What is phimosis?
They call phimosis the process in which the skin of the foreskin is hardened and cannot normally retract over the glans.
It is a normal situation in the baby, as only 5% of these can retract the skin of the foreskin well, and at 3 years 90% can retract it normally. Thus, below this age we will only call non-physiological phimosis, that is, abnormal phimosis, in the event that there is an obstruction at the exit of urine.
It is necessary that the foreskin can leave the glans exposed; later in life it will be necessary for sexual activity.
In children, the main thing is to have a good urinary flow and be able to clean the area, since between the foreskin and glans (in the balano-prepucial groove) accumulates what we call 'smegma', a whitish substance product of the process of scaling of the glans and foreskin, susceptible to superinfection.
Can it get complicated?
When the superinfection we mentioned earlier occurs, the so-called ‘balanitis’, the penis is red and swollen and you can see the output of a white material down the tip of the penis. Another complication is paraphimosis, which can occur when the foreskin is retracted in a very forced way, but it cannot go back 'strangling' the glans, which becomes considerably swollen.
My son has a slightly narrow foreskin. Does it need to be operated on?
In principle, it will be your pediatrician who controls it, and will most likely advise you to do some exercises, which very often solve the problem; we advise you to do them carefully and patiently, as doing them abruptly usually leads to small wounds on the foreskin, usually with bleeding, and which end up becoming scars (scarring phimosis) that permanently close the foreskin, making -the surgery tributary.
The skin goes down to a certain point without any problems, but then it is stuck. Is it phimosis?
It is not a phimosis, they are simply preputial balano adhesions. Your pediatrician can pick them up at the same office, or if he or she deems it necessary, at the hospital consultation.
I have heard / seen in the newspaper / on the Internet that there is an ointment that cures phimosis. Is the treatment effective?
We know these ointments and know that they are being used; we have not been able to find clear evidence of its effectiveness in the medical literature, but we are conducting a study to verify its effects. In the future we think we can tell you what is really in this treatment.
So who is the child to intervene?
In principle, those who have been complicated, either by paraphimosis or balanitis, those with urinary obstruction (the foreskin swells when urinating) and, in general, those children over 3 years in which it is not achieved a good result with the exercises.
My son has to undergo phimosis. Will I have to enter? Is it painful? Is the postoperative difficult?
It will only take a few hours in the hospital: he will come in the morning and be able to leave in the afternoon. During admission he will have no pain; it will be operated on under general anesthesia or with sedation and local anesthesia, and drugs will be administered immediately after surgery. At home, we may recommend some painkillers, and you may have discomfort at first urination. In general, however, in 1 or 2 days the child no longer has any discomfort.