Stage 1 phimosis. Phimosis: norm and pathology, manifestations, when and how to treat. Elimination of phimosis using a bloodless method

Phimosis is the inability to expose the head of the penis. Only 4% of newborn boys have a foreskin that is so mobile that the head of the penis can be fully exposed. At the age of 6 months, the head of the penis opens in 20% of boys, and at the age of 3 years, the foreskin moves well and allows the head of the penis to be exposed in 90% of boys. Therefore, children under 3 years of age are not recommended to undergo circumcision, the indication for which is phimosis. The exception is cases of severe inflammation of the head of the penis (balanitis), as well as difficulty urinating and complications arising in connection with this, when surgery is recommended at any age.

Symptoms

The main symptom is the inability to remove the head of the penis. There may be no complaints, but with severe phimosis, complaints of urination problems appear. During urination, the child is worried and strains. Urine, entering the preputial cavity, swells it and exits through the narrowed opening in a thin stream or drops.

In cases where the inflammatory process is associated, typical complaints are pain in the area of ​​the glans penis and foreskin, purulent discharge from the opening of the foreskin, enlarged lymph nodes, and increased temperature. With paraphimosis, acute pain occurs in the restrained head, the head increases in size and turns blue. This is an emergency situation that requires immediate attention.

In adult patients, there are complaints of decreased potency as a result of a psychological reaction to painful sensations during sexual intercourse.

Causes

Trauma to the penis, which may result in the formation of scar tissue leading to narrowing of the foreskin (so-called cicatricial phimosis);
Inflammation of the foreskin of the penis (balanoposthitis), also leading to scarring and phimosis;
Genetic predisposition to the formation of phimosis as a result of insufficiency of connective tissue in the body, in particular its elastic component.
[edit] Classification

There are four degrees of phimosis:

• It is possible to open the head only in a calm state; during an erection, exposure of the head of the penis is difficult, sometimes painful
• It is difficult to remove the head in a calm state; during an erection, the head does not open
• The head of the penis either does not open at all, or opens only in a calm state, not completely
• The head of the penis is not exposed, urination becomes extremely difficult - urine is released in drops or in a thin stream
• In addition, there is relative phimosis - a narrowing of the foreskin, which becomes significant and noticeable only when the penis is erect.

With phimosis of 1-2 degrees, pain occurs during an erection, when the foreskin begins to stretch on the head of the penis. With 3-4 degrees of phimosis, pain during erection is usually absent, which is due to the small size of the preputial ring and the impossibility of exposing the head.

Complications

Severe phimosis leads to stagnation of smegma - a fat-like secretion of the glands of the foreskin, which is a good breeding ground for a variety of bacteria. All this can ultimately lead to the development of an inflammatory process. Hygienic problems with the accumulation of smegma under the foreskin can also arise with unexpressed phimosis.

With grade 4 phimosis, maximum narrowing of the foreskin occurs and the formation of an obstruction to the outflow of urine. The swelling of the foreskin in the form of a bag and the release of urine drop by drop is only an external manifestation of the narrowing. At this stage of phimosis, serious disturbances occur in the mechanism of urine outflow from the bladder, which leads to the development of infectious complications in the urethra.

Paraphimosis is the pinching of the head of the penis by the narrowed foreskin. As a rule, paraphimosis occurs when trying to expose the head, during sexual intercourse or masturbation. Incarceration leads to swelling of the head, which at a certain stage makes its reverse reduction impossible. The head turns blue and is sharply painful. Paraphimosis is an emergency condition requiring urgent intervention. Sometimes simple manual reduction of the head is sufficient. With severe edema, reduction is impossible in most cases and surgery is required to longitudinally dissect the foreskin or excise its layers.
Inflammatory complications with phimosis develop as a result of injury to the foreskin and the inability to provide hygienic care, which leads to the accumulation of smegma in the preputial sac, which is a good breeding ground for the proliferation of bacteria. Most often, this leads to the development of balanoposthitis (inflammation of the glans and foreskin of the penis). Pain, redness, and itching appear in the area of ​​the head of the penis. The diagnosis is made based on complaints and examination.
The accretion of the foreskin to the head of the penis most often occurs with phimosis of grade 3-4, but can also occur with less significant narrowing. Prolonged close contact of the head and the inner layer of the foreskin leads to epithelial gluing of the contacting surfaces and the formation of adhesions (synechia). The longer such fusions exist, the wider the area of ​​fusion becomes and the stronger the connection between the head and the foreskin. Treatment of synechiae is only surgical.
Treatment

Non-drug

The basis of non-drug therapy is gradual manual stretching of the foreskin. This method of treating phimosis was proposed by Dr. Beaugé M, who noticed that the methods of masturbation (masturbation) in patients with phimosis often differ from the methods of those who do not have it. The proposed method of treatment: transition to masturbation with complete retraction of the foreskin and exposure of the head. According to the doctor's observations, this method is often effective after 3 weeks.

Gradual stretching of the foreskin with regular tension on the head of the penis (but not too actively!) until it becomes painful. This training is carried out daily for 5-10 minutes. As the hole expands, move on to limited masturbation.

Gradual stretching of the foreskin by inserting two fingers into the preputial sac and spreading them a greater distance each time. The effectiveness of stretching methods is 75%. [source not specified 426 days]

Also, treatment of phimosis is possible as follows: daily, better when taking a bath, when the skin becomes more elastic, retract the foreskin as much as possible without causing yourself severe pain, and also during any urination with clean hands, open the head very slightly, without causing yourself any pain. in any case. In 1.5-2 months, even after severe phimosis, it will be possible to open the head.

The technique of gradual gentle stretching of the foreskin makes it possible to achieve opening of the head in children with physiological phimosis within 1-2 months. In children with hypertrophic phimosis - within 2-4 months.

If the foreskin does not lose its elasticity and is not affected by cicatricial changes, its stretching can be applied. This can be done under local anesthesia. Some surgeons perform foreskin plastic surgery to increase the diameter of the preputial ring without excision of the foreskin.

With phimosis of the second degree and higher, in no case should you try to sharply expose the head.

Medication

The essence of drug therapy is the regular and long-term use of corticosteroid ointments on the glans penis and foreskin. The use of these drugs to some extent increases the elasticity of the foreskin tissue, as a result of which it stretches, which can help cure the disease. In addition, the use of glucocorticoids reduces swelling and inflammation and accelerates the healing of microcracks.

Thus, during a clinical study conducted from 1985 to 1990, the effectiveness and safety of using clobetasol in the form of 0.05% cream for external use was shown. The drug was applied to the foreskin once a day for 1 to 3 months (average treatment time was 49 days), while patients were advised to simultaneously stretch the foreskin until painful sensations appeared. in 70% of cases, treatment had a positive effect (patients were additionally monitored for the absence of relapses in the next 4 years) and allowed to avoid surgical intervention. At the same time, this drug was well tolerated and there were no serious side effects (the drug does not have the systemic effect on the hypothalamic-pituitary-adrenal system characteristic of corticosteroids).

Similar data were obtained from a clinical study in 2003-2005, which assessed the effectiveness of betamethasone (0.05% cream). The drug was used twice a day with simultaneous massage of the foreskin for 2 months, and in 85.9% of cases the therapy was successful (92 patients participated in the study). No systemic or local side effects were noted.

Surgical

Currently, surgical methods for treating phimosis are rarely used and only in cases where there is no effect from other methods.

The approved surgical treatment is three longitudinal incisions with transverse suturing.

Surgical treatment of phimosis in children is carried out by separating the adhesions of the preputial sac using a metal probe and a gauze pad.

In case of cicatricial changes in the foreskin, its complete circular excision (Circumcision) is indicated.

In some cases, instead of circumcision, a Schloffer operation is performed. Under local anesthesia, a zigzag incision is made in the foreskin and the edges are sutured again. As a result, the foreskin is completely preserved, but its opening expands.

The effectiveness of the surgical method is 99-100%.

Circumcision with hypertrophic phimosis is dangerous due to the occurrence of relapse and hidden penis. Recurrence of phimosis more often occurs when attempting to preserve the foreskin (plastic surgery - up to 2.4%)

Surgical treatment is indicated for children with cicatricial phimosis; conservative measures are not effective. The method of choice is circumcision of the foreskin with mandatory complete excision of scar tissue.

