Definition of phimosis
"Shrinkage of the foreskin": this is the most classic definition attributed to phimosis. In reality, as we shall see in the discussion of the article, the condition could hide more serious disorders than a "simple" stenosis (narrowing) preputial, not so much for the phimosis in itself, rather for the consequences that could derive from it. It is not accurate to talk about a real disease, since phimosis indicates rather a peculiarity of male genital anatomical morphology, such as to originate possible complications or diseases [from //www.fimosi.com/].
Generalities and Symptoms
In severe phimosis, the man could even complain of discomfort or pain when urinating: in similar situations, the patient could also incur a progressive narrowing of the urethral meatus (external orifice of the urethra, located at the end of the penis).
In other words, the phimosis represents an anatomical condition in which the dimensions of the preputial leaflet are not sufficient for the correct sliding of the glans.
To learn more: Phimosis symptoms
Classification
There are several types of phimosis: in this regard, different sub-categories can be identified:- Congenital phimosis : preputial stenosis is present since birth. In such circumstances, surgery is recommended only when the phimosis degenerates in the tight form (the patient complains of serious difficulty in passing urine) or when the conformation of the foreskin is such as to prevent proper intimate hygiene. The therapies recommended to remedy the phimosis are contradictory: some doctors recommend the exercise of sliding to those who have phimosis, useful for increasing skin elasticity; 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. [taken from pediatric surgery. Approach and management of the child with surgical problems of GB Paris].
- Acquired phimosis : occasionally arises following inflammatory processes at the glans / foreskin (balanopostitis, balanitis xerotica obliterans), bacterial genital infections, ammoniacal dermatitis and, sometimes, also due to the aforementioned preputial gymnastics. Under similar conditions, it is not uncommon for the patient to complain of a progressive narrowing of the foreskin: when the condition worsens, the patient can hardly cover the glans again with the preputial mucocutaneous leaflet. In this case, surgical treatment is recommended.
- Unstoppable phimosis : the opening of the glans is possible, even partially, during erection. In such circumstances, the condition could evolve into paraphimosis (suffocation of the glans), from which it is impossible to re-coat the balano itself.
- Fimosi serrata : the form of phimosis that causes greater physical-psychological disturbances in humans, since it causes not only pain on urination, but also a flaccid penis, which in some circumstances could represent a remarkably embarrassing and unpleasant disorder.
Complications of phimosis
The phimosis, as already analyzed, is not a disease but a particular anatomical conformation of the male genitals: in the presence of phimosis, the patient is more at risk of balanopostites, postites or balanites in acute form, since the stagnation of smegma or urine in situ, which in turn is a possible trigger for infections. The foreskin appears painful, sometimes itchy, reddened; often, a yellowish substance escapes from the urethral meatus, which creates irritation.
A cascade of chain events, thus, worsening, could generate painful calcifications at the level of the internal preputial leaflet. In similar situations, it seems that the patient is more at risk of genital neoplastic forms (eg penile carcinoma).
When the phimosis is accompanied by a short frenulum, the patient is usually subjected to a circumcision or an operation to lengthen the frenulum.
The paraphimosis, mentioned above, consists of the strangulation of the glans and could complicate the pre-existing phimosis. Paraphimosis could cause glans congestion and edema at the level of the foreskin, and then generate ulceration and necrosis of preputial tissue. Surgery, circumcision or plastic surgery to enlarge the preputial orifice is recommended. [taken from Surgery, volumes 1-2 of R. Dionigi].
Diagnosis
The diagnosis is based on clinical observation, which must be made by the doctor; 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 thorough examination of the urinary tract is recommended, associated with a flowmetry, or 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 finds other disorders, no surgery or other treatment is necessary.
In the case of the aforementioned phimosis, the doctor could prescribe to the patient creams based on steroid substances, combining a few delicate movements aimed at uncovering the glans, which should not be frequent, since they could even aggravate the condition.
In patients who, in addition to presenting preputial stenosis, manifest a clear 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 renal.
Another option for treating phimosis, replacing circumcision, is represented by the enlargement of the preputial orifice and / or the lengthening of the short frenulum.
Summary
Phimosis: in short
| Disorder | phimosis |
| Description | Narrowing of the foreskin |
| Typical disorders associated with phimosis |
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| Classification of phimosis |
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| Complications of phimosis |
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| Diagnosis of phimosis | Generally, a doctor's visit (clinical observation) is sufficient. In cases of severity, biopsy and flow measurement is recommended |
| Treatment against phimosis |
→ no treatment → topical application of steroid ointments → gentle movements to uncover the glans
→ circumcision → enlargement of the preputial orifice → lengthening of the short frenulum |
