What is it?
A adult phimosis it is the inability to expose the glans when the foreskin retracts, caused by a ring that prevents it from retracting. The function of the foreskin is to protect the glans and the urethral meatus. Its internal portion consists of mucosa and the external portion of skin (stratified tissue). The mucosa of the foreskin covers the mucosa of the glans. The glans is one of the places on the body that has the most sensory endings, and therefore this tissue is specialized in capturing sensitivity during intercourse, being essential for triggering the sensitive erotic stimulus.
At birth, only 4% of newborns retract the foreskin at birth. The incidence of complete foreskin retraction increases with age, while the rate of phimosis decreases. At the end of the first year, retraction of the foreskin is possible in only 50% of boys, and approximately 89% in the third year, 8% between 6-7 years and 1% at 16-18 years.
The symptoms of phimosis in adults are caused by the inflammatory process, with hyperemia (redness), edema, itching until erosion (superficial ulceration). Thus, they are more intense when there is local infection, and in these circumstances, purulent secretion can be seen.
Balanitis can evolve with adhesion between the glans and the foreskin, which can cause pain and difficulty in exposing the glans, damaging and favoring new episodes of balanitis. Painful erection, foreskin bleeding, urinary burning can occur. Extreme cases of preputial obstruction, in newborns, preputial dilation caused by obstruction of the preputial ring to the urinary stream can be observed.
It is performed by physical examination when exposing the glans and observing that its exposure is impossible. The presence of phimosis predisposes the child to the onset of local inflammation caused by the constant irritative contact of the urine with the glans and foreskin (balanoposthitis). When bacterial proliferation occurs, balanopostitis can cause adhesions between the foreskin and the glans, and may make adhesions more intense and causing adhesions that can cause scarring of the glans and foreskin. Phimosis can occur at any time in life, including the elderly, caused by repetitive inflammatory processes that worsen the preputial ring, by increasing local fibrosis throughout life.
Treatment of phimosis in adults
Initial treatment can be performed with moisturizers to improve skin elasticity and facilitate shrinkage for daily hygiene. In some cases, especially in children, local low-potency corticosteroid creams may be used. The presence of smegma, secretions of the sebaceous and sweat glands, and cells that are discharged from the mucosa can cause maceration and aseptic irritation of the mucous membranes, which may predispose to local infection.
Only the patient with true phimosis should be operated.
If there is severe preputial stenosis, the removal of the stenotic skin that obstructs the glans (postectomy) at any age should be indicated. The foreskin should not be removed in its entirety, and the glans should be partially covered until at least its middle third. This is important not to impair the function of the sebaceous and sweat glands located in the foreskin and glans, as well as in the preputial crown (Batson glands, producing mucus).
Prevention of phimosis in adults
Surgery should be indicated at any age, as long as the patient has true phimosis. All men are born with a foreskin and therefore should not be operated just because they have a foreskin. Rare cases with exuberant foreskin may be indicated for surgery, especially if there is discomfort and / or cause discomfort during intercourse, or if they have recurrent balanoposthitis.
The erection may show the stenotic preputial ring and at the end of the relationship, it is common to observe preputial edema. Postectomy prevents paraphimosis (constriction of the preputial ring that leads to edema and pain, and can be intense causing ischemia and even necrosis of the glans, if not treated quickly), recurrent urinary tract infections, severe or recurrent balanoposthitis and obliterating xerotic balanoposthitis. Thus, surgery also decreases the incidence of sexually transmitted diseases, such as HIV and cancer of the penis and in women, cancer of the cervix.