Phimosis occurs only in men. About 5% of the male population needs treatment for this disease. The diagnosis of phimosis of a physiological nature is made in all boys under three years of age. However, it is not considered pathological.

The disease is that the head of the penis is not exposed. There are two stages of phimosis:

1. Lightweight, in which the leaves of the foreskin, when excited, make it difficult to open the head of the penis. In this case, in the normal state, opening occurs easily.
2. Heavy, which is accompanied by the accumulation of urine during urination, first in the bag and only then is it brought out, and then drop by drop.

The main cause of the disease is epithelial adhesion of the head of the penis to the inner side of the foreskin. From the age of three, the preputial sac begins to stretch, which contributes to the further opening of the head. Due to physiological changes, signs of phimosis disappear.

Phimosis of the penis can also be pathological. It occurs as a result of narrowing of the foreskin. This type of disease can be congenital or acquired. With congenital phimosis, the penis has the appearance of a “proboscis”. Acquired may occur due to complications after balanoposthitis.

There are 4 degrees of pathological phimosis:

1. The first degree is characterized by a calm opening of the head of the penis at rest. When excited, pain may occur.
2. In the second degree of phimosis, the head in the normal position of the penis is exposed with difficulty; when excited, opening is impossible.
3. In the third degree, the head of the penis does not open at rest, and difficulty urinating occurs.
4. Fourth degree. Its symptoms are the head does not open, urine comes out very slowly, sometimes with pain, the skin of the foreskin looks like a bag.

Causes of phimosis

There are the following reasons for the development of phimosis in an initially healthy boy:

• genetic predisposition;
• flat feet;
• varicocele;
• heart disease, including heart valves;
• uneven development of the penis and foreskin during puberty.

Later, the main reasons for the narrowing of the flesh are phimosis itself: due to the fact that the foreskin is narrow, the leaf inside it is injured. In this case, scars appear on the tissues, which contributes to additional narrowing of the flesh.

During adolescence, the risk of wounds and cracks increases, the causes of which are associated with an erection or the onset of sexual activity.

Symptoms of pathological phimosis

The first symptoms of phimosis in an initially healthy man are discomfort during sexual relations. It can be:

• painful sensations during sexual intercourse. These are symptoms of grade 1-2 phimosis.
• early ejaculation;
• decreased potency.

Men often develop psychological problems. This is due to the abnormal appearance of the penis. As a result, a man develops various complexes, so not only urological treatment is prescribed, but also psychotherapeutic treatment.

Treatment of phimosis

If phimosis is detected, what should you do? There are several ways to treat phimosis.

Corticosteroid-type therapy is available to treat phimosis without surgery. It is based on regular rubbing of special steroid creams and ointments into the penis. Thanks to this, the skin becomes more elastic, swelling goes away, and microcracks heal. However, this method of treatment takes a long time. It will take a lot of time and patience to get a positive result.

Application of foreskin stretching, in which the skin is stretched using fingers or special tools. This treatment is also quite long and unpleasant. Manipulations are carried out daily, for at least half an hour. Treatment of phimosis without surgery can last from several months to six months. When stretching the foreskin, you can simultaneously use steroid ointments, which will help speed up the treatment process.

These methods are suitable for the treatment of stage 1-2 phimosis.

At stages 3-4 of phimosis, surgery is indicated for the patient. Surgical intervention consists of circumcision or circumcision of the foreskin. During the operation, the skin is removed completely or partially, which helps to completely eliminate the problem.

Like any surgical treatment, circumcision also has contraindications: the operation cannot be performed in case of inflammation. First, antibacterial treatment is prescribed. Only after completing the full course is surgery to remove the flesh performed.

There are situations when swelling of the penis appears. In this case, the constricting ring of flesh is cut to prevent necrosis of the penis.

The best treatment for any disease is timely prevention. There are no specific preventive measures to prevent phimosis. This is due to the fact that the disease is genetic.

However, from birth it is worth keeping the health of the penis under control. To do this, you need to regularly and thoroughly wash the glans penis and foreskin. To avoid inflammation, it is necessary to periodically clean the genitals.

Complications of phimosis

Phimosis of the genital organ can lead to the following complications:

1. Development of balanoposthitis, inflammation spreading to the head of the penis and foreskin. The causes of the complication are the appearance of wounds and cracks on the petals of the foreskin due to tight stretching. At the same time, microcracks do not bleed and do not cause discomfort. But when the wounds heal, scars form. The skin in these places is no longer so elastic. Because of this, a narrowing of the flesh occurs, which is accompanied by the progression of the disease.
2. The skin of the foreskin adheres to the head of the penis. Normally, this does not cause any problems for men. But if you try to open the head, pain and bleeding occur.
3. Pinching of the head of the penis by the tissue of the foreskin. This happens during sexual contact. This anomaly is called paraphimosis. If these signs appear, you must immediately visit a doctor in order to avoid complications.
4. Necrosis of the tissues of the head of the genital organ. This occurs when the opened head of the penis is compressed by the skin of the foreskin. Normal blood flow to the organ is stopped, causing tissue death.

Rarely, but there are still complications after surgery to remove the foreskin. They come in two types:

1. Acute, during which the patient feels urinary retention, bleeding or suppuration of the wound formed after the operation appears. This complication occurs when the operation is performed incorrectly or poorly and sutures are applied. Acute symptoms also appear due to damage to blood vessels during surgery.
2. Chronic: meatitis or inflammation in the external opening of the urethra. With this disease, painful urination appears, and redness appears in the canal itself. Antibacterial therapy, ointments and creams are used for treatment. Inflammation in the external urethral canal may also occur. As a result, cicatricial narrowing may occur. This complication is called meatostenosis. A man experiences difficulty urinating: long, sometimes painful. With this disease, repeated surgical intervention is required, in which the correct contours of the canal are formed.

Nowadays, despite the general availability of medical information, phimosis is still a fairly widespread pathology, primarily because it is not given due attention.
On the other hand, quite a lot of different information has now appeared on radio, television, and the Internet. Whatever treatment methods are offered, however, the effectiveness of many of them raises some doubts.
In this article we will talk about what phimosis is, what are the causes of its occurrence, the degree of development, and treatment methods.

Physiological, pathological…

Phimosis is a narrowing of the foreskin of the penis, manifested in pain or the inability to expose its head. Depending on the severity of the narrowing, it is customary to distinguish between physiological and pathological phimosis.
As a rule, physiological phimosis occurs in most children under 2-3 years of age. Until now, doctors have not come to a common opinion as to what age phimosis should be considered physiological, when it is necessary to operate on a child, etc. It should also be taken into account that physiological phimosis has all the same complications as pathological phimosis.
The question of the advisability of the operation and its timing for “childhood phimosis” is decided individually, in each specific case. More often, phimosis in children goes away on its own, the head opens and there are no problems with the foreskin. But until the head is opened, you need to pay special attention to its hygiene and treat the head at least once a day with antiseptic drugs.
Now most experts believe that by the age of 6-7 years the head of the penis should open freely, and if this does not happen, then surgery is necessary.
As for phimosis in adult men, it can persist since childhood, or it can develop over time, during puberty. This period is characterized by rapid growth and development of the genital organs. Sometimes, a discrepancy may appear between the development of the penis and the foreskin, when the flesh is smaller than the head, its opening is narrower, and it is difficult or impossible to open the head. Most often, this is phimosis of 1-2 degrees, but phimosis preserved from childhood can be at least 3 degrees.

Phimosis keeps pace with age

In adolescents, young men and adult men, phimosis steadily progresses, this is due to the appearance of erections, masturbation and sexual activity. During an erection, the head of the penis enlarges and the foreskin stretches tightly. In this case, small cracks and microcracks appear on the foreskin; they do not bleed and do not cause any concern. But as they heal, a scar or microscar forms in their place. Scar tissue is less elastic than normal foreskin tissue, therefore, with the appearance of each new scar, the foreskin narrows more and more, and the disease progresses. This process is especially pronounced during sexual intercourse; ruptures of the foreskin can be significant and accompanied by heavy bleeding.

One reason, two reasons...

Causes of phimosis include:

• trauma to the penis, which may result in the formation of scar tissue leading to narrowing of the foreskin (so-called cicatricial phimosis);
• inflammation of the foreskin of the penis (balanoposthitis), also leading to scarring and phimosis;
• genetic predisposition to the formation of phimosis as a result of insufficiency of connective tissue in the body, in particular its elastic component.

