Phimosis in children: what it is, how to treat it and where to go in London

At Diga33, our consultants often get calls from worried parents about how to treat phimosis in their children. Given the very common nature of the problem, we decided to write a post on the subject. Here there is everything you should know on this topic and, above all, how to cure it naturally and to prevent it. Let’s start with defining this disorder: the phimosis is the narrowing of the foreskin, which is the skin that covers the end of the penis. Phimosis leads to the inability to uncover the glans (the tip of the penis), lowering the skin. Phimosis may be evident when the penis is erect (erect phimosis) or, in severe cases, when the penis is flaccid.

My child has phimosis: is it normal?

In the first days of life of a baby, the opening point of the foreskin is very narrow: the internal part of the foreskin and the external part of the glans are almost glued together (there are called “adhesions”) and this is absolutely normal. This condition does not allow to pull back the foreskin and to uncover of the glans. The penis of babies at birth and in the first years of life is therefore “closed”.

Gradually, as the child grows up, these adhesions dissolve; this process, combined with spontaneous erections, determines the natural detachment and an enlargement of the foreskin. At the end of the first year of life, it is possible to pull back the foreskin in only about half of children, at three years of age in about 90% of them.

In newborns and infants with diapers, the foreskin plays an important defensive function against the irritating action of stool and urine.

Therefore, phimosis can occur in childhood, but this kind of phimosis is normal. You are a parent of a boy, don’t be scared, in most cases, the phimosis disappears naturally after 3 years.

physiological phimosis is quite normal up to 3 years. Only after 3 years, if the child continues to have the foreskin closed, it is good to have it assessed by an Andrologist in London.

For babies, from the first year onward, it is recommended to gently lower the foreskin, of course without forcing it or causing any harm to the little one. 

On the other side, pathological phimosis can becongenital or acquired. If congenital, a parent may notice the problem in babies after the age of 3 when it should disappear. Acquired phimosis, on the other hand, can also occur in children who initially had a foreskin that opened up correctly. This condition arises as a result of trauma or because of an inflammatory disease called lichen sclerosus (BXO), which causes the foreskin to shrink. 

The majority of traumas are caused by incorrect manoeuvres of retraction of the foreskin!

How do I know if my child has phimosis?

In children, the signs of phimosis can be found in the glans: it can be red, swollen or painful. The child may have difficulties urinating or have blood in the urine. Unfortunately, phimosis can be completely asymptomatic and therefore it may take some time to notice it. In some cases, the phimosis would only allow for a partial lowering of the foreskin. In other cases (called Balanoposthitis), the skin does not retract due to the stagnation of pee and can become inflamed and cause pain. Paraphimosis may occur when the foreskin gets stuck under the glans and can no longer pulled back. If this happens, do not hesitate and call the hospital: a doctor will perform a recovery manoeuvre. If there is to much delay, a circumcision may be needed.   

When should you seek immediate care for your child who has phimosis?

  • If your child can not urinate; or
  • In case of paraphimosis (the foreskin gets stuck under the glans and can no longer be pulled back)

When should you contact a Urologist in London for my child who has phimosis?

  • If your child has fever
  • If you see redness, swelling or blisters on the baby’s foreskin
  • If you see liquid coming out (drainage) from the baby’s foreskin
  • If your baby has pain when urinating

How is phimosis treated in children?

As already mentioned, in children phimosis can improve without any treatment. However, it is key to never pull the foreskin back forcefully. Beyond causing more pain, this makes the situation worse and can cause paraphimosis.

In the presence of a phimosis or a suspicion of it, a urological examination with your urologist in London is always recommended. Following the consultation, you can get a diagnosis and think about the type of treatment to apply. The treatments are of two types, conservative and surgical.

Conservative and natural treatments of phimosis

If this is an option, conservative treatments are always preferred to surgical ones. They entail the application of cortisone creams for 40 or 50 days. 

In 90% of children, the use of these creams, combined with constant preputial “retraction” exercises during the moment of intimate hygiene, delicately solve this problem.

Surgical treatment of phimosis

Circumcision is an outpatient surgery that involves the removal of the foreskin. The result is that the glans remains exposed, and therefore not covered by the skin, even when the penis is at rest. Circumcision is performed using a local anaesthetic (lidocaine), applied by an injection with a small needle at the base of the penis. The surgeon then proceeds by cutting the part of the foreskin which is narrowed and then stitching it up using absorbable sutures. 

When is necessary to perform a circumcision?

The health reasons that recommend the intervention are:

  • Phimosis (abnormal narrowing of the foreskin) in which medical therapy with locally applied cortisone creams for 40-50 days has not been successful.
  • Phimosis so tight that it hinders the emission of urine during urination (presence of a filiform jet that stops several times and the formation of a temporary and small collection of urine between the glans penis and foreskin during urination). This situation, in addition to causing discomfort to the child, increases the risk of urinary tract infection.

At what age is it necessary to intervene?

In the presence of a simple phimosis, it is recommended to perform the circumcision after 6 years of age. The presence of an obstacle to urination (tight phimosis) and recurrent infections of the foreskin and glans are indications for earlier interventions. The paediatrician or Urologist will assess when it is appropriate to intervene.

To sum up

We started this post with a simple question: “Phimosis in children, where to go?”. As discussed, this question has many answers. Nevertheless, the best choice is to call your Urologist Andrologist in London. Diga33 is here for you and your child. We are waiting for your call!

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