Let’s define what foreskin is before talking about phimosis.
The foreskin, or prepuce, is the extra protective penile skin extending about half an inch beyond the tip of the head of the penis, or glans, protecting that part of the penis. Phimosis is the penile skin that cannot be pulled back to expose the head of the penis. This is almost always normal in children as the skin can be retracted in only 4% of newborns. Those areas of attachment of the foreskin on the penis are called preputial adhesions. The skin will eventually slowly detach itself with time and growth.
Is Phimosis a Problem?
Well, it depends, but probably not. Phimosis is not a problem if the skin is healthy. Healthy skin with phimosis is supple, stretchy, and not scarred at the tip. This is the case in about 99% of uncircumcised children
Phimosis is only a problem if the tip of the skin is damaged, scarred, or there is difficulty urinating because the skin is too tight. Ballooning of the skin is not uncommon but is not necessarily a problem on its own. Ballooning is fine if the urine comes out freely and empties on its own immediately after voiding. However, it is a concern if the urine remains trapped under the foreskin, causes discomfort with urinating, or requires squeezing to get it out.
Does Anything Have to Be Done to Address Phimosis?
There is no special care or treatments needed if the child has no issue urinating and if the skin is healthy. In most cases, phimosis will go away on its own with time and growth. When it will go away is hard to predict as it can happen within a few months of life or a few years. A study shows that 60% resolved by seventh grade (1).
How Do You Care for the Uncircumcised Penis With Phimosis?
The short answer is there is nothing special to do as long as the skin is healthy, and the child has no urinary symptoms related to phimosis. In most cases, the body will address phimosis in its own time. Special massages, creams, and baths are not necessary. Wash the area like the rest of the body when bathing and do not worry about cleaning inside the skin that is not retractable. Do not forcefully retract the skin or even try to pull it down if the skin is tight. This can be very painful, causing bleeding and skin cracking that will lead to scarring. Regular diaper changes with diaper cream as needed should be done, like any other child.
What Is Smegma?
Besides being a silly word, smegma is normal and not a problem. Smegma is the accumulation of shedding dead skin cells under the foreskin. It looks like white, pearly material and it does not represent an infection or abnormality. Believe it or not, this stuff serves a purpose by helping separate preputial adhesions and therefore helping the penile skin retract. Some kids can produce more than others. Wiping it off or washing it off when bathing can be helpful.
But I Just Want to Retract the Foreskin!
Some older kids and parents are bothered by not being able to retract the skin, even if everything is normal. That is understandable, which is why there are three options. First, after learning about phimosis, you can just give it more time if your doctor reassures you that everything is fine. For option number two, you can use a steroid cream and perform stretching exercises to help move things along. Phimosis will resolve in 90% of kids after four weeks of cream and exercise. Sometimes two rounds of steroid cream may be necessary. Option number three is circumcision. Newborn circumcisions can be done in the hospital soon after birth or sometimes in the office. Otherwise, they can be done on children older than 6 months under general anesthesia in the hospital’s operating room and are well tolerated.
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