From first to fourth

It is customary to distinguish 4 degrees of phimosis:
At first degree It is possible to remove the head only in a calm state; during an erection, exposure of the head of the penis is difficult, sometimes painful.
In the second degree Difficulties arise when removing the head in a calm state; during an erection, the head does not open.
Third degree manifests itself in the fact that the head of the penis either does not open at all, or opens only in a calm state, and even then not completely.
For phimosis fourth degree the head of the penis is not exposed, urination becomes extremely difficult - urine is released drop by drop or in a thin stream.
The main manifestation of phimosis of 1-2 degrees is pain that occurs during an erection, when the foreskin begins to stretch on the head of the penis.
With significant, 3-4 degree phimosis, pain during erection is usually absent, which is associated with the small size of the preputial ring and the impossibility of exposing the head.
Severe phimosis leads to stagnation of smegma - a fat-like secretion of the foreskin glands, which is a good breeding ground for a variety of bacteria. All this can ultimately lead to the development of an inflammatory process. By the way, hygienic problems with the accumulation of smegma under the foreskin can also arise with unexpressed phimosis.
With grade 4 phimosis, maximum narrowing of the foreskin occurs and the formation of an obstruction to the outflow of urine. The swelling of the foreskin in the form of a bag and the release of urine drop by drop is only an external manifestation of the narrowing. At this stage of phimosis, serious disturbances occur in the mechanism of urine outflow from the bladder, which leads to the development of infectious complications in the urethra.

And if phimosis is not treated...

Untreated phimosis can lead to various complications, such as:
Paraphimosis– pinching of the head of the penis by the narrowed foreskin. Typically, paraphimosis occurs when trying to expose the head or during sexual intercourse. As a rule, strangulation occurs with phimosis of 2-3 degrees, when it is possible to remove the head (it should be noted that with 4 degrees of narrowing, paraphimosis does not occur), but this requires some effort. Incarceration leads to swelling of the glans penis, making it impossible to reverse it. The head turns blue, and when you touch it, a sharp pain occurs. Paraphimosis is an emergency condition that requires immediate intervention. Sometimes simple manual reduction of the head is sufficient. With severe swelling, reduction is impossible in most cases, and then the person requires an operation to longitudinally dissect the foreskin or excise its layers.
Inflammatory complications with phimosis this is a common occurrence. Due to the impossibility of providing the necessary hygienic care, smegma accumulates in the preputial sac, in which bacteria multiply. In most cases this leads to the development balanoposthitis(inflammation of the glans and foreskin of the penis). In this case, pain, redness, and itching appear in the area of ​​the head of the penis. The diagnosis of “balanoposthitis” is made based on the patient’s complaints and an in-person examination. In some cases, inflammation of the urethra occurs - urethritis, which is manifested by pain and pain when urinating, as well as frequent urges associated with irritation of the nerve endings of the urethra. Treatment usually comes down to the use of local antiseptics or uroseptics. However, in the presence of phimosis, urethritis may recur.
Phimosis of 3-4 degrees is fraught growth of the foreskin to the head of the penis, although this complication can occur with less significant narrowing. Close, prolonged contact of the head and the inner layer of the foreskin leads to epithelial gluing of the contacting surfaces and the formation of adhesions (synechia). The longer such fusions exist, the wider the area of ​​fusion becomes and the stronger the connection between the head and the foreskin. In this case, surgical treatment is performed.

One day - and everything is in order!

The most effective treatment for phimosis is circumcision. During this operation, the foreskin is removed completely or partially, as a result of which there are no more problems with exposing the head of the penis.
Of course, our Center performs operations for phimosis. Our patients often ask how difficult this operation is. The question of the complexity of any operation is not easy for any doctor, since there are no “easy” operations. Each surgical intervention is a responsibility for human health, so we approach all operations as complex. However, if we consider that we have been treating phimosis for a very long time, we can say that we have worked out circumcision to a sufficient extent. Technique circumcision operations is relatively simple, and therefore the risk of developing postoperative complications is reduced to almost zero. As for further postoperative stay, the patient (if desired) can either stay in the hospital for a day, or the operation can be performed on an outpatient basis - in the morning he comes for the operation and goes home in the evening. As a rule, after 2 weeks a man can live a full life.

The main problem of patients with phimosis remains pain when trying to expose the head of the penis in an erect state. In some cases, it is completely impossible to open it, regardless of whether an erection is present or not. In addition, there may be problems with urination, as well as the accumulation of spegma in the sac and classic hygienic inconveniences associated with limited ability to clean the head. In advanced conditions, doctors also detect inflammation of the outer epithelium and urethra. The symptoms described above are typical for both adolescents and men.

Species and types

Doctors distinguish 4 degrees of severity of the phimosis condition:

• 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
• 2nd degree. During an erection, the head does not open at all; there are difficulties in removing it in the normal state.
• 3rd degree. The head can be partially exposed only when the penis is not erect.
• 4th degree. The head is not exposed at all; during urination, the stream does not flow freely, but inflates the preputial sac, and then flows out in rare drops or a very thin stream from the scarlet slit at the end of the penis. As a rule, in this case there is chronic inflammation due to the impossibility of removing secretions from the head, and in some cases smegmolites are formed - solid formations from stagnant smegma. Sometimes a urethral infection develops.

The main subtypes of phimosis include:

• Physiological phimosis. One of the most common types of problem, the vast majority occurs in children under three years of age. In fact, this phenomenon is the underdevelopment of the foreskin after the period of infancy: in the first year of life, in all male babies, the epithelium is practically closed and fits tightly to the head of the penis. After some time, it “opens”, so up to the age of three or four years, physiological phimosis can be considered a variation of the age norm, naturally, if it does not cause severe inflammation, as well as pain during urination. By the age of five or six, this type of phimosis goes away on its own, and the head of the penis can open freely. If this event does not occur, then you need to contact a specialist.
• Hypertrophic. This type of phimosis is identified by thickening of the epithelium of the foreskin, its protrusion beyond the head in the form of a “trunk”. If there is no proper treatment, this phimosis develops into hypogonadism.
• Atrophic. In this case, the foreskin becomes significantly thinner and even completely atrophies.
• Scar. Here, along with classic phimosis, the formation of scars of various sizes on the edges of the foreskin is observed.

Thus, physiological phimosis IS NOT a pathology in children under 5-6 years of age and there is NO NECESSITY to treat it.

Causes

There are no absolutely clear and distinct reasons for the occurrence of phimosis in representatives of the stronger sex. The most likely include:

1. Congenital genetic problems that are the initial factor in systemic insufficiency of the elastic element of connective tissue in the human body.
2. Inflammatory processes such as balanoposthitis, which often lead to cicatricial phimosis.
3. Physical injury to the penis, glans or epithelium.
4. Diseases of the circulatory system.
5. Age-related changes (aging and “sclerosis” of the skin).

Complications of phimosis

Phimoses can cause a number of negative consequences, some of which require urgent surgical intervention.

First of all, the consequence of the problem is regular inflammation under the foreskin, caused by stagnation of secretions. In addition, the above condition often leads to infection of the urethra due to improper excretion of urine and its return to the urinary canal.

The most dangerous consequence of phimosis is considered to be paraphimosis - a sharp pinching of the head of the penis by the flesh. Paraphimosis usually occurs due to attempts to expose the head during sexual intercourse or masturbation. In this case, the foreskin blocks the blood flow to the end of the penis, which in turn leads to swelling of the organ, its blueness and other negative conditions. If it is impossible to return the epithelium to its original state on its own, then emergency surgical intervention will be required in the form of a longitudinal incision of the epithelium or excision of its “leaves.”

Treatment of phimosis without surgery

In the vast majority of cases, it is rational to eliminate phimosis surgically, but there are also non-operative methods, although they do not work immediately and in some cases do not have the desired effect.

Foreskin stretching

The main and fairly good method of non-operative treatment of phimosis. It consists of periodic gradual stretching of the foreskin. The simplest method is masturbation with the strongest possible retraction of the epithelium and corresponding exposure of the head of the penis.

Gradual stretching must be done until the onset of moderate pain and repeated in several approaches two to three times a day (10-15 minutes). In the process of expanding the passage, you can increase the amplitude of translational movements, up to complete exposure of the head. For greater effectiveness, you can take a hot bath before the procedure and, when the skin becomes more elastic, perform the act of masturbation with maximum amplitude.

