pulled up, while there is no need to expose the head;
• a syringe without a needle should be inserted into the gap formed. Here you can not do without outside help, one person will pull off the skin, and the second will inject the medicinal solution;
• fluid should be injected under pressure to flush out accumulated secretions.

cicatricial phimosis

Cicatricial phimosis can also be congenital or acquired. Provocateurs of the acquired form are inflammatory processes of the external genitalia and urinary tract. Removal of the head is not possible due to the fact that inflammation provokes severe swelling. If this can be achieved, then phimosis turns into paraphimosis, which requires the prompt assistance of specialists.

A hole in the foreskin of a small diameter is a clear sign of the presence of a cicatricial form of the disease. With inflammation as a result of edema, this hole narrows.

A common complication of cicatricial phimosis are infectious processes with chronic foci, this is due to the fact that it is impossible to fully carry out hygiene procedures. This can negatively affect the sexual sphere.

phimosis treatment

Treatment of phimosis is conservative and operative. Initially, conservative methods are applied, which include the following:

• manual stretching of the foreskin, it is carried out daily and gradually;
• the use of specially equipped devices designed for stretching;
• drug treatment, including the use of ointments with softening and stretching properties.

The use of conservative techniques is a rather controversial issue among doctors, and this is due to the fact that some argue that their use only postpones the need for surgery. As practice shows, it was not conservative methods that led to the occurrence of complications, such as paraphimosis, but self-treatment of patients and the assumption of gross errors. In addition, it is worth considering the fact that cicatricial phimosis is not treated conservatively, since the scar tissue does not stretch.

Tension methods

First, let's look at the general rules of these techniques:

• you should first consult a doctor and then be under supervision;
• stretching should be gradual. If the procedure causes pain, then this is already wrong;
• manipulations are carried out not occasionally, but regularly.

Let's talk about three tension methods:

• exposure of the head during masturbation. Manipulation is carried out daily for twenty minutes. There are data from ongoing studies, during which it turned out that the technique allows you to eliminate phimosis in one month with the first and second severity of the pathological process;
• stretching of the foreskin. The procedure is carried out during the morning shower or after urination, and its essence lies in the tension of the foreskin on the head of the penis;
• finger stretch. The fingers are inserted into the preputial cavity and then separated.

Medical treatment

For the treatment of pathological phimosis, ointments containing corticosteroid substances are used, and have the following effect on the body:

• softening of the foreskin;
• increase in elasticity;
• reduction of the inflammatory process.

Still, not everyone can use ointments. So, the presence of an infection of viral, bacterial or fungal origin is an absolute contraindication. Prolonged and uncontrolled use can lead to unpleasant complications, namely: thinning of the skin, damage to blood vessels, hyperpigmentation.

Alternative treatment

You should not reassure yourself with the thought that traditional medicine will eliminate the narrowing of the foreskin, this is a big delusion. Non-traditional techniques can only be an auxiliary measure that will help reduce clinical symptoms.

Usually used decoctions of medicinal herbs that have anti-inflammatory, softening and bactericidal action: chamomile, calendula, string. Usually, before stretching, in order to achieve a high efficiency of the procedure and its safety, baths are made. The foreskin is steamed within fifteen minutes. As for contraindications, these are individual intolerance and allergic reactions.

Surgery for phimosis

In the early stages of the pathological process, exercises and drugs are used, but with advanced forms, surgical intervention becomes the only hope for a return to a full life.

If you find several of the following signs, you should resort to surgical intervention:

• pain when urinating that is not eliminated by drugs;
• smegma accumulates under the skin, which provokes inflammatory processes;
• swelling and hyperemia of the penis;
• scarring and formation of adhesions.

Surgery is not required in cases where pain can be controlled with conservative methods. Also, the process occurring in a mild form is eliminated in a conservative way.

Currently, there are various methods of surgical correction, the choice of which depends on age, type of disease, severity of the disease.

Bloodless method

The technique is usually used in the treatment of children. Its advantage is minimal intervention and preservation of the functional activity of the foreskin.

The specialist introduces a probe, thanks to which the adhesive formations are separated. Usually, two or three such procedures are enough to completely eliminate phimosis. To prevent relapse, you must follow medical recommendations:

• daily manual opening of the foreskin;
• rinse the cavity with a weak solution of potassium permanganate.

circular excision

Circumcision (circumcision) is the most common solution to the problem. The advantages of circular excision are two important points:

• rapid elimination of symptoms;
• no recurrences.

One, but a significant drawback is the complete excision of the foreskin, and, accordingly, the loss of its functions. Absolute indications for circumcision are:

• cicatricial phimosis;
• paraphimosis;
• stage 4 phimosis;
• chronic balanoposthitis.

Plastic surgery

Plastic surgery is an alternative method that allows you to simultaneously eliminate phimosis and at the same time partially preserve the foreskin. During this manipulation, the size is much smaller compared to circular excision, so the foreskin is not removed.

Plastic surgery has a number of disadvantages:

• long rehabilitation period;
• a meager list of indications;
• the likelihood of a relapse.

laser removal

Safety, a short recovery period, a pronounced pain syndrome - all this is characteristic of the laser method. In this case, instead of a scalpel, the doctor uses a laser beam, with which you can perform both complete excision of the foreskin and plastic surgery.

One of the advantages is the high accuracy of cuts and, as a result, minimal tissue damage. In addition, the laser beam has bactericidal properties and at the same time cauterizes blood vessels, preventing blood loss.

Care in the postoperative period

The first urination after surgery will be the most painful. To reduce pain, prepare a basin of warm water in which the tip of the penis is placed. In warm water, the muscles relax, due to which the pain will be less pronounced.

After each urination, you should wash the head and change the bandage. Bandages with antibacterial ointments are usually used, which contributes to the speedy healing.

So, phimosis is a disease that occurs in the stronger sex and is associated with the narrowness of the foreskin and the limitation of its mobility. The disease can be physiological and pathological.

An important role in the development of the disease is played by the attitude to hygiene procedures. Phimosis can be dangerous due to the development of serious complications, such as paraphimosis. In some cases, the disease is not treated, but goes away on its own, while in others, qualified help from a specialist is required.

A consultation with a doctor will help determine the next steps. There are conservative and operational methods for solving the problem, the expediency of using one or another method in your particular case can be judged by a specialist. Self-medication can seriously damage your health!

The main problem of patients with phimosis remains pain when trying to expose the head in the erectile state of the penis. In some cases, it is completely impossible to open it, regardless of whether an erection is present or not. In addition, there may be problems with urination, as well as the accumulation of sperm in the pouch and the classic hygienic inconvenience associated with limiting the possibility of cleaning the head. When the condition is neglected, doctors also detect inflammation of the extreme epithelium and urethra. The above symptoms are typical for both men and women.

