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Phimosis and balano-prepucial adhesions. What to do?

Phimosis is the inability to retract the foreskin, which is the skin of the penis that covers the glans. On the inside the foreskin is attached to the outer layer of the glans which is called balano-foreskin adhesions. These layers sometimes accumulate fatty material known as smegma cyst and can sometimes become infected causing balanitis.

Phimosis is characteristic in many children. The foreskin in a newborn is contracted around the glans; in the first months of life it is attached to it and should not try to reproach. At the end of the first year, retraction of the foreskin behind the glandular furrow is possible in 50% of children, reaching 90% at 3 years of age. Phimosis affects 8% of children aged 6-7 years, only 1% in young people aged 16-18 and 0.5% in adults.

The diagnosis is very simple and can be seen with the naked eye: the foreskin is not retracted or partially removed. If you try to bring the foreskin back to discover the glans, it is very difficult or impossible. In other cases, it can be worn behind the glans, but a ring is formed that constricts the penis and can be painful on erection. It can also make it difficult to reposition the foreskin on the glans due to the disproportion between the ring and the glans (paraphimosis).

Conservative treatment of phimosis

The treatment of phimosis depends on the time of evolution of the condition, the age of the patient, previous infections or the degree of phimosis.

In general, no action should be taken in children under 3-4 years of age, as balano-foreskin adhesions will generally be released physiologically.

It is currently advised that during the bath, parents remove the foreskin for cleaning the glans if possible. Doing so should not be done medically or surgically on the penis. Only in the case of a phimosis that does not present a favorable evolution can treatment with topical corticosteroids (betamethasone cream 0.05-0-1%) be attempted.

Phimosis surgery: circumcision

The indications for performing the circumcision can be multiple; from the medical causes we have previously discussed in which foreskin retraction cannot be performed (phimosis at any age, recurrent glans infections or balanoposthitis, phimosis that generate phimotic rings during erection and / or hinder sexual intercourse) . Also, circumcision may be due to religious, social, cultural reasons.

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