An alternative method of stretching is to insert two little fingers into the preputial sac and periodically move them apart to stretch. This procedure is less traumatic than classic masturbation, but is less effective.

Drug treatment

The basis of drug therapy for phimosis is to apply corticosteroids in the form of ointments to the head of the penis - this type of drug gives elasticity to the epithelium and also relieves inflammation and swelling.

The most effective ointments for this task are considered to be clobetasol and betamethasone. They must be applied daily and once to the head of the penis for two months. In this case, the method can be combined with the above-described stretching of the epithelium.

Treatment of phimosis with surgery

Surgery is still considered the most effective method of getting rid of phimosis. Surgical intervention usually consists of making three zigzag longitudinal incisions in the foreskin with their subsequent stitching.

When treating phimosis in children, a more gentle method is used, based on neutralizing adhesions at the head using a special metal probe. However, if the foreskin is covered with scars, then a safer and more effective method would be complete circumcision of the epithelium in a circle. In rare cases, to preserve aesthetics, more expensive plastic surgery with preservation of the foreskin is used, however, in some cases, after this procedure, a relapse of the problem may occur.

The effectiveness of surgery to treat phimosis is close to one hundred percent.

Postoperative period

Despite the high effectiveness of surgical intervention, some doctors note the regular occurrence of various complications in operated patients. Most often, these are minor bleeding caused by not very careful suturing, as well as meatitis and meatostenosis - the former are inflammations of the outer part of the urethra, the latter are caused by a narrowing of the canal of this component of the genitourinary system.

In order to avoid such problems in the first ten days, you must regularly take baths with potassium permanganate and use antibacterial creams approved by your doctor. In some cases, repeated surgical intervention may be necessary, most often to eliminate defects in the appearance of the foreskin (plastic) or to restore the meatus - the correct contours of the urethra.

Useful video

Elena Malysheva in the program “Live Healthy!” about men's problems

Doctor Komarovsky about what will happen if phimosis in a child is not treated

FAQ

What is the name of the operation for phimosis?

Surgery for phimosis can be called differently, depending on the type of surgery performed. Most often, two types of operations are used in this case:

1. Circumcision is a classic circular circumcision of the foreskin. In this case, the epithelium is cut circularly while maintaining the basic structure of the frenulum. If necessary, the sutures are connected with cutgut; after the procedure, a bandage based on the Vaseline component is applied; after a couple of hours, the patient can walk and urinate independently.
2. Operation according to Schloffer. Here the surgeon makes a zigzag incision and stitches the epithelium in places where the transitions shift. As a result, the foreskin is preserved, but the hole is enlarged.

Treatment of phimosis 2nd degree

Treatment of grade 2 phimosis is possible only with surgery. During the operation, the foreskin is removed, which allows the cause of the disease to be permanently eliminated. Without timely surgical intervention, the disease gradually progresses, causing serious complications. The most dangerous consequence is paraphimosis.

With phimosis of the 2nd degree, a man has difficulty in removing the head of the penis in a calm state. During an erection, it is impossible to retract the foreskin. These unpleasant symptoms complicate sexual life, creating discomfort during sexual intercourse. Therefore, when the first signs of the disease appear, you should immediately contact a specialist.

Diagnosis of grade 2 phimosis is not difficult and does not require special measures. Usually it is enough for the doctor to perform a general visual examination. If there is an inflammatory process, an additional smear is taken for analysis - it allows us to identify the causes that provoked the disease.

Radio wave treatment

Today, one of the most effective methods of treating phimosis is circumcision with Surgitron, a modern device for radio wave surgery. The equipment makes a non-contact and bloodless cut of soft tissue, affecting the affected area with waves with a frequency of 3.8-4.0 MHz. The main advantages of this method of treating grade 2 phimosis include:

• absence of pain and discomfort, since the device does not cause muscle spasms and does not affect sensory receptors;
• high precision of impact, which eliminates the risk of injury to healthy tissues;
• excellent cosmetic effect - after circumcision of the foreskin there are no scars left on the skin;
• absence of relapses and postoperative complications - suppuration, inflammation, swelling;
• antiseptic effect, eliminating the risk of infection entering the wound.

On average, circumcision of the foreskin with Surgitron takes about half an hour. The rehabilitation period after circumcision is much easier and faster compared to other treatment methods. The patient does not require hospitalization and is discharged on the same day. After the operation, no special care is required. It is necessary to observe the rules of personal hygiene and visit a doctor in a timely manner.

For more information about the treatment of stage 2 phimosis, sign up for a preliminary consultation at our clinic. The doctor will conduct an examination, prescribe additional tests if necessary, and develop an individual course of therapy. By following the andrologist's recommendations, you will quickly recover after the procedure. To make an appointment, get additional information and clarify the cost of services, please call.

Causes of stage 1 phimosis, treatment of the disease and photo of the disease

Phimosis is not a deadly disease, but its presence in the lives of men makes noticeable adjustments to their lifestyle and, what is more noticeable for men, to their intimate lives.

At the initial stage of the disease, extremely unpleasant symptoms appear only in the presence of sexual arousal, which inevitably affects relationships with the opposite sex.

What is phimosis?

Phimosis is a narrowing of the skin fold of the genital organ (prepuce, skin duality), making it difficult to retract it behind the head of the penis during sexual arousal, during hygiene procedures, etc. This pathology, like many others, goes through several stages. The first is the easiest of them.

The diagnosis of stage I phimosis in clinical practice refers to the initial stage of narrowing of the foreskin, in which unpleasant symptoms are observed only in the presence of an erection. If the genital organ is in a completely relaxed state, the disease may not manifest itself in any way.

However, even mild phimosis can lead to paraphimosis - pinching of the head by a loop of the foreskin.

Paraphimosis is fraught with necrosis of the genital organ. In the absence of timely medical attention, amputation of the penis may be required.

Stage 1 phimosis is observed in children and adults. In childhood, the pathology can go away on its own.

This usually happens by 6-7 years, sometimes earlier. Such phimosis in clinical practice is considered to be physiological.

The problem with phimosis in adult patients is pathological in nature and cannot go away on its own. The disease develops for a number of reasons, and is eliminated only through appropriate therapy.

Symptoms and signs of stage 1 phimosis

Physiological phimosis of the 1st degree does not manifest itself in children. In adult men, pain occurs when erecting the genital organ.

This phenomenon is associated with excessive tension of the prepuce on the head of the penis. In this case, the skin loop can move behind the head, which is dangerous due to the occurrence of paraphimosis, however, at the initial stage of the disease, with special effort, a man can help himself on his own.

At the same time, in the absence of an erection, the penis duplicator moves behind its head without any problems and returns to its original position.

Independent elimination of pinching of the head by the foreskin is fraught with the formation of microtraumas, which can provoke the progression of the disease.

Against the background of pain, a man may develop erectile dysfunction of psychological origin - the patient, even before the onset of an erection, worries about the upcoming discomfort.

Causes

Possible causes of the pathological form of phimosis include the following:

• injuries to the prepuce, resulting in the formation of scar tissue;
• inflammatory diseases of the glans penis and duplications of various etiologies;
• genetic predisposition, implying insufficient elasticity of the skin.

Phimosis 1st degree: photo

Treatment of phimosis 1st degree

It is necessary to get rid of stage I phimosis as soon as possible after the first symptoms appear. It is recommended to use both conservative and surgical methods - their choice depends on the characteristics of the disease and its causes.

Without surgery

The only non-surgical method for eliminating phimosis is stretching the prepuce manually or using special medical devices. It is recommended to carry out the procedures every minute. You can increase skin elasticity by using moisturizing creams and corticosteroid ointments.

Methodology of the procedure:

1. Preparation. To begin with, it is recommended to treat the foreskin with a solution of Chlorhexidine or Miramistin. Then, after preliminary drying the skin, you need to generously lubricate it with an external agent prescribed by a specialist.
2. After absorbing part of the cream or ointment, carefully lift the skin fold and gently stretch it to the sides. If discomfort occurs, stretching should be stopped. After the pain subsides, the procedure is repeated.

This method is inconvenient because it requires a very long period of use - from 6 months.

Surgical method

Removing the penis duplication is considered the most effective method of getting rid of phimosis. This method is indicated in the following situations:

1. With a tendency towards progression of the disease.
2. At high risk of relapse.
3. Increasing cases of infection of the glans organ and foreskin (balanitis and balanoposthitis).

