What is Phimosis? Know the Symptoms, Diagnosis and Therapy

Generalities And Symptoms

The foreskin represents the retractable mucocutaneous layer that surrounds the glans of the penis : in the case of phimosis, the preputial stenosis prevents the actual uncovering of the glans, making not only sexual intercourse painful ( dyspareunia ), but also simple erection .

In severe phimosis, the man may even complain of discomfort or pain when urinating : in similar situations, the patient may also experience a progressive narrowing of the urethral meatus (external orifice of the urethra, located at the end of the penis).
In other words, phimosis represents an anatomical condition in which the dimensions of the preputial layer are not sufficient for the correct sliding of the glans.

To learn more: Phimosis symptoms

Classification

There are several types of phimosis: in this regard, several sub-categories can be identified:

• Congenital phimosis : Preputial stenosis is present from birth. In similar circumstances, surgery is recommended only when the phimosis degenerates into a serrated form (the patient complains of serious difficulty urinating) or when the shape of the foreskin is such as to prevent correct intimate hygiene . The therapies recommended to remedy phimosis are contradictory: some doctors recommend the sliding exercise to people with phimosis, which is useful for increasing skin elasticity ; on the other hand, some texts advise against the so-called foreskin gymnastics, especially for children, which is even considered the most common cause of acquired phimosis. [adapted from Pediatric surgery. Approach and management of the child with surgical problems by GB Paris].
• Acquired phimosis : occasionally it arises as a result of inflammatory processes of the glans/prepuce ( balanoposthitis , balanitis xerotica obliterans), genital bacterial infections,   ammonia dermatitis and, sometimes, also due to the aforementioned preputial gymnastics. In similar conditions, it is not uncommon for the patient to complain of a progressive narrowing of the foreskin: when the condition worsens, the patient is hardly able to cover the glans again with the preputial mucocutaneous layer. In that case, surgical treatment is recommended.
• Non-closed phimosis : the uncovering of the glans is possible, albeit partially, during erection. In similar circumstances, the condition could evolve intoparaphimosis (suffocation of the glans), which makes it impossible to coat the barnacle again.
• Phimosis serrata : the form of phimosis that causes major physical-psychological disturbances in humans, as it causes not only pain whenurinating, but also a flaccid penis, which in some circumstances could represent a remarkably embarrassing and unpleasant ailment.

Complications Of Phimosis

Phimosis, as already analysed, is not a disease but a particular anatomical conformation of the male genitalia: in the presence of phimosis, the patient is more at risk of acute balanoposthitis, postitis or balanitis, since the stagnation of smegma or urine in situ, itself a possible trigger for infections. The foreskin appears sore, sometimes itchy, red; often, from the urethral meatus, a yellowish substance comes out which creates irritation.

A cascade of chain events, therefore which, getting worse, could generate painful calcifications at the level of the internal preputial layer. In similar circumstances, it seems that the patient is more at risk of neoplastic forms at the genital level (e.g. penile carcinoma ).
When phimosis is accompanied by a short frenulum , the patient usually undergoes a circumcision or an operation to lengthen the frenulum.

The paraphimosis, mentioned above, consists of strangulation of the glans and could complicate the pre-existing phimosis. Paraphimosis could cause congestion of the glans and edemaat the level of the foreskin, to then in turn generate ulceration and necrosis of the preputial tissue. Surgery, circumcision or plastic surgery to widen the preputial orifice is recommended. [taken from Surgery, volumes 1-2 by R. Dionigi].

Diagnosis

The diagnosis is based on clinical observation, which must be performed by the physician; generally no biopsy or other invasive tests are necessary, except for those patients who, in addition to presenting phimosis, also complain of difficulty and burning during urination . In the latter case, a more in-depth examination of the urinary tract is recommended, associated with flowmetry , i.e. the measurement of the volume of urine excreted per unit of time.

Therapy

Generally, congenital phimosis is not a serious condition, so unless the patient has other problems, no surgery or other treatment is needed.
In the case of just mentioned phimosis, the doctor could prescribe ointments based on steroid substances to the patient, associating a few delicate movements aimed at uncovering the glans, which must not be frequent, as they could even aggravate the condition.
In patients who, in addition to presenting preputial stenosis, show an evident urination disorder, circumcision could be an effective solution: in similar cases, in fact, the inability to urinate in a natural and simple way could cause serious complications, particularly at the renal .

Another option for the treatment of phimosis, in place of circumcision, is represented by the enlargement of the preputial orifice and/or the lengthening of the short frenulum.

Summary

Phimosis – in short