Species and types

Doctors distinguish 4 degrees of severity of phimosis:

• 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
• 2nd degree. During an erection, the head does not open at all, there are difficulties in its withdrawal in the normal state.
• 3rd degree. The head can be partially exposed only in the non-erect state of the penis.
• 4th degree. The head is not exposed at all, in the process of urination the stream does not flow freely, but inflates the preputial sac, and then flows out in rare drops or a very thin stream from the scarlet slit of the end of the penis. As a rule, in this case, there is chronic inflammation due to the impossibility of removing the secret from the head, and in some cases, smegmolites are formed - solid formations from stagnant smegma. Sometimes an infection of the urethra develops.

The main subspecies of phimosis include:

• Physiological phimosis. One of the most common types of problem, the vast majority occurs in children under three years of age. In fact, this phenomenon is an underdevelopment of the foreskin after the period of infancy: in the first year of life, in all male babies, the epithelium is practically closed and fits snugly against the head of the penis. After some time, it “opens”, therefore, until the age of three or four years, physiological phimosis can be considered a variation of the age norm, of course, if it does not cause severe inflammation, as well as pain during urination. By the age of five or six, this type of phimosis resolves on its own, and the head of the penis can open freely. If this event does not occur, then you need to contact a specialist.
• Hypertrophic. This type of phimosis is identified by the thickening of the epithelium of the foreskin, its protrusion beyond the head in the form of a "trunk". If there is no proper treatment, this phimosis flows into hypogonadism.
• atrophic. In this case, the foreskin is significantly thinned and even completely atrophied.
• Cicatricial. Here, along with the classic phimosis, there is the formation of scars of various sizes on the edges of the foreskin.

In this way, physiological phimosis IS NOT a pathology in children under 5-6 years old and there is no need to treat him.

Causes

There are no absolutely clear and clear causes of phimosis in the stronger sex. The most likely include:

1. Congenital genetic problems, which are the initial factor of systemic insufficiency of the elastic element of the connective tissue in the human body.
2. Inflammatory processes like balanoposthitis, which often lead to cicatricial phimosis.
3. Physical injury to the penis, head or epithelium.
4. Diseases of the circulatory system.
5. Age-related changes (aging and "sclerosis" of the skin).

Complications of phimosis

Phimosis can cause a number of negative consequences, some of which require urgent surgical intervention.

The consequence of the problem is regular inflammation under the foreskin, caused by stagnation of the secret. In addition, the above condition often leads to infection of the urethra due to improper excretion of urine and its backflow into the urinary canal.

The most dangerous consequence of phimosis is paraphimosis - a sharp infringement of the head of the penis, flesh. Paraphimosis usually occurs due to attempts to expose the head during intercourse or onanism. The foreskin at the same time blocks the blood flow of the end of the penis, which in turn leads to swelling of the organ, its blueness and other negative condition. If it is impossible to return the epithelium to its original state on its own, then an emergency surgical intervention will be required in the form of a longitudinal section of the epithelium or excision of its “leaves”.

Treatment of phimosis without surgery

In the vast majority of cases, it is rational to eliminate phimosis in an operative way, however, there are also non-operative methods, although they do not act immediately and in some cases do not have the proper effect.

Stretching of the foreskin

The main and fairly good method of non-operative disposal of phimosis. It consists in a periodic phased stretching of the foreskin. The easiest way is masturbation with the strongest retraction of the epithelium and the corresponding exposure of the head of the penis.

Gradual stretching must be done before the onset of a moderate pain syndrome and repeated in several approaches two to three times a day (10-15 minutes). In the process of expanding the passage, it is possible to increase the amplitude of translational movements, up to the complete exposure of the head. For greater efficiency, you can take a hot bath before the procedure and, when the skin becomes more elastic, perform an act of masturbation with maximum amplitude.

An alternative way to stretch is to insert two little fingers into the preputial sac and periodically spread them apart to stretch. This procedure is less traumatic than classical masturbation, but is less effective.

Medical treatment

The basis of drug therapy for phimosis is the application of corticosteroids in the form of ointments to the head of the penis - this type of drug gives elasticity to the epithelium, and also relieves inflammation and swelling.

The most effective ointment preparations for this task are considered to be clobetasol and betamethasone. They must be applied daily and once on the head of the penis, for two months. In this case, the method can be combined with the above-described stretching of the epithelium.

Treatment of phimosis with surgery

Surgery is still considered the most effective method of getting rid of phimosis. Surgical intervention usually consists in the formation of three zigzag-longitudinal incisions of the foreskin with their subsequent stitching.

When a more gentle method is used, based on the neutralization of adhesions at the head, using a special metal probe. However, if the foreskin is scarred, then a safer and more effective method would be to completely circumcise the epithelium in a circle. In rare cases, to preserve aesthetics, they use more expensive plastic surgery with preservation of the foreskin, however, in some cases, after this event, a recurrence of the problem may occur.

The effectiveness of surgical intervention for the treatment of phimosis approaches one hundred percent.

Postoperative period

Despite the high efficiency of surgical intervention, some doctors note the regular appearance of various complications in operated patients. Most often, these are small bleeding caused by not too accurate suturing, as well as meatitis and meatostenosis - the former are inflammation of the outer part of the urethra, while the latter are due to the narrowing of the canal of this component of the genitourinary system.

In order to avoid such problems in the first ten days, you must regularly take baths with potassium permanganate, use antibacterial creams approved by your doctor. In some cases, repeated surgery may be necessary, most often to eliminate defects in the appearance of the foreskin (plastic) or to restore the meatus - the correct contours of the urethra.

Useful video

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Dr. Komarovsky on what will happen if phimosis in a child is not treated

phimosis- a condition characterized by the narrowness of the foreskin, which leads to a limitation of its mobility. Thus, the first, and often the only, sign of phimosis is the inability to expose the glans penis at rest and / or during an erection.

The foreskin or prepuce in men is called the skin fold covering the glans penis. The preputium is a specialized tissue, the structure of which in many ways resembles the structure of the eyelids of the eyes and labia in women.

The foreskin consists of two sheets that are attached at coronal sulcus located at the base of the glans penis. The outer leaf is lined with a thin skin epithelium, and the surface of the inner leaf is a mucous membrane.

Additional fixation of the prepuce provides bridle, located on the underside of the head and limiting the shift of the foreskin towards the base of the penis. The structure of the frenulum of the foreskin is in many ways similar to the structure of the frenulum of the tongue.