All these phenomena inevitably lead to a deterioration in the man’s condition and a high risk of paraphimosis.

To resolve the problem, use one of the following methods:

1. Surgical intervention using a classic scalpel. The advantage of the operation is its low cost. Disadvantages - long recovery.
2. Removal of the foreskin using a radio wave scalpel. The advantage of the method is low trauma and a short rehabilitation period. Disadvantages - the relatively high cost of the procedure.
3. Elimination of phimosis with laser. The advantages of the method are low trauma and almost zero risk of infection, short rehabilitation period. The disadvantage is the high cost of the procedure.

Read about circumcision for religious reasons, as well as which nationalities accept it and what the Bible interprets in this publication.

A contraindication to circumcision of the foreskin by any of these methods is an inflammatory process in the acute stage.

Progression of first degree phimosis

In the absence of adequate measures to eliminate grade 1 phimosis, there is a possibility of pathology progressing. At the same time, the man experiences more and more pronounced discomfort due to the progressive narrowing of the prepuce. Against this background, the patient may experience:

• difficulty urinating due to pressure on the penis;
• inflammatory processes;
• pain in the head of the penis in the absence of an erection;
• accumulation of large volumes of urine under the foreskin.

Such situations require immediate response and serious treatment, including surgery or even amputation of the penis.

The video below will tell you how to track grade 1 phimosis in boys so that it does not develop into a critical form of the disease as they grow older.

Conclusion

Phimosis is wrongly considered a condition that needs to be hidden from others, and especially from doctors. This problem can be solved relatively painlessly if you seek help at the initial stage of the disease.

Otherwise, the pathology threatens rapid progression and life-threatening complications. Independent attempts to eliminate the narrowing of the foreskin can end in failure, so it is better to treat phimosis under the guidance of a doctor.

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Half of my relatives are Muslims, and it is customary for them to undergo circumcision. Our boys do not have these problems to begin with - phimosis, other diseases, this is also hygienic - all sorts of dirt does not collect, which then leads to inflammation and other unpleasant diseases, and prolongs the time of sexual intercourse for obvious reasons. The penis is such a delicate and important organ that it is better for boys to try to prevent possible problems in early childhood.

I had a genetic predisposition to this disease and decided to treat it after the first signs of the disease appeared, without waiting for it to get worse. I chose surgery with a radio wave scalpel. Yes, it is much more expensive than with a regular scalpel, but it heals faster and soon you could start having sex again. I don't see the point in saving on my own health.

It seems to me that phimosis is sometimes simply a product of poor personal hygiene. In general, if the foreskin is narrow from birth, then this problem must be surgically solved once and for all. Moreover, nowadays it is not difficult and painless. And there is nothing to be ashamed of. And it is imperative to maintain personal hygiene in the future.

In addition to personal hygiene, if the foreskin is narrow, you need to pull the flesh back every time you take a shower or bath and try to open it more. My child had phimosis, the doctor recommended doing such procedures every day and after a while everything opened up by itself. Although all the relatives insisted that we should not waste time and correct the situation surgically.

Phimosis: norm and pathology, manifestations, when and how to treat

Phimosis (from the Greek “to tighten”) is a condition in which it is impossible to completely remove the head from the foreskin due to its narrowing. It occurs in 90% of boys before the onset of puberty and is a manifestation of the physiological maturation of the penis. Phimosis in men is a pathological condition. It develops in 2-3% of adults and leads to a number of serious complications and impoverishes the sensations of sexual intercourse. In the early stages, phimosis can be successfully treated with conservative methods, so it is important to notice the pathology in time and consult a doctor.

Development mechanism

The penis is a man's external genital organ, whose main function is to introduce sperm into a woman's vagina. Its most sensitive part is called the head; it contains the largest number of nerve endings. It is covered with a thin, delicate epithelium, which is similar in structure to the red border of the lips. At the top of the head, a slit-like opening opens the urethra - the male seminal and urinary tract. With its lower part it fuses with the cavernous bodies of the penis, forming its shaft. In this place, the penis has a thickening - the coronal groove, which can be felt immediately under the head.

The delicate skin of the head is protected from damage by a fold of skin – the foreskin (prepuce). It consists of 2 sheets:

• External - identical in structure to the epidermis of the skin, has an upper keratinizing layer;
• Internal - covered with thin epithelium, similar to mucous membranes. It has a large number of modified sebaceous glands that produce a waxy substance - smegma. Their secretion serves to moisturize the head and facilitate gliding during sexual intercourse.

The foreskin begins from the coronary groove and tightly covers the entire head, forming a slit-like preputial cavity. At the front it opens with a hole that easily stretches and releases the head out. Normally, in a sexually mature man, the foreskin easily moves away, completely exposing the upper part of the penis. In the back of the head, the inner leaf of the prepuce is tightly fused with its tissues in the form of a frenulum. The thickness of the frenulum contains a huge number of nerve endings and capillaries, so stimulating it during sexual intercourse gives a man pleasure.

The foreskin performs the following functions:

1. Protects the urethra from penetration of pathogens by covering its opening;
2. Prevents mechanical irritation and damage to the thin epithelium on the surface of the head, maintaining its sensitivity;
3. Facilitates gliding during sexual intercourse due to the production of smegma and a smooth inner leaf;
4. Increases the pleasure received during coitus by stimulating the nerve endings of the head and frenulum. This is an important factor in evolutionary terms: without strong positive emotions, people would refuse sex and have less chance of procreation.

Phimosis, as a pathological condition, develops after inflammation or injury of the foreskin. As a result of exposure, tissues are destroyed and the inflammatory process starts. It goes through certain stages and necessarily ends with organization - restoration of the integrity of the organ. Deep damage is replaced with the formation of rough connective tissue, which significantly reduces the elasticity of the foreskin. High activity of restoration processes leads to the formation of synechiae - connective tissue partitions between the inner layer of the prepuce and the head of the penis. They hold them firmly together and prevent the top of the penis from being exposed.

Classification

It should be understood that phimosis is not a disease, but a special condition that is associated with the physiological characteristics of the body (age), heredity and damage to the tissue of the foreskin. In this regard, the following forms of phimosis are distinguished:

• Physiological – occurs in most boys before the onset of puberty, and is associated with the functional maturation of the preputial cavity. It is not a pathology and resolves on its own after 7 years.
• Pathological – occurs as a result of inflammation, injury, metabolic disorders and requires treatment:
• Hypertrophic (proboscis);
• Atrophic;
• Scar.

The incidence of one form or another of phimosis directly depends on age. In children, in the overwhelming majority of cases, it is physiological in nature, and in men it is caused by cicatricial changes.

According to the severity of the process, 4 degrees of phimosis are distinguished:

1. In a calm state, the head is completely released; during an erection, its removal is difficult and painful;
2. At rest, the head of the penis is difficult to remove; during erection, it is completely covered by the foreskin and cannot be released;
3. The head can be partially withdrawn only at rest;
4. The head is constantly hidden by the foreskin and is not visible. During urination, urine first fills the preputial sac and only then is released drop by drop.

Physiological phimosis

A boy's genital organs begin to form after weeks of intrauterine development. The head of the penis and the foreskin are formed from a common rudiment in the third trimester of pregnancy, their separation occurs at the site of the coronal sulcus. The cells of the prepuce begin to actively divide, significantly outpacing the tissue of the penis in their growth. As a result, they surround the head in the form of a cup and close it with a cavity. The anatomical proximity and commonality of tissue lead to the formation of delicate epithelial septa between the inner layer of the foreskin and the skin of the glans.

Development of the penis during child growth. Before

10 years fused glans and foreskin are the norm

In a newborn child, the preputial cavity is completely delimited from the environment by similar cords, which prevents pathogenic microflora from entering it. By 3-4 months of life, the sebaceous glands of the foreskin begin to function. They produce smegma, which accumulates in small quantities in the preputial cavity. Its infection and development of the inflammatory process are prevented by epithelial septa in the area of ​​the foreskin opening. Gradually, these thin strands are destroyed, the smegma moves to the exit and is released through the resulting free spaces. It can be seen as small white waxy flakes on the baby's underwear.

By the time of puberty, the septa are completely or partially reduced and the mobility of the foreskin increases. During masturbation or after the start of sexual activity, the head begins to be completely released, although the process may be painful at first. Thus, physiological phimosis resolves independently during puberty and does not require treatment.

