What is it?
A phimosis in childhood (phimosis) is the difficulty of exposing the glans (head of the penis), because the foreskin (skin that covers the glans) adheres to the glans, making it difficult to expose them. This is normal in the first months of the baby's life, only 4% of the newborns retract the foreskin at birth, however, the foreskin is released until the 3 years.
Studies show that at the end of the first year, glans exposure is not possible in 50% of boys with phimosis in childhood. Thus, this percentage drops to 11% at 3 years old, to 8% at 7 years old and to only 1% at 16-18 years old.
The symptoms, when they occur, are caused by the inflammatory process, with hyperemia (redness), edema, itching until erosion (superficial ulceration) and are more intense when there is local infection, when purulent secretion can be seen.
As balanitis (or inflammation of the skin of the foreskin) can develop with adherence between the glans and the foreskin. In this way, it can cause pain and difficulty in exposing the glans, damaging and favoring new episodes of balanitis in children with phimosis in childhood. In addition, painful erection, foreskin bleeding and burning urination may occur. In 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 appearance of local inflammation caused by constant irritative contact between the urine and the glans and foreskin (balanoposthitis). When bacterial proliferation occurs, balanoposthitis can cause adhesions between the foreskin and the glans, which can become more intense and cause scar deformities between the glans and the foreskin. THE phimosis it can happen at any time in life, even in old age, when it can be caused by repetitive inflammatory processes that worsen the preputial ring.
The initial treatment can be carried out with moisturizers to improve the skin's elasticity and facilitate its retraction for daily hygiene. In some cases, especially in children, low-power local steroid creams may be used. In the presence of smegma, secretions from the sebaceous and sweat glands and cells that peel off the mucosa can cause maceration and aseptic irritation of the mucous membranes, which may predispose to local infection.
Only the child with phimosis true.
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).
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 on 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.
A 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, balanoposthitis severe or recurrent and obliterating xerotic balanoposthitis. Surgery also decreases the incidence of sexually transmitted diseases, such as HIV and penis cancer and in women, cervical cancer.