As a rule, during an erection, the foreskin moves towards the base of the penis and exposes the glans penis. In the normal state, the prepuce completely covers the head, so that the inner surface of the foreskin forms a preputial cavity (preputial sac) - a narrow gap between the head and the foreskin.
Thus, the foreskin performs a protective function, protecting the mucous membrane of the glans penis from drying out and adverse external influences. It is for this reason that in the treatment of phimosis, doctors try to preserve this anatomical formation and resort to circumcision (removal of the foreskin) only in extreme cases.
How common is phimosis?
It should be noted right away that phimosis is a very common phenomenon and in many cases does not cause much concern to patients.

This is due to the fact that the head and foreskin during fetal development are formed from the same tissue. The development of the external genital organs continues until the end of puberty, so congenital physiological phimosis is observed in more than 95% of newborn male infants.

By the beginning of the second year of life, the glans penis opens only in 20% of babies, and by the beginning of the third - in 50%. As a rule, spontaneous elimination of physiological phimosis occurs at preschool age (3-6 years).

However, cases are far from unique when the glans penis opens for the first time during puberty, due to an increase in the level of sex hormones that help soften and stretch the skin of the foreskin.

In many peoples of the world, a gene of predisposition to the preservation of physiological childhood phimosis in adulthood is common. So, for example, in some countries of Southeast Asia, phimosis in adult men is considered the norm, except in cases where the narrowing of the foreskin leads to painful symptoms.

And in the culture of Ancient Greece, the long and narrow foreskin was not only not considered a pathology, but was also perceived as a sign of beauty and masculinity. The naked head of the penis was considered obscene because it reminded of circumcision. Ancient frescoes depict the custom of artificially gradually lengthening the foreskin.
For this, the ancient Greek youths used a special leather ribbon - kinodesma, one end of which was attached to the foreskin, and the other was tied around the waist. Wearing kinodesma was seen as a manifestation of special modesty and decency.

phimosis classification

Phimosis can be divided into two main classes:

• associated with the developmental features of the glans penis and foreskin physiological phimosis in children;
• pathological phimosis.

This classification is of great importance, since it determines medical tactics: in case of physiological phimosis in children, hygiene measures and medical supervision are recommended, and in case of pathological phimosis, conservative treatment or surgical elimination of the defect is recommended.

According to the mechanism of development, hypertrophic and atrophic phimosis are distinguished.

Hypertrophic phimosis characterized by a significant elongation of the foreskin (due to its very characteristic appearance, it is also called proboscis phimosis).

Statistically, hypertrophic phimosis is more common in obese boys, which is associated with both metabolic disorders and the accumulation of fatty tissue in the pubic area.

About atrophic form of phimosis they say in cases where the foreskin, on the contrary, is reduced in volume and tightly fits the head of the penis. At the same time, the preputial opening is narrowed and does not pass the head.

Causes of phimosis

Most common congenital phimosis, when physiological phimosis does not eliminate itself and the opening of the glans penis does not occur - neither in childhood, nor during puberty.

The reasons for this anomaly have not yet been studied. The fact that phimosis is more common in some peoples than in others speaks in favor of the existence of a genetic predisposition to congenital phimosis.

Clinical studies have shown that congenital phimosis is often combined with other anomalies in the structure of the connective tissue and the musculoskeletal system, such as flat feet, scoliosis, and heart defects.

In children, a common cause of the development of pathological phimosis are injuries, including those received during gross violent attempts by parents to “fix” physiological phimosis in young boys.

In such cases, adhesions are formed between the mucous membranes of the glans penis and the foreskin, leading to a narrowing of the preputial cavity and the development of secondary pathological phimosis.

And finally, a fairly common cause of phimosis in children and adults is infectious and inflammatory processes in the preputial sac, leading to the formation of a characteristic cicatricial phimosis.

Degrees of pathological phimosis

Anatomically, there are four degrees of narrowing of the preputial ring.

With phimosis first degree possible free removal of the glans penis in a calm state, during an erection, the exposure of the glans is difficult or painful.

O second degree phimosis is said when difficulties with exposing the head occur even at rest. During an erection, the head is either completely hidden under the foreskin, or only a small part of it is exposed, often swelling in the form of a ball.

At third degree phimosis, it is no longer possible to bring the glans penis beyond the preputial ring.

fourth degree phimosis is characterized by such a sharp narrowing of the foreskin, which causes difficulty in urination.

It should be noted that it is customary to talk about the first or third degrees of pathological phimosis when the patients are adults or adolescents. As for the fourth degree, normally in children's physiological phimosis, the preputial cavity has an opening sufficient for the free discharge of urine.

Therefore, such signs as the filling of the preputial sac during urination and / or narrowing of the urine stream, even if they occur in early infancy, clearly indicate a pathology and require emergency medical intervention.

Symptoms of pathological phimosis in adults

In cases where phimosis does not yet cause problems with urination, the most common complaints of patients are expressed to a greater or lesser extent inconvenience during sexual relations, such as:

• soreness during intercourse (with phimosis of the first or second degree);


• premature ejaculation;


• decrease in the intensity of sexual sensations during intercourse;


• decrease in potency.

In addition, many men suffering from phimosis complain of purely psychological problems associated with the "wrong" appearance of the penis. Often they develop various kinds of complexes, so that it is necessary to conduct combined treatment with a urologist and a psychotherapist.

At the same time, it is not uncommon for men with severe phimosis to experience absolutely no problems sexually.

What is the danger of asymptomatic phimosis in adults

Today, one can meet opposing points of view regarding medical tactics in those cases of phimosis that are not accompanied by the appearance of any unpleasant symptoms. Indeed, is it worth correcting the "defect", which among many peoples was considered a sign of beauty?

Unfortunately, phimosis poses a significant threat to the health of an adult male. The fact is that the cells of the mucous membrane of the inner leaf of the prepuce secrete a special secret that has a rather complex composition (fats, bactericidal substances, pheromones (exciting substances), etc.). This secret is the main part of smegma (translated from Greek as “sebum”), which also includes dead epithelial cells and microorganisms.

The activity of cells of the glandular epithelium of the foreskin increases by the period of puberty (the maximum smeg formation occurs at the age of 17-25 years) and progressively decreases in older men.
Normally, smegma protects the mucous membranes of the glans penis and the inner surface of the foreskin from drying out, and also acts as a natural lubricant during intercourse.

