Phimosis - Circumcision (Children)

Phimosis is defined as a narrowing or constriction of the foreskin opening which prevents it from being drawn back over the glans.

Recurrent infections of the foreskin (Balanitis) may present with pain, redness and sometimes purulent discharge.

This is due to the adherence of the inner surface of the foreskin with the glans penis. Naturally these 'adhesions' separate by the age of 5 years. 90% of boys by this age will be able to retract their foreskins.

"Physiological" Phimosis is common in boys under the age of 5 years.

This may be due to forceful retraction of the foreskin which leads to small tears at the opening of the foreskin. Eventually, this may lead to scarring and Phimosis.

Poor hygiene may lead to recurrent infections of the foreskin (Balanitis). This in turn may lead to scarring of the foreskin opening.

Clinically, the patient may complain of the following symptoms:

• Inability to retract or difficulty in retracting the foreskin
• Ballooning of the foreskin when passing urine
• Poor stream and dribbling after passing urine

Signs:

• "Pin-hole" opening of the foreskin
• Inability to see the underlying glans penis

Diagnosis is made upon clinical examination.

Application of low-dose steroid creams such as 1% Hydrocortisone or Bethamethasone to the foreskin tip twice daily over a period of one month. The success rate is approximately 70%.

Once the foreskin is found to be retractile, the application of the steroid cream can be stopped. Parents are then encouraged to continue retracting the foreskin daily at bath times.

Surgery to remove the skin covering the tip of the penis is called Circumcision.

This procedure can be done as a day surgery and is usually performed under general anaesthesia. Duration of the surgery is approximately 20 to 30 minutes and there will be 'dissolvable' stitches in the wound which will take about 2 to 3 weeks to dissolve.

Following surgery, pain can be controlled by giving paracetamol regularly every 4 to 6 hours for the first two to three days.

To keep the wound clean, it is recommended that short baths or showers be taken daily. This can start the day after the operation has been carried out.

Often there are "yellowish" scabs that form on the glans penis in the first few days after surgery. Do not try to remove them as this may cause bleeding and pain. Patients are advised to leave them alone as they will fall off once the underlying skin has healed.

Loose undergarments and clothing are recommended for the first five days.