Treatment in case of inflammation

Despite the naturalness of phimosis, in some cases there is a need for medical care. If the boy is insufficiently cared for or does not observe personal hygiene, pathogenic microflora enters the preputial sac from the skin and an inflammatory process develops. Clinically, this is manifested by redness along the edge of the preputial opening, local soreness and an unpleasant odor from the penis. Subsequent inflammation leads to the formation of cicatricial phimosis, which will require surgical treatment.

If such symptoms are detected in a child, parents should contact a pediatric urologist or pediatric andrologist. Previously, the technique of instantly opening the foreskin with a sharp jerking movement was widely practiced. This procedure is extremely painful for the boy and can cause psychological trauma. In addition, a single-stage opening damages the foreskin and can cause cicatricial phimosis in the future.

Today, doctors recommend gradual opening of the head by 1-2 mm. It is carried out after a warm bath, preferably with the addition of antiseptics: a weak solution of potassium permanganate, a decoction of chamomile, calendula, and sage. It should be taken 2 times a week for minutes. After the water procedure, the foreskin is treated with a healing ointment (bepanten, solcoseryl) or baby cream to increase its elasticity and prevent rupture. The skin is moved back no more than 2 mm in one procedure. This method can be used to treat phimosis at home for several months.

If the method described above is ineffective, the surgeon or urologist cuts the resulting adhesions with a probe. He performs the procedure on an outpatient basis without pain relief or under local anesthesia. The doctor inserts a thin metal rod with a rounded end into the preputial sac and moves it around the circumference of the head of the penis. Subsequently, the boy’s penis should be washed daily using antiseptic solutions.

Video: phimosis - norm and pathology, Dr. Komarovsky

Pathological phimosis

The causes of pathological phimosis are:

• Genetic defect of connective tissue;
• Metabolic disease;
• Inflammatory diseases of the foreskin and head of the penis;
• Trauma to the penis;
• Sexually transmitted infections;
• Age-related changes.

Hypertrophic

Hypertrophic phimosis is the next most common after physiological phimosis in children. It is an excessive development of the foreskin, which hangs from the penis with a long proboscis. At its end, the “proboscis” narrows and opens into a tight ring, through which removal of the head is not always possible. As a rule, this condition is caused by the obesity of the child - excessively developed subcutaneous fat tissue retracts the foreskin and reduces its elasticity.

A long proboscis lengthens the path for excretion of urine and smegma, resulting in favorable conditions for the growth of pathogenic microflora. Increased humidity in the preputial sac and accumulated secretions of the sebaceous glands are an ideal environment for the growth of bacteria. They damage the epithelium of the head and inner layer of the foreskin with the development of an inflammatory reaction - balanoposthitis. In children with diabetes mellitus, yeast fungi often multiply in the preputial sac, which is manifested by unbearable itching of the genitals and white cheesy discharge. Balanoposthitis often ends with the formation of a scar form of phimosis.

Another cause of pathology is underdevelopment of the penis against the background of the normal size of the foreskin. It is detected during the boy's puberty and is usually associated with insufficient production of testosterone by the testicles (hypogonadism). In this case, phimosis is combined with short stature, lack of muscle mass, female-pattern hair growth, lack of facial hair growth, high-pitched voice, and depression. Treatment of this condition is carried out jointly by a urologist and an endocrinologist or andrologist.

Scarred

Cicatricial phimosis is the most common form of the disease among adult men. Its causes are any conditions that lead to inflammation in the area of ​​the foreskin or glans. Among sexually transmitted infections, the most common cause of balanoposthitis with cicatricial phimosis is Treponema pallidum, the causative agent of syphilis and Trichomonas. Genital herpes virus, human papillomavirus and candida also often cause inflammation of the head. In children, cicatricial phimosis is rare and in approximately a third of cases it is not possible to determine the cause of the disease.

The disease progresses gradually. In the first weeks after inflammation, thin connective tissue bridges are formed, which slightly limit the mobility of the foreskin. In just a few months, they thicken significantly, becoming dense and rough. The mobility of the foreskin is reduced, the head remains closed even during an erection, and attempts to bring it out are accompanied by severe pain. Forced exposure of the head leads to small ruptures, bleeding and the formation of new scars.

The last degrees of phimosis disrupt the self-cleaning of the preputial cavity and the process of urination. Urine washes around the glans, mixes with the infected smegma, and flows back into the urethra after the man stops urinating. As a result, the patient develops urinary tract infections: urethritis, cystitis, pyelonephritis. In addition, cicatricial phimosis interferes with the normal course of sexual intercourse. There is a need for additional lubrication, the man receives insufficient stimulation and feels pain when the foreskin is stretched.

Treatment of pathological forms

Diagnosis and treatment of phimosis is carried out by a urologist, surgeon or andrologist. If the cause of the disease is a sexually transmitted infection, the patient is additionally observed by a dermatovenerologist, who prescribes antibacterial therapy. In this case, both partners must undergo treatment.

Treatment with a conservative method is carried out for the first two degrees of phimosis, if the adhesions are thin and arose no more than a month ago. In such cases, the patient is recommended to gradually stretch the foreskin after a hot bath. An anti-inflammatory ointment containing glucocorticoids (lokoid, hydrocortisone) and absorbable ointment contratubes is applied to the head of the penis. The head should be opened carefully, avoiding injury to the foreskin. After the procedure, local healing drugs (solcoseryl, bepanten, panthenol) are indicated.

The surgical treatment method is circumcision or circumcision. The operation involves the complete removal of the foreskin, leaving the head permanently open. The intervention is performed under general anesthesia in children and local anesthesia in adults. The surgeon first cuts and bends the outer layer of the foreskin, then carefully excises the adhesions in the preputial sac. After both leaves are isolated, he cuts them off along the coronal groove. The surgeon closes the resulting wound with absorbable suture material, that is, removal of sutures after surgery is not required. In the postoperative period, 1-2 dressings are performed and the patient is discharged home. Complete tissue healing occurs within 2-3 weeks and after this period you can resume sexual activity.

surgery for phimosis

Complications and prevention

The most common complications of phimosis are:

1. Pinching of the head (paraphimosis) - develops when trying to forcibly remove the head of the penis from the preputial cavity. A dense ring of foreskin compresses the tissue of the glans, it swells and increases in size. As a result, its reverse reduction becomes impossible, the blood supply to the tissue is disrupted, and without urgent medical care the situation ends in necrosis - necrosis of the strangulated part of the head.
2. Balanoposthitis is an inflammation of the foreskin and head of the penis.
3. Urethritis, cystitis, pyelonephritis - develop with grade 4 phimosis due to impaired urine flow.
4. Increment of the foreskin to the head - the most damaged areas, due to their tight junction with each other, heal with a single scar, which is not always possible to excise.

The most important preventative measures are:

• Careful hygiene of the genital organs, daily washing of the child and timely change of diapers or diapers;
• Use of barrier methods of contraception (condom) during casual sex;
• Treatment of underlying diseases (diabetes mellitus).

Phimosis– a condition characterized by narrowness of the foreskin, which leads to limited mobility. Thus, the first, and often the only, sign of phimosis is the inability to expose the head of the penis at rest and/or during erection.

The foreskin or prepuce in men is the fold of skin covering the head of the penis. The preputium is a specialized tissue, the structure of which is in many ways similar to the structure of the eyelids and labia in women.

The foreskin consists of two sheets that are attached to coronal sulcus located at the base of the head of the penis. The outer leaf is lined with thin skin epithelium, and the surface of the inner leaf is a mucous membrane.

Provides additional fixation of the preputium bridle, located on the underside of the glans and limiting the movement of the foreskin towards the base of the penis. The structure of the frenulum of the foreskin is in many ways similar to the structure of the frenulum of the tongue.

Typically, during an erection, the foreskin moves towards the base of the penis and exposes the head of the penis. In its normal state, the prepuce completely covers the head, so that the inner surface of the foreskin forms a preputial cavity (preputial sac) - a narrow gap between the head and the foreskin.
Thus, the foreskin performs a protective function, protecting the mucous membrane of the glans penis from drying out and adverse external influences. It is for this reason that when treating phimosis, doctors try to preserve this anatomical formation and resort to circumcision (removal of the foreskin) only in extreme cases.
How common is phimosis?
It should be noted right away that phimosis is a very common phenomenon and in many cases does not cause much concern to patients.