However, the secret of the glands of the mucous membrane of the inner leaf of the foreskin is an excellent living environment for many pathogens. Therefore, smegma stagnation in the preputial sac can cause the development of infectious and inflammatory diseases, such as balanitis (inflammation of the mucous membrane of the glans penis) and balanoposthitis (combined inflammation of the mucous membranes of the glans penis and the inner layer of the foreskin).

In addition, according to many studies, with prolonged stagnation of smegma, carcinogenic substances form and accumulate in it, which contributes to the development of oncological diseases in men (papillomas of the glans penis, penile cancer) and their sexual partners (cervical cancer).

In childhood, the cleansing of the prepuce sac occurs independently, since the amount of smegma secreted is small. Adult men, in order to prevent the development of complications, must follow the rules of hygiene, that is, make a toilet every day, which consists in washing the foreskin and glans penis with warm water and soap.

With phimosis, this procedure is usually difficult. Thus, the narrowing of the foreskin in adults contributes to the accumulation of smegma in the preputial sac.

Even in cases where phimosis is not manifested by any unpleasant symptoms, doctors advise taking care of eliminating the pathology, since, in addition to the risk of developing infectious, inflammatory and oncological diseases, one should also take into account the possibility of developing such a serious complication as paraphimosis.

Paraphimosis as a severe complication of phimosis in adults

By paraphimosis is meant such a complication of phimosis, when the withdrawn glans penis is restrained in the shifted foreskin.

Caught in a tight ring of the narrowed foreskin, the head swells, while the pressure of the ring increases. Thus, a vicious circle is created: the violation of blood circulation caused by strong compression increases the swelling of the head, and the swelling increases the pressure on the head of the foreskin ring.

In adult men and adolescents, paraphimosis most often occurs during intercourse or masturbation. It should be noted that such a complication is typical only for phimosis of the first or second degree, since more severe forms of phimosis simply do not allow the possibility of exposing the glans penis.

Clinically, paraphimosis is manifested by acute pain, the head of the penis swells and acquires a bluish tint. Over time, the intensity of the pain syndrome decreases due to severe circulatory disorders. In advanced cases, the strangulated head becomes purple or black.

Severe and prolonged circulatory disorders can lead to deep necrosis (necrosis) of the tissues of the foreskin and the glans penis. Therefore, paraphimosis is an extremely dangerous complication that requires immediate help.

First aid for paraphimosis in men is to immediately seek specialized medical care. In the early stages of the development of paraphimosis, doctors can manually reduce the glans penis (this manipulation is very painful, therefore, it is performed after the administration of narcotic analgesics). In more severe cases, they resort to dissection of the ring of the foreskin.

Physiological phimosis in children

First of all, it should be noted an essential feature of physiological phimosis in infants: the lack of mobility of the foreskin is by no means associated with the narrowness of its opening.

At such a tender age, in most boys, the inner layer of the foreskin is soldered to the glans penis. It is for this reason that in no case should you try to forcefully expose the head - this will lead to erosion of the inner surface of the preputial cavity, the development of an inflammatory process and the occurrence of secondary pathological phimosis.

The well-known pediatrician Komarovsky rightly claims that in 99 cases out of 100, the complications of physiological phimosis in babies are associated with rude and illiterate intervention carried out by the parents themselves on the advice of relatives, neighbors and even, sadly, doctors.

If the boy is not bothered by anything (no problems with urination, pain, itching, etc.), no additional measures to correct phimosis should be taken. It is only necessary to make a regular toilet every day, washing the perineum and genitals with water. Soap is best used no more than once every three to four days, avoiding getting into the preputial sac.

Separation of the mucous membranes of the glans penis and the inner layer of the foreskin occurs due to the gradual desquamation of epithelial cells. This is a rather slow process that should not be artificially stimulated.

Desquamated epithelial cells form the basis of the so-called children's smegma, which, accumulating, slowly moves towards the exit and is excreted in the form of grains along with urine. Unlike adult smegma, children's smegma does not pose a danger in terms of developing infections and oncological diseases.

Physiological phimosis in itself performs an important protective function, it protects the delicate yet unformed epithelium of the glans penis and the inner layer of the foreskin from external aggressive agents.

Until what age can phimosis in a boy be considered a physiological phenomenon

To date, doctors have not agreed on the age at which phimosis in a boy should be considered a pathology, and when it is necessary to take special measures to eliminate it. Therefore, in the articles of specialists, you can see various figures - 2-3 years, 5-7 years, 7-10 years and even 14-17 years.

If we focus on clinical data, then the probability of self-elimination of physiological phimosis in a five-year-old boy is 90%, at the age of 10 years - 83%, and by the age of thirteen it decreases to 33%.

Many pediatricians advise parents to take a wait-and-see approach until puberty: if there are no alarming symptoms, it is best to wait, since phimosis can be treated at an older age.

It should be noted that the persistence of phimosis by the age of 11-13 may be associated with a low blood level of male sex hormones, which have a beneficial effect on the process of softening and stretching the foreskin.

In addition, it is necessary to distinguish congenital physiological phimosis from secondary phimosis resulting from any infectious and inflammatory diseases.

Of course, only a specialist can make such a diagnosis. But in cases where the child has already observed the opening of the glans penis, and then there was a narrowing of the foreskin, we are most likely talking about pathological phimosis.

Can physiological phimosis cause problems in boys and what to do in such cases

Physiological phimosis in children rarely causes complications. Problems most often arise when basic hygiene rules are violated, as well as overheating and an increased tendency to allergic reactions.

In cases where the severity of unpleasant symptoms is insignificant (itching, slight redness, anxiety of the child), you can try to fix the problem yourself. Many pediatricians recommend washing the preputial cavity with a warm solution of furacilin using a conventional ten-millimeter syringe.

The procedure is as follows:

• Draw a warm solution of furacilin or an ectericide into the syringe;


• Pull the skin up without exposing the head;


• Insert a syringe without a needle into the resulting gap (it is more convenient to carry out this manipulation together, so that one person pulls the foreskin, and the other performs actions with the syringe);


• Release the solution from the syringe under pressure, washing out the accumulated secretions.

If necessary, repeat washing several times and complete the procedure by instilling oily solutions into the gap (2-3 drops of vaseline, olive oil or an oil solution of vitamin A).

With an increased tendency of the child to allergic reactions (exudative diathesis, atopic dermatitis, etc.), unpleasant symptoms may be associated with exposure to allergen substances excreted in the urine or with their contact effect on the skin.

• if possible, eliminate the alleged agent (revise the menu, medications taken, antibiotics, vitamins, used diapers, household chemicals, etc.);
• avoid exposure to chemicals on the skin;
• increase the amount of fluid you drink to speed up the “washing out” of allergens from the body.

