Phimosis

Definition of phimosis

“Narrowing of the foreskin”: this is the most classic definition attributed to phimosis. In reality, as we will see in the discussion of the article, the condition could hide more serious disorders than a "simple" preputial stenosis (narrowing), not so much for the phimosis itself, rather for the consequences that could derive from it. of real disease, since phimosis rather indicates a peculiarity of the male genital anatomical morphology, such as to give rise to possible complications or diseases [taken from http://www.fimosi.com/].

Generalities and Symptoms

The foreskin represents the retractable mucocutaneous sheet that surrounds the glans penis: in case of phimosis, the preputial stenosis prevents the real 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 leaflet are not sufficient for the correct sliding of the glans.

For further information: Symptoms Phimosis

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 such circumstances, surgery is recommended only when the phimosis degenerates into the tight form (the patient complains of serious difficulty in urinating) or when the shape of the foreskin is such as to prevent proper intimate hygiene. The recommended therapies to remedy the phimosis are contradictory: some doctors recommend the sliding exercise to subjects with phimosis, useful for increasing the elasticity of the skin; on the other hand, some texts advise against the so-called preputial gymnastics, in particular for children, considered even the most common cause of acquired phimosis . [adapted from Pediatric surgery. Approach and management of the child with surgical problems by G. B. Paris].
• Acquired phimosis: occasionally arises as a result of inflammatory processes in the glans penis / foreskin (balanoposthitis, balanitis xerotica obliterans), bacterial genital 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 only unlikely to be able to cover the glans again with the preputial mucocutaneous sheet. In that case, surgical treatment is recommended.
• Non-tight phimosis: the uncovering of the glans is possible, albeit partially, during erection.In such circumstances, the condition could evolve into paraphimosis (suffocation of the glans), resulting in the impossibility of re-dressing the same barnacle.
• Tight phimosis: the form of phimosis that causes major physical-psychological disturbances in men, since it causes not only pain when urinating, but also a flaccid penis, which in some circumstances could represent a remarkably embarrassing and unpleasant disorder.

Complications of phimosis

Phimosis, as already analyzed, 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 balanoposthitis, postiti or balanitis in acute form, since the stagnation of smegma or urine in situ, in turn a possible trigger for infections. The foreskin appears painful, sometimes itchy, red; often, from the urethral meatus, a yellowish substance emerges 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 situations, it seems that the patient is at greater risk of neoplastic forms at the genital level (eg penile cancer).
When phimosis is accompanied by a short frenulum, the patient usually undergoes a circumcision or a "frenulum lengthening operation."
The paraphimosis, mentioned above, consists in strangulation of the glans and could complicate the pre-existing phimosis. Paraphimosis could cause congestion of the glans penis and edema of the foreskin, which in turn generates ulceration and necrosis of the preputial tissue. Surgery, circumcision or plastic surgery aimed at enlarging the preputial orifice is recommended. [adapted from Surgery, volumes 1-2 by R. Dionigi].

Diagnosis

Diagnosis is based on "clinical observation, which must" be done 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 a flowmetry, ie the measurement of the volume of urine excreted per unit of time.

Therapy

Generally, congenital phimosis is not a serious condition, therefore, unless the patient experiences other disorders, no surgery or other treatment is required.
In case of phimosis just mentioned, the doctor could prescribe the patient ointments based on steroid substances, associating a few and delicate movements aimed at uncovering the glans, which should not be frequent, as they could even aggravate the condition.
In patients who, in addition to presenting preputial stenosis, manifest an obvious 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 level renal.
Another option for the treatment of phimosis, in place of circumcision, is represented by the "enlargement of the preputial orifice and / or by the lengthening of the short frenulum."

Summary

Phimosis: in short

I disturb

Phimosis

Description

Narrowing of the foreskin

Typical disorders associated with phimosis

• dyspareunia
• pain during erection
• discomfort or pain when urinating
• progressive narrowing of the urethral meatus

Classification of phimosis

• Congenital phimosis: present since birth
• Acquired phimosis: following inflammatory processes, genital bacterial infections, ammonia dermatitis
• Non-serrated phimosis: the uncovering of the glans is possible (only partially) during erection
• Tight phimosis: pain on urination, flaccid penis

Complications of phimosis

• risk of balanoposthitis, postiti or balanitis in acute form
• painful calcifications at the level of the internal preputial layer
• neoplastic forms at the genital level (e.g. penile cancer)
• ulceration and necrosis of the preputial tissue

Diagnosis of phimosis

Usually, a visit to the doctor (clinical observation) is sufficient. In cases of severity, biopsy and flowmetry is recommended

Therapies against phimosis

• Congenital phimosis: Generally, this is not a serious condition

→ no treatment
→ topical application of steroid ointments
→ gentle movements to uncover the glans

• Tight / acquired severe phimosis:

→ circumcision
→ enlargement of the preputial orifice
→ short frenulum lengthening