This is due to the fact that the head and foreskin are formed from the same tissue during intrauterine development. The development of the external genitalia continues until the end of puberty, so congenital physiological phimosis is observed in more than 95% of newborn male infants.

By the beginning of the second year of life, the head of the penis opens in only 20% of infants, and by the beginning of the third - in 50%. As a rule, spontaneous elimination of physiological phimosis occurs in preschool age (3-6 years).

However, it is far from unique that the head of the penis opens for the first time already during puberty, due to an increase in the level of sex hormones that help soften and stretch the skin of the foreskin.

Many peoples of the world have a common gene for predisposition to the persistence of physiological childhood phimosis into adulthood. So, for example, in some countries of Southeast Asia, phimosis in adult men is considered normal, except in cases where narrowing of the foreskin leads to painful symptoms.

And in the culture of Ancient Greece, a long and narrow foreskin was not only not considered a pathology, but was also perceived as a sign of beauty and masculinity. The exposed head of the penis was considered obscene because it was reminiscent of circumcision. Ancient frescoes depict the custom of artificially gradually lengthening the foreskin.
To do this, ancient Greek youths used a special leather tape - kinodesma, one end of which was attached to the foreskin, and the other was tied around the waist. Wearing a kinodesma was seen as a manifestation of special modesty and decency.

Classification of phimosis

• associated with the development of the glans penis and foreskin physiological phimosis in children;
• pathological phimosis.

According to the mechanism of development, hypertrophic and atrophic phimosis are distinguished.

Hypertrophic phimosis characterized by significant elongation of the foreskin (due to its very characteristic appearance, it is also called proboscis phimosis).

Statistically, hypertrophic phimosis is more common in obese boys, which is associated both with metabolic disorders and with the accumulation of fatty tissue in the pubic area.

About atrophic form of phimosis they say in cases where the foreskin, on the contrary, is reduced in volume and tightly fits the head of the penis. In this case, the preputial opening is narrowed and does not allow the head to pass through.

Causes of phimosis

The reasons for this anomaly have not yet been studied. The fact that phimosis occurs more often in some peoples than in others indicates the existence of a genetic predisposition to congenital phimosis.

Clinical studies have shown that congenital phimosis is often combined with other structural abnormalities of the connective tissue and musculoskeletal system, such as flat feet, scoliosis, and heart defects.

In children, a common cause of the development of pathological phimosis is injuries, including those received during grossly violent attempts by parents to “correct” physiological phimosis in little boys.

In such cases, adhesions form between the mucous membranes of the glans penis and the foreskin, leading to a narrowing of the preputial cavity and the development of secondary pathological phimosis.

And finally, a fairly common cause of phimosis in children and adults are infectious and inflammatory processes in the preputial sac, leading to the formation of a characteristic cicatricial phimosis.

Degrees of pathological phimosis

For phimosis first degree It is possible to freely remove the head of the penis in a calm state, but during an erection, exposure of the head is difficult or painful.

ABOUT second degree phimosis is said to occur when difficulty exposing the head occurs even at rest. During an erection, the head is either completely hidden under the foreskin, or only a small part of it is exposed, often swelling in the form of a ball.

At third degree phimosis, it is no longer possible to move the head of the penis beyond the preputial ring.

Fourth degree phimosis is characterized by such a sharp narrowing of the foreskin that it causes difficulty urinating.

It should be noted that it is customary to talk about the first to third degrees of pathological phimosis when the patients are adults or adolescents. As for the fourth degree, normally in childhood physiological phimosis the preputial cavity has an opening sufficient for the free passage of urine.

Therefore, signs such as filling of the preputial sac during urination and/or narrowing of the urine stream, even if they occur in early infancy, clearly indicate pathology and require emergency medical intervention.

Symptoms of pathological phimosis in adults

• pain during sexual intercourse (with phimosis of the first or second degree);


• premature ejaculation;


• decreased intensity of sexual sensations during intercourse;


• decrease in potency.

At the same time, it is not uncommon for men with severe phimosis to experience absolutely no problems sexually.

What is the danger of asymptomatic phimosis in adults?

Unfortunately, phimosis poses a significant threat to the health of an adult man. The fact is that the cells of the mucous membrane of the inner leaf of the prepuce secrete a special secretion that has a rather complex composition (fats, bactericidal substances, pheromones (exciting substances), etc.). This secretion is the main part of smegma (translated from Greek as “sebum”), which also includes dead epithelial cells and microorganisms.

The activity of cells of the glandular epithelium of the foreskin increases during puberty (maximum smegma formation occurs at the age of 17-25 years) and progressively decreases in older men.
Normally, smegma protects the mucous membranes of the glans penis and the inner surface of the foreskin from drying out, and also acts as a natural lubricant during sexual intercourse.

However, the secretion of the glands of the mucous membrane of the inner layer of the foreskin is an excellent living environment for many pathogens. Therefore, stagnation of smegma in the preputial sac can cause the development of infectious and inflammatory diseases, such as balanitis (inflammation of the mucous membrane of the glans penis) and balanoposthitis (combined inflammation of the mucous membranes of the glans penis and the inner layer of the foreskin).

In addition, according to many studies, with prolonged stagnation of smegma, carcinogenic substances are formed and accumulate in it, which contributes to the development of cancer in men (papillomas of the glans penis, penile cancer) and their sexual partners (cervical cancer).

In childhood, cleansing of the preputial sac occurs independently, since the amount of smegma secreted is small. To prevent the development of complications, adult men must follow the rules of hygiene, that is, perform a daily toilet routine, which consists of washing the foreskin and glans penis with warm water and soap.

With phimosis, this procedure is usually difficult. Thus, the narrowing of the foreskin in adults contributes to the accumulation of smegma in the preputial sac.

Even in cases where phimosis does not manifest itself with any unpleasant symptoms, doctors advise taking care of eliminating the pathology, since, in addition to the danger of developing infectious-inflammatory and oncological diseases, one should also take into account the possibility of developing such a serious complication as paraphimosis.

Paraphimosis as a severe complication of phimosis in adults

The head, caught in a tight ring of narrowed foreskin, swells, and the pressure of the ring increases. Thus, a vicious circle is created: the circulatory disturbance caused by strong compression increases the swelling of the head, and the swelling increases the pressure on the head of the foreskin ring.

In adult men and adolescents, paraphimosis most often occurs during sexual intercourse or masturbation. It should be noted that this complication is typical only for phimosis of the first or second degree, since more severe forms of phimosis simply do not allow the possibility of exposing the glans penis.

Clinically, paraphimosis is manifested by acute pain, the head of the penis swells and becomes bluish. Over time, the intensity of the pain syndrome decreases due to severe circulatory disorders. In advanced cases, the strangulated head becomes purple or black.

Severe and prolonged circulatory disorders can lead to deep necrosis (death) of the tissues of the foreskin and glans penis. Therefore, paraphimosis is an extremely dangerous complication that requires immediate help.

First aid for paraphimosis in men is to immediately seek specialized medical help. In the early stages of the development of paraphimosis, doctors can perform manual reposition of the glans penis (this manipulation is very painful, so it is performed after the administration of narcotic analgesics). In more severe cases, they resort to cutting the foreskin ring.

Physiological phimosis in children

At such a tender age, for most boys, the inner layer of the foreskin is fused to the head of the penis. It is for this reason that you should never try to forcibly expose the head - this will lead to erosion of the inner surface of the preputial cavity, the development of an inflammatory process and the occurrence of secondary pathological phimosis.

The well-known children's doctor Komarovsky rightly asserts that in 99 cases out of 100, complications of physiological phimosis in children are associated with rude and illiterate intervention carried out by the parents themselves on the advice of relatives, neighbors and even, sadly, doctors.

If nothing bothers the boy (no problems with urination, pain, itching, etc.), no additional measures should be taken to correct phimosis. It is only necessary to perform a regular toilet every day, washing the perineum and genitals with water. It is best to use soap no more than once every three to four days, avoiding it getting into the preputial sac.

Separation of the mucous membranes of the glans penis and the inner layer of the foreskin occurs due to the gradual desquamation of epithelial cells. This is a fairly slow process that should not be artificially stimulated.