However, it is impossible to abuse the treatment at home in any case. If, despite all efforts, unpleasant symptoms persist, you should seek specialized medical help (the attending pediatrician or pediatric urologist).

Even in cases where the boy's phimosis was unconditionally recognized as physiological, you should immediately consult a doctor if the following alarming symptoms appear:

• there are problems with urination (difficulty urinating, soreness, etc.);


• there are pronounced signs of inflammation (swelling and redness in the foreskin area, pain syndrome).

Complications of phimosis in children requiring specialized medical care

Complications of phimosis in children requiring specialized medical care include the following pathological conditions:

• balanoposthitis;
• paraphimosis;
• urinary retention.

Balanitis, fasting and balanoposthitis in children

Balanite called inflammation of the glans penis, fasting- inflammation of the foreskin.

Balanoposthitis- combined infectious and inflammatory lesions of the glans penis and foreskin.

These diseases in boys are several times more common than in adult men. The latter circumstance is connected precisely with the physiological features of the structure of the children's male genital organ.

In addition to physiological phimosis, important predisposing factors for the development of inflammatory processes in the glans penis in children are:

• diabetes mellitus (high sugar in the urine contributes to the development of infection in the preputial cavity);
• obesity (violation of metabolic processes, deterioration of conditions for personal hygiene measures);
• avitaminosis (decrease in the overall resistance of the body).

As a rule, acute balanitis, fasting or balanoposthitis begins unexpectedly against the background of full health. At the same time, in most cases, it is possible to determine the impact that served as an impetus for the development of the disease. It could be:

• trauma resulting from a rough attempt to expose the head of the penis;
• acute allergic reaction (excretion of food or drug allergens in the urine or direct contact with the allergen (diapers, cosmetics, soap, washing powder, etc.));
• overheating;
• severe hypothermia, which can cause a sharp decrease in immunity;
• external injury, including uncomfortable clothing (too tight panties with a seam in the middle, snake injury, etc.).

In children, the most common is a combined inflammatory lesion of the glans penis and foreskin.

Symptoms of the disease are quite typical:

• redness and swelling in the foreskin (fasting);
• through the hole you can see the hyperemic area of ​​the head (balanitis);
• pain aggravated by urination (irritating effect of urine on the inflamed tissue of the head and foreskin);
• itching and discomfort;
• serous or serous-purulent discharge.

The severity of these symptoms, as well as an increase in lymph nodes, fever, the appearance of symptoms of intoxication (weakness, lethargy, headache, loss of appetite) serve as an indicator of the severity of the disease.

If you suspect an infectious inflammation of the glans penis and / or foreskin, you should immediately consult a doctor who will prescribe the necessary treatment.

In case of recurrence of the disease, as well as in the case of the formation of secondary phimosis, the question of surgical treatment may arise.

Paraphimosis in children

In young boys, this pathology most often occurs as a result of a violent attempt to expose the head of the penis, undertaken by inept parents during the "correction" of physiological phimosis.

The clinic and complications of phimosis in boys are the same as in adult men. A very strong pain syndrome, redness and rapidly progressive swelling of the glans penis is characteristic. Untimely or inadequate medical care can lead to irreparable consequences in the form of necrosis of the foreskin and penis.

First aid for paraphimosis in children. There are a lot of tips on the net for resetting the head on your own (applying cold to reduce swelling, using oil, etc.). Of course, much depends on the severity of paraphimosis (the severity of edema and pain) and the state of the child's mentality.

But it is wiser not to follow such advice. The reduction of the glans penis with paraphimosis is a very painful procedure that is performed under anesthesia in medical institutions (in pediatric practice, intravenous anesthesia is used, which implies a short-term, but complete loss of consciousness).

So it is best not to waste precious time and not to mock the child, but to seek medical help as soon as possible. Transportation of patients in such cases is carried out in the supine position with legs apart.

Difficulty urinating

Difficulties in urination occur with a very narrow opening of the foreskin. In such cases, a very characteristic symptom is observed: swelling of the preputial sac with urine during urination. The stream of urine becomes thin and intermittent, and sometimes the urine comes out in drops.

In addition, in such cases, children often complain of pain and discomfort during urination. They begin to avoid going to the toilet, which leads to the development of secondary enuresis (day and night).
Difficulties urinating in infants are manifested by restlessness, crying and severe straining when urinating.

This pathology leads to increased pressure in the urinary tract, which is fraught with serious complications. Therefore, difficulty in urination is an indication for emergency elimination of phimosis.

Medical tactics in the treatment of pathological phimosis

Today, along with surgical methods for the treatment of pathological phimosis, conservative methods are widely used, such as:

• gradual daily manual stretching of the foreskin;


• the use of special devices that stretch the foreskin;


• drug treatment of phimosis (the use of steroid ointments that help soften and stretch the tissue of the foreskin).

The attitude of specialist doctors to the above methods of treating phimosis is far from unambiguous. Some professionals consider conservative treatment as a dubious way to "postpone until tomorrow" the inevitable operation.

Such a dismissive attitude was greatly facilitated by the fact that many patients self-medicate without consulting with professionals and often make gross mistakes that lead to serious complications (paraphimosis, infectious and inflammatory diseases of the foreskin).

In addition, it is often not taken into account that cicatricial forms of phimosis are an absolute contraindication to the use of conservative methods. The fact is that scar tissue does not stretch, so all attempts to eliminate phimosis are doomed to failure in advance.

Meanwhile, there is evidence of the effectiveness of conservative methods in many patients, even with the second or third degree of congenital phimosis.

An important positive aspect of all non-surgical treatments for phimosis is the “naturalness” of their impact, since they actually repeat the mechanism of physiological self-elimination of age-related phimosis.

In addition, conservative treatments for phimosis allow you to fully preserve the unconditionally important functions of the foreskin and avoid unpleasant side effects and complications.

Thus, in the absence of contraindications, conservative methods may well be used as a useful alternative. Of course, treatment should be carried out after consultation with a specialist and under the supervision of a physician.

However, in cases where it is necessary to achieve a quick and radical elimination of phimosis for medical reasons (for example, with phimosis of the fourth degree) or for personal reasons, it is better to give preference to surgical intervention.

Non-drug conservative treatment of phimosis. Tension methods.

Stretching methods came into use in the last years of the last century, when original statistical studies were carried out, showing that the risk of developing congenital phimosis depends on the method of masturbation.

As a result, a hypothesis was put forward about the possibility of eliminating congenital phimosis by the method of gradual stretching of the foreskin and special methods for the conservative elimination of pathology were developed.

