Phimosis is normal in children and typically resolves by age 5. Treatment is not required in the absence of complications such as balanitis Balanitis, Posthitis, and Balanoposthitis Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both. Inflammation of the head of the penis has both infectious... read more , urinary tract infections Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra... read more (UTIs), urinary outlet obstruction, unresponsive dermatologic disease, or suspicion of carcinoma.
Betamethasone cream 0.05% two to three times a day applied to the tip of the foreskin and the area touching the glans for 3 months is often effective. Stretching the foreskin gently with 2 fingers or over an erect penis for 2 to 3 weeks with care not to cause paraphimosis is also successful. If conservative measures are ineffective, circumcision is the preferred surgical option.
In adults, phimosis may result from balanoposthitis Balanitis, Posthitis, and Balanoposthitis Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both. Inflammation of the head of the penis has both infectious... read more or prolonged irritation. Risk of UTI, penile cancer, HIV, and sexually transmitted infections is increased. The usual treatment is circumcision.
Paraphimosis can occur when the foreskin is left retracted (behind the glans penis). Retraction may occur during catheterization or physical examination. If the retracted foreskin is somewhat tight, it functions as a tourniquet, causing the glans to swell, both blocking the foreskin from returning to its normal position and worsening the constriction.
Pearls & Pitfalls
Paraphimosis should be regarded as an emergency, because constriction leads quickly to vascular compromise and necrosis of the glans penis. Firm circumferential compression of the glans with the hand may relieve edema sufficiently to allow the foreskin to be restored to its normal position. If this technique is ineffective, a dorsal slit done using a local anesthetic relieves the condition temporarily. Circumcision is then done when edema has resolved.