Phimosis

Disease Description (Causes and Symptoms)

• Definition: Phimosis is a condition in which the foreskin cannot be retracted to expose the glans. In newborns, the foreskin and glans are physiologically attached, and this thickened state is normal, but they should separate as the child grows. Pathological phimosis is a condition in which the foreskin becomes narrowed by a fibrous tight ring (scar tissue), preventing exposure of the glans.
• Causes and pathophysiology: Causes include congenital physiological adhesions that do not improve naturally, scarring caused by repeated infections, chronic inflammation (e.g., balanoposthitis), and skin diseases (e.g., balanitis xerotica obliterans/BXO). It may worsen when the risk of infection increases due to conditions such as diabetes. Forcibly retracting the foreskin may instead cause scarring.
• Main symptoms: Redness, swelling, and pain of the glans and foreskin; purulent discharge (symptoms of balanoposthitis); and urinary problems such as a weak urine stream. Paraphimosis is an emergency in which the retracted foreskin constricts the penis and causes impaired blood flow.

Treatment Methods

• Conservative management
  • Hygiene management: Wash with warm water and soap 2–3 times a day, and keep the inner surface of the foreskin dry. Avoid forced retraction.
  • Topical treatment: If there is an infection, use a topical antibiotic ointment and, if necessary, administer oral antibiotics. In cases of mild pathological phimosis without recurrent inflammation, applying a potent topical corticosteroid (e.g., 0.05% betamethasone cream) for a certain period (generally 4–8 weeks) often produces improvement (follow the doctor’s instructions).
  • Incision and drainage: If there is significant pus, an incision and drainage of the foreskin or separation of adhered areas may be performed.
• Procedures/surgery
  • Circumcision (excision of the penile foreskin): Recommended in cases of pathological phimosis, recurrent balanoposthitis, urinary problems caused by true phimosis, or paraphimosis (an emergency). Partial or complete excision may be performed, and the choice of general or local anesthesia depends on the patient’s condition.
  • Foreskin-preserving surgery, such as preputioplasty, may also be considered in some cases.
• Precautions (including self-care)
  • If you have diabetes, manage your blood glucose carefully to reduce the risk of infection.
  • Do not forcibly retract the foreskin (risk of scarring and paraphimosis).
  • Follow postoperative wound-care instructions (maintaining cleanliness, taking prescribed medications, and observing the recommended timing for resuming sexual intercourse).
• Management of complication risks
  • Paraphimosis (emergency), difficulty passing urine, recurrent infections, worsening due to scarring, and, rarely, effects on sexual function and sensation (rare after surgery).

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • A list of currently used medications (especially anticoagulants, antiplatelet agents, steroids, etc.)
  • Allergy history (medications, anesthetics, etc.)
  • History of previous surgeries and records of examinations or treatments related to the male reproductive organs, if any
  • The time symptoms began, changes in symptoms (a recent photograph of the current condition, if possible), and a record of urination patterns (urine stream, pain during urination, etc.)
  • Whether diabetes, immunosuppressive diseases, or systemic diseases are present, and records of fever, redness, or discharge
• Preparing in advance the information the doctor may ask about can help make the consultation smoother:
  • The presence or absence of pain, redness, and discharge, and factors that worsen them
  • Whether previous treatments (ointments, antibiotics, etc.) were used and their effects
  • Sexual history and history of exposure to sexually transmitted diseases

Examples of General Questions to Ask the Doctor

• Is this treatment (topical corticosteroids/antibiotics) suitable for my condition? What are the expected effects and how long will it take?
• Is surgery necessary in my situation, and how likely is improvement with conservative treatment instead of surgery?
• If surgery is performed, what are the options (partial excision vs. complete excision), the type of anesthesia, the pain and recovery period, and the risk of complications?
• I have diabetes. What additional care should I receive to reduce the risk of infection and recurrence?

Examples of Condition-Specific Questions

• How likely is it that topical corticosteroids will improve the condition, and what precautions (side effects) should I be aware of when using them?
• What criteria do you use to recommend circumcision in children (or adults), and is there a recommended age or timing?

Additional guidance: If urgent medical attention is needed (sudden severe pain; the foreskin has been retracted and cannot be returned to its normal position; dark discoloration, coolness, severe swelling, fever, or systemic symptoms), visit an emergency room or a Department of Urology immediately.