The general rules for these methods are:

• mandatory preliminary consultation with a professional and subsequent medical supervision;
• gradual stretching (in no case should pain be allowed);
• manipulation regularity.

Method head exposure with masturbation was one of the first developed conservative methods for the treatment of congenital phimosis. This method consists in daily exercises to expose the head of the penis, which should be carried out for at least 10-15 minutes a day.

There is evidence that it is possible to achieve elimination of phimosis of the first or second degree with the help of exercises to expose the head in three to four weeks.

Method stretching of the foreskin consists in the daily tension of the foreskin on the head of the penis during the morning shower, as well as after urination until pain occurs.

This method is often used to delay the self-elimination of phimosis in childhood. In such cases, it is quite effective, but the duration of the course of treatment largely depends on the type of phimosis and can reach 3-4 months with hypertrophic (proboscis) phimosis.

Method digital stretching consists in the careful introduction of the fingers into the preputial cavity and their gradual dilution.

According to some reports, the effectiveness of the methods described above in congenital phimosis reaches 75%.

Treatment of phimosis with ointments (drug treatment of phimosis)

Drug treatment of phimosis is a combination of the above methods of tension with the use of ointments containing corticosteroid drugs.

• softening and increasing the elasticity of the foreskin;


• a decrease in the severity of inflammatory reactions (drugs in this group are called steroidal anti-inflammatory drugs).

It has been proven that the combination of the use of corticosteroid ointments with tension methods allows you to achieve a faster effect, promotes the speedy healing of microcracks and protects against unpleasant pain.

Drug therapy is especially indicated for children and adolescents (recommended by the American Association of Pediatricians), since it is at this age that the most likely to achieve the elimination of congenital phimosis by conservative methods.

However, it should be borne in mind that such ointments are far from being shown to everyone. So, for example, a contraindication to the local use of corticosteroid drugs is the presence of a bacterial, viral or fungal infection - both acute and chronic.

Long-term use of drugs can cause unpleasant side effects (thinning of the skin, hyperpigmentation, disruption of the structure of superficial vessels), and with uncontrolled use, systemic effects of corticosteroids may occur, which is fraught with dangerous complications.

Therefore, it is possible to use ointments with corticosteroids only after a thorough examination and consultation with a specialist who has sufficient experience in the treatment of congenital phimosis by this method.

Of course, an individual selection of the drug and the dose of the medicinal substance is necessary, as well as constant medical monitoring of the results of therapy.

Alternative methods of treating phimosis

It should be noted right away that traditional medicine, like homeopathy, is absolutely powerless in the fight against the narrowing of the foreskin.

However, some of the favorite means of traditional healers are widely used as an aid. We are talking about decoctions of herbs that have anti-inflammatory, bactericidal and softening effects, such as:

• chamomile;
• calendula;
• succession.

Decoctions are prepared according to a standard recipe, which can be read on the packaging of medical raw materials purchased at a pharmacy, and are used for baths carried out before stretching the foreskin.

Steaming the skin of the foreskin in a bath with a decoction of herbs for 15-20 minutes promotes effective, painless and safe stretching.

This kind of preliminary procedures is especially recommended for children and adolescents.
During the treatment of phimosis, you can alternate the decoctions of various medicinal herbs or use a collection of medicinal plants for the decoction.

The only contraindication to the use of traditional medicine as an adjuvant in the treatment of phimosis may be individual intolerance or allergies (very rare).

Surgical treatment of phimosis

Elimination of phimosis by a bloodless method

This surgical manipulation is most often used in children, its indisputable advantage is minimal intervention and preservation of the functions of the foreskin.

First, a special probe is inserted into the preputial cavity, which separates the synechia (adhesions) formed between the glans penis and the inner layer of the foreskin. To do this, the probe is carefully advanced inward to the coronary sulcus and slow movements are made in a clockwise direction.

Then the opening of the foreskin is expanded with the help of a Pean clamp: the ends of the clamp are inserted into the hole and the branches are parted.

Often two or three such manipulations are enough to completely eliminate phimosis. In cases where there is no positive dynamics, a more invasive surgical intervention is indicated.
After sessions of bloodless elimination of phimosis, it is necessary to follow all the recommendations of the surgeon in order to prevent fusion of the mucous membranes of the foreskin and the glans penis.

Within a month, anti-relapse measures are shown: daily manual opening of the foreskin and washing the preputial cavity with a weak solution of potassium permanganate. If this manipulation is too painful or unpleasant for the child, it can be performed once every two to three days, but not less often.

Surgical interventions for phimosis

To date, a sufficiently large number of methods for the surgical correction of pathological phimosis have been developed. The choice of the method of the operation depends on the age of the patient, the type of phimosis (atrophic or hypertrophic, congenital or cicatricial), the severity of the pathology, as well as the qualifications of the operating surgeon and the capabilities of the clinic where they applied for help.

Surgical interventions for phimosis are most often performed under local anesthesia, an indication for the use of general anesthesia may be:

• too young age of the patient;
• increased emotional lability;
• individual intolerance to drugs used for local anesthesia;
• patient's personal preference.

All surgical procedures performed for phimosis are one-day operations and do not require a long stay of the patient in the hospital. Complications are extremely rare.

After the operation, discomfort in the area of ​​​​the surgical wound is possible for several days, however, as a rule, it is possible to do without additional pain medication.

In cases where there is a need to remove sutures, this manipulation is performed 7-10 days after surgery. Before removing the stitches, it is necessary to make dressings every other day and make sure that urine does not get on the postoperative wound.

As a rule, within two weeks after the operation, the patient can have sex. Until this time, it is advisable to wear tight underwear that provides additional support for the penis.

Circular excision of the foreskin

Circular excision of the foreskin, which in medicine is often called circumcision, and "in the world" - circumcision, is the most common operation to eliminate pathological phimosis.

Important positive aspects of this surgical intervention are the rapid elimination of all unpleasant symptoms and the absence of relapses (this is the only surgical intervention for phimosis that provides 100% efficiency).

The only but significant drawback of the method is the complete elimination of the foreskin, and, consequently, the irretrievable loss of all its functions. However, it should be taken into account that millions of men in the world annually circumcise for religious reasons and do not suffer at all.

Circumcision is a non-alternative method for cicatricial phimosis, as well as for the fourth degree of phimosis, paraphimosis and recurrent balanoposthitis (the operation is performed after the elimination of the acute process).

Operations for plastic surgery of the foreskin in pathological phimosis

An alternative to circumcision is plastic surgery aimed at eliminating phimosis in combination with partial preservation of the foreskin.

