Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Where as phimosis is normal in infancy and childhood, the incidence of persistent phimosis in 7th grade boys is about 1% (reference Department of Urology, San Francisco).
Smegma, a oily smelly collection of decaying skin cells from the glans penis and inner foreskin that is often noted upon retraction of the foreskin. During infancy and childhood this natural skin shedding helps to separate the foreskin from the head of the penis. Yet it is unwelcome by most adults and can be associated with inflammation or infection. Inflammation of the glans is called balantitis and of the foreskin posthitis.
The likelihood that phimosis in adulthood will self-cure or be permanently vanquished with topical steroid creams is unrealistic. With each tear, normal elastic fibers are replaced with collagen or scar,tissue only contributing to the vicious cycle.
The ultimate remedy is a proper circumcision with emphasis on removing all involved scarified tissue. For patients who desire a high circumcision, this is usually not, possible without producing a ring like contractcure on the shaft which acts as a tourniquet restricting lymphatic drainage and blood flow. Perpetual will ultimately lead to numbness and loss of tissue viability.
Eventually the judgement of the patient leads to an emergency room visit. Continued inward pressure on the glans while puling up the foreskin may lead to simple reversal. If the degree of inflammation is severe, a dorsal slit can be performed which simply opens the phimosis ring and postpones a more definitive circumcision until a more optimal time.
Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North AmericaInternational Society for Sexual Medicine
Phimosis with micro-tears
Paraphimosis, early stage with constriction and
swelling of distal shaft and glans