Phimosis

Anatomy The penis consists of a body called the “shaft” and a head called the “glans”, which is covered by a layer of mucous membrane and sliding skin, called the “prepuce”.

Definition Phimosis refers to the presence of a fibrous ring at the level of the foreskin, which makes it difficult or even impossible to retract the foreskin skin. It can affect the child and in some cases the adult. In the more marked forms, the foreskin is so narrow that it does not allow the external urethral orifice to be seen and, when the patient urinates, the pee first collects under the foreskin forming a sort of balloon and then comes out. In less severe forms it is possible to retract the foreskin and the fibrous ring appears as a collar that strangles the penis, giving it an hourglass appearance.

Symptoms Phimosis can be asymptomatic or cause the following problems:

• inflammation of the glans penis and foreskin (balanoposthitis) with redness, swelling and burning in the glans penis and foreskin due to accumulation of urine under the foreskin and poor hygiene.

• paraphimosis: the foreskin, once retracted to uncover the glans, can no longer be brought back into position; the fibrous ring chokes the penis more and more, which becomes more and more swollen, making it even more difficult for the foreskin to ascend. The patient is in great pain. This is a serious complication: it is necessary to take the patient as soon as possible to the Emergency Department of the nearest hospital, where the foreskin will be manually brought back into the correct position or, in case of failure, circumcision will be performed in urgency.

Painful erections and difficulties in sexual intercourse: Diagnostic investigations A simple medical examination allows you to appreciate the possible presence of this pathology and to evaluate the any indication for corrective surgery.

Methods of treatment In the presence of phimosis, a conservative treatment using cortisone-based creams is recommended in the first instance to be applied daily for about 2 months. Such treatment leads to the resolution of phimosis in 90% of cases.

In cases where conservative treatment is unsuccessful, we recommend circumcision, i.e. the removal of the foreskin. This intervention must be performed in hospitalization.