So with preputioplasty, in contrast to the circular excision of the foreskin, the foreskin is not completely removed, since a much smaller incision is made.

Another common method of foreskin plasty is called the Schloffer method. During the operation, the surgeon does not make a straight, but a zigzag incision, and then stitches the edges in such a way as to significantly expand the opening, while preserving the foreskin.

In addition, Roser's methods of foreskin plasty, spiral foreskin plasty, etc. are widely used.

The general disadvantages of such operations include a longer recovery period, the possibility of relapses and a relatively short list of indications. So, for example, operations with partial preservation of the foreskin cannot be performed in patients with severe cicatricial forms of phimosis.

phimosis laser treatment

Treatment of phimosis with a laser is such an operative intervention, when instead of a surgeon's scalpel, the energy of a laser beam is used.

With the help of a laser, it is possible to perform both circular excision of the foreskin (laser circumcision) and plastic surgery that preserves the foreskin.

Laser surgery is characterized by high precision incisions, so that damage to surrounding tissues is minimal.

In addition, laser beams cut the tissue, simultaneously cauterizing the vessels, and have a bactericidal effect.
Thus, laser surgery has the following advantages:

• safety (there is no risk of bleeding and infection of the surgical wound);
• less pronounced pain syndrome;
• short recovery period.

Surgery for laser correction of pathological phimosis is usually performed under local anesthesia.

Compared to conventional surgery, the postoperative period with laser correction of phimosis is more comfortable (there is practically no tissue swelling, there is no need for dressings, removal of sutures, etc.) and lasts only three to four days. However, doctors do not advise starting sexual activity earlier than two weeks after the operation.

Normally, the head of the penis is covered with a skin sheet (foreskin), which is well extensible and easily slides along the surface of the head of the penis, exposing and covering it.

In violation of the extensibility of the skin, an attempt to open the head of the penis is accompanied by unpleasant sensations and pain.

In advanced cases, the head of the penis may not open at all due to tight fusion of the epithelium of the foreskin with the epithelial lining of the head.

The totality of the described symptoms, along with the fact of a narrow hole in the skin sheet covering the penis, allows us to speak of the diagnosis of phimosis.

So, phimosis in men is the impossibility of exposing the glans penis due to the narrowness of the foreskin and its outlet. In this case, an attempt to open the head is accompanied by discomfort and pain.

Approximately 96% of boys at birth have difficulty retracting the skin from the surface of the head of the penis, which is associated with natural adhesion of the epithelial linings of the foreskin and the head, congenital narrowing of the skin sheet covering the head of the penis, a short frenulum, which reduces the mobility of the skin over the head of the penis.

In this case, we speak of physiological phimosis.

With this variant of phimosis, over time, there is an increase in the mobility of the foreskin (repeated erections, keratinization of the inner epithelium contribute to an increase in skin mobility, separate the adjacent epithelial sheets).

In about 2% of cases, violation of the exposure of the head persists for life.

Rice. 1 - The foreskin is normal and with phimosis. Source - http://www.aboutkidshealth.ca/

How common is phimosis?

2. Causes

Phimosis in men and boys is divided into primary (congenital) and acquired (secondary). With congenital phimosis, there is no clear relationship with any triggering factors.

As a rule, in this case, the physiological course of phimosis is noted and conservative management of the patient is possible. Rarely, congenital shortening of the frenulum occurs, which can cause congenital phimosis.

Secondary (pathological) phimosis develops against the background of a concomitant lesion of the head and skin flap of the foreskin.

The causes of secondary phimosis can be:

1. 1 Infectious and inflammatory lesions of the head and foreskin as a result of non-compliance with the norms of hygienic treatment of the genital organs, repeated balanitis / balanoposthitis, uncontrolled diabetes mellitus. With these pathologies, there is a narrowing of the foreskin and a change in its ability to stretch, which leads to a clinic of pathological phimosis.
2. 2 Forcible opening of the foreskin in physiological phimosis (attempts by caring parents to open the head of the penis in a boy) can lead to tears, bleeding and subsequent formation of adhesions between the head and its skin.
3. 3 Another cause of pathological phimosis is xerotic balanitis obliterans. The exact etiology of this disease has not been established.
4. 4 Repeated bladder catheterizations .

3. Phimosis as a variant of the norm

As we noted earlier, phimosis can be physiological and pathological.

Physiological phimosis is present from birth and is not accompanied by any symptoms, with the exception of impaired exposure of the head of the penis. Most often, there is a resolution of physiological phimosis before the end of the boy's puberty.

Pathological phimosis, as a rule, is a secondary disease that develops against the background of concomitant pathology.

For example, with improper hygienic care of the genitals under the foreskin, smegma can accumulate in the space between its leaf and head.

Smegma is dead cells desquamated from the surface of the epithelial lining of the head and foreskin. It can serve as a breeding ground for microorganisms, contributing to the development of inflammation.

Chronic inflammation leads to scarring of the skin flap, the formation of adhesions between the foreskin and the epithelium of the head of the penis. The result of this pathological process is the development of secondary phimosis.

4. Symptoms and signs of pathology

1. 1 The narrow ring of the foreskin, its cicatricial deformity, adhesions completely block the exposure of the head of the penis.
2. 2 The appearance of pain in the head of the penis in an erect state.
3. 3 Bleeding from the injured skin of the foreskin, head of the penis.
4. 4 Recurrent infections of the organs of the urinary system.
5. 5 Infection, inflammation of the head of the penis (balanitis).
6. 6 Pain in the foreskin.
7. 7 Weakening of the stream due to blockage of urine outflow through the urethra. Intermittent urination, need to strain, discomfort when urinating.

The table below shows the degrees (stages) of phimosis in adults and children.

Table 1 - Degrees (stages) of phimosis. Source - https://phimosisjourney.wordpress.com/

The classification of phimosis according to the origin, course and mechanism of violation of the exposure of the head is given below.

Table 2 - Classification of phimosis in adults and children

5. What complaints do the child's parents make?

As a rule, the only complaint of the boy's parents is the inability to fully expose the head of the penis when taking a bath, with hygienic care for the genitals.

In response to attempts to retract the skin flap, the child begins to act up, scream.

Less often there is a complaint of swelling of the foreskin at the beginning of urination, which can also be a variant of the norm in children.

6. Examination of the patient

1. 1 In physiological phimosis, the only sign is the inability to fully retract the foreskin. The skin flap over the head of the penis looks normal, without pathological changes.
2. 2 With pathological phimosis, cicatricial narrowing of the foreskin ring can be determined.

Rice. 2 - Physiological phimosis (left) and pathological (right). Source - Medscape.com

7. What is the diagnosis based on?

Diagnosis does not require laboratory and instrumental studies. The diagnosis of phimosis is made on the basis of an examination, a characteristic clinical picture.

The attending physician will always distinguish pathological phimosis from physiological, determine the stage of the disease and, if possible, establish the cause of phimosis.

8. What to do if there are problems with skin retraction from the head of the penis?

What to do if the head of a child or a man does not open? If you suspect that the child has problems with the foreskin, it is recommended to seek advice from a pediatric urologist / surgeon. An adult man needs to seek help from a urologist in a planned manner (to the clinic).

9. To treat or not to treat?

Treatment tactics depend on what type of phimosis the patient has. Therefore, both for the patient, parents (if the symptoms of phimosis develop in a child), and for the attending physician, it is important to learn to draw a clear line between the physiological and pathological variant of the disease.

With pathological phimosis, the patient is shown surgical treatment, with physiological phimosis, a conservative resolution of the disease is possible.

A clear concept of the norm and pathology, the mechanisms of the development of the disease allows you to reduce the frequency of visits to the doctor and independently carry out the prevention of phimosis at home.

10. Features of treatment in children

If parents turn to a pediatrician with a complaint about the inability to remove the skin from the head of the boy's penis for hygienic treatment, then in this case the doctor first differentiates pathological phimosis from physiological.

Further tactics of treating a child depend on the age of the child, the mechanism of development of phimosis, the severity of symptoms, the cause and concomitant pathological conditions.

In the absence of signs of pathological phimosis, parents should be reassured that their child's skin retraction difficulties are normal in this age group.

It is necessary to teach parents the rules for hygienic treatment of the child's external genital organs (washing the penis with soapy water, followed by rinsing with warm water, carefully retracting the foreskin when taking a bath, showering, urinating, teaching the child to independently retract the foreskin, avoiding effort, pain, discomfort during the time of its release).

Explain that hygiene, together with the growing up of the child (erections, keratinization of the inner layer of the foreskin), is likely to lead to the restoration of the mobility of the skin flap. In children, phimosis can be treated without surgery.

10.1. Local therapy and ointments

Topical steroid therapy may be the first choice in the conservative treatment of pathologic phimosis.

The effectiveness of ointments, creams based on corticosteroids varies from 65 to 95%. The exact mechanism of action of topical steroid-based ointments has not been established.

It is assumed that the therapeutic effect is achieved due to the anti-inflammatory and immunosuppressive effects of drugs. The use of topical steroids is accompanied by mild side effects, including pain in the foreskin, its hyperemia.

After a couple of months from the abolition of the course of steroids, it is possible to restore problems with the foreskin. In such cases, it is possible to prescribe a second course.

In order to stop side effects from local steroids, the patient is prescribed topical ointments based on non-steroidal anti-inflammatory drugs (Diclofenac).

10.2. Stretching of the foreskin

The procedure is performed by a urologist on an outpatient basis. Foreskin stretching is inexpensive, effective, and safe. Often, special balloon dilators are used to perform the procedure.

10.3. Surgery

• Plastic surgery of the skin flap over the head of the penis is performed in case of fear of possible complications and risks. Depending on the method (skin incision along the posterior surface of the head, followed by transverse suturing of the skin sheet, plasty of the lateral surface of the sheet, dissection of the frenulum).

Plastic surgery is less painful, is accompanied by a lower likelihood of complications, and a faster recovery of the patient. The only negative point of these operations is the possibility of recurrence of phimosis.

11. Treatment tactics in adults

Treatment of phimosis without surgery in adults is not carried out, since the risk of complications (paraphimosis) is high. Adult males usually undergo circumcision. That is why it is better to start treatment of pathological phimosis earlier, in adolescence.

12. When is emergency care needed?

Patients diagnosed with phimosis rarely require emergency medical care. However, in the case of paraphimosis, emergency assistance from a urologist is needed. This condition most often occurs when trying on their own, with an effort to open the glans penis.

Paraphimosis - infringement of the base of the head of the penis by a narrowed foreskin. A narrow ring of skin, when retracted behind the base of the head, can cause a violation of the venous outflow from the head and lead to its edema.

Rice. 3 - Paraphimosis (compression of the base of the head with a swollen flap of the foreskin). Source - Medscape.com

Edema of the head and skin flap leads to difficulty in returning the foreskin to its normal position. The result of acute infringement may be necrosis of the glans penis.

With paraphimosis, it is necessary to remove the infringement of the head. As a rule, to eliminate paraphimosis, the doctor first uses minimally invasive techniques, and if they are ineffective, he resorts to surgical treatment.

All invasive manipulations must be performed under sterile conditions.

Methods for eliminating paraphimosis:

Figure 4 - Aspiration of blood from the head of the penis. Source - Medscape.com

13. Prevention

Prevention of phimosis consists in proper hygienic care of the area of ​​​​the head of the penis and the skin above it.

1. 1 Do not try to often remove the foreskin with normal exposure of the head of the penis.
2. 2 If the foreskin is not completely retracted, then do not try to retract it at once.
3. 3 If the head is not completely exposed, it is important to teach the child to gently retract the foreskin while taking a bath / shower, urinating.
4. 4 During the abduction of the skin flap, the child should stop before the appearance of pain, discomfort.
5. 5 It is important not to allow effort when retracting the skin of the foreskin. Excessive exposure can lead to microcracks, skin ruptures, followed by scar formation.
6. 6 During bathing, the foreskin is treated with soapy water, washed with water and dried with a towel. After treatment, it is necessary to return the skin flap to the opposite position, the foreskin should again cover the head of the penis.
7. 7 It is important to avoid the use of concentrated soap solutions, as their use can irritate the skin and mucous membranes, exacerbating the symptoms of the disease.

Figure 5 - Vertical incision of the foreskin. Source - Medscape.com

Key points

Key points
1) It is necessary to clearly distinguish physiological from pathological phimosis, normal from pathology
2) Physiological phimosis is present to some extent in 96% of boys and is a variant of the norm
3) Physiological phimosis can independently resolve by puberty and only in 2% passes into a pathological form.
4) In the treatment of physiological phimosis, the most important is the correct hygienic treatment of the foreskin and the head of the penis, the prevention of injuries, infection of the foreskin.
5) In the treatment of pathological phimosis, surgical methods are most effective, but topical application of ointments based on corticosteroids is possible.
6) Among the surgical methods for the treatment of phimosis, methods of various plastic surgery of the foreskin and the generally accepted operation of circumcision (circumcision) stand out.