The exfoliated epithelial cells form the basis of the so-called children's smegma, which, accumulating, slowly moves towards the exit and is excreted in the form of grains along with urine. Unlike adult smegma, children's smegma does not pose a risk for the development of infections and cancer.

Physiological phimosis itself performs an important protective function; it protects the delicate, unformed epithelium of the glans penis and the inner layer of the foreskin from external aggressive agents.

Until what age can phimosis in a boy be considered a physiological phenomenon?

If we focus on clinical data, then the probability of self-elimination of physiological phimosis in a five-year-old boy is 90%, at the age of 10 years - 83%, and by the age of thirteen it decreases to 33%.

Many pediatricians advise parents to take a wait-and-see attitude before reaching puberty: if there are no alarming symptoms, it is best to wait, since phimosis can be treated at an older age.

It should be noted that the persistence of phimosis by the age of 11-13 may be associated with a low level of male sex hormones in the blood, which have a beneficial effect on the process of softening and stretching of the foreskin.

In addition, it is necessary to distinguish congenital physiological phimosis from secondary phimosis resulting from any infectious and inflammatory diseases.

Of course, only a specialist can make such a diagnosis. But in cases where the child has already experienced an opening of the head of the penis, and then a narrowing of the foreskin occurs, we are most likely talking about pathological phimosis.

Can physiological phimosis cause problems in boys and what to do in such cases

In cases where the severity of unpleasant symptoms is insignificant (itching, slight redness, restlessness of the child), you can try to eliminate the problem yourself. Many pediatricians recommend washing the preputial cavity with a warm solution of furatsilin using a regular ten-millimeter syringe.

The procedure is as follows:

• Draw a warm solution of furatsilin or ectericide into the syringe;


• Pull the skin up without exposing the head;


• Insert a syringe without a needle into the resulting gap (it is more convenient to carry out this manipulation together, so that one person retracts the foreskin, and the other performs actions with the syringe);


• Release the solution from the syringe under pressure, flushing out any accumulated secretions.

If a child has an increased tendency to allergic reactions (exudative diathesis, atopic dermatitis, etc.), unpleasant symptoms may be associated with exposure to allergen substances excreted in the urine or with their contact effect on the skin.

• if possible, eliminate the suspected agent (review the menu, medications taken, antibiotics, vitamins, diapers used, household chemicals, etc.);
• avoid exposure to chemicals on the skin;
• increase the amount of fluid consumed to quickly “wash out” allergens from the body.

Even in cases where phimosis in a boy was unconditionally recognized as physiological, you should immediately consult a doctor if the following alarming symptoms appear:

• problems arise with urination (difficulty urinating, pain, etc.);


• there are pronounced signs of inflammation (swelling and redness in the foreskin, pain).

Complications of phimosis in children requiring specialized medical care

• balanoposthitis;
• paraphimosis;
• urinary retention.

Balanitis, posthitis and balanoposthitis in children

Balanoposthitis– combined infectious and inflammatory lesion of the glans penis and foreskin.

These diseases occur several times more often in boys than in adult men. The latter circumstance is connected precisely with the physiological characteristics of the structure of the child’s male genital organ.

In addition to physiological phimosis, important predisposing factors to the development of inflammatory processes in the area of ​​the glans penis in children are:

• diabetes mellitus (high sugar content in the urine contributes to the development of infection in the preputial cavity);
• obesity (metabolic disorders, deterioration of conditions for personal hygiene);
• vitamin deficiency (decreased overall body resistance).

• injury received during a crude attempt to expose the head of the penis;
• acute allergic reaction (excretion of food or drug allergens in the urine or direct contact with the allergen (diapers, cosmetics, soap, washing powder, etc.));
• overheating;
• severe hypothermia, which can cause a sharp decrease in immunity;
• external injury, including from uncomfortable clothing (panties that are too tight with a seam in the middle, injury from a snake, etc.).

The symptoms of the disease are quite characteristic:

• redness and swelling in the foreskin (posthitis);
• through the hole you can see the hyperemic area of ​​the head (balanitis);
• pain that increases with urination (irritant effect of urine on the inflamed tissue of the head and foreskin);
• itching and discomfort;
• serous or serous-purulent discharge.

If you suspect an infectious inflammation of the glans penis and/or foreskin, you should immediately consult a doctor who will prescribe the necessary treatment.

With relapses of the disease, as well as in the case of secondary phimosis, the question of surgical treatment may arise.

Paraphimosis in children

The clinical picture and complications of phimosis in boys are the same as in adult men. Characterized by very severe pain, redness and rapidly progressing swelling of the glans penis. Untimely or inadequate medical care can lead to irreparable consequences in the form of necrosis of areas of the foreskin and penis.

First aid for paraphimosis in children. There are a lot of tips online for how to straighten the head on your own (applying cold to reduce swelling, using oil, etc.). Of course, a lot depends on the severity of paraphimosis (severity of swelling and pain) and the child’s mental state.

But it is wiser not to follow such advice. Reduction of the glans penis in case of paraphimosis is a very painful procedure, which in medical institutions is performed under anesthesia (in pediatric practice, intravenous anesthesia is used, which implies a short-term but complete loss of consciousness).

So it is best not to waste precious time and not to abuse the child, but to seek medical help as soon as possible. In such cases, patients are transported in a supine position with legs apart.

Difficulty urinating

In addition, in such cases, children often complain of pain and discomfort during urination. They begin to avoid going to the toilet, which leads to the development of secondary enuresis (daytime and nighttime).
Difficulty urinating in infants is manifested by restlessness, crying and severe straining when urinating.

This pathology leads to increased pressure in the urinary tract, which is fraught with serious complications. Therefore, difficulty urinating is an indication for emergency elimination of phimosis.

Medical tactics in the treatment of pathological phimosis

• gradual daily manual stretching of the foreskin;


• the use of special devices that stretch the foreskin;


• drug treatment of phimosis (use of steroid ointments that help soften and stretch the tissue of the foreskin).

This disdainful attitude was greatly facilitated by the fact that many patients self-medicate without consultation with professionals and often make gross mistakes leading to serious complications (paraphimosis, infectious and inflammatory diseases of the foreskin).

In addition, it is often not taken into account that cicatricial forms of phimosis are an absolute contraindication to the use of conservative methods. The fact is that scar tissue does not stretch, so all attempts to eliminate phimosis are doomed to failure.

Meanwhile, there is evidence of the effectiveness of conservative methods in many patients, even with the second or third degree of congenital phimosis.

An important positive aspect of all non-surgical methods of treating phimosis is the “naturalness” of their effects, since they actually repeat the mechanism of physiological self-elimination of age-related phimosis.

In addition, conservative methods of treating phimosis make it possible to fully preserve the absolutely important functions of the foreskin and avoid unpleasant side effects and complications.

Thus, in the absence of contraindications, conservative methods may well be used as a useful alternative. Of course, treatment should be carried out after consultation with a specialist and under the supervision of a doctor.

However, in cases where it is necessary to achieve rapid and radical elimination of phimosis for medical reasons (for example, with phimosis of the fourth degree) or for personal reasons, it is better to give preference to surgical intervention.

Non-drug conservative treatment of phimosis. Tension methods.

As a result, a hypothesis was put forward about the possibility of eliminating congenital phimosis by gradually stretching the foreskin and special methods for conservatively eliminating the pathology were developed.

The general rules of these techniques are:

• mandatory preliminary consultation with a professional and subsequent medical supervision;
• gradual stretching (in no case should pain be allowed);
• regularity of manipulations.

There is evidence that it is possible to eliminate phimosis of the first or second degree with the help of exercises to expose the head in just three to four weeks.

Method foreskin stretching consists of daily pulling the foreskin onto the head of the penis during the morning shower, as well as after urination until pain appears.

This method is often used when the self-elimination of phimosis in childhood is delayed. In such cases, it is quite effective, but the duration of treatment largely depends on the type of phimosis and can reach 3-4 months for hypertrophic (proboscis) phimosis.

Method finger sprain consists of carefully inserting the fingers into the preputial cavity and gradually spreading them apart.

According to some data, the effectiveness of the methods described above for congenital phimosis reaches 75%.

Treatment of phimosis with ointments (drug treatment of phimosis)

• softening and increasing the elasticity of the foreskin;


• reducing the severity of inflammatory reactions (drugs in this group are called steroidal anti-inflammatory drugs).

Drug therapy is especially indicated for children and adolescents (recommended by the American Association of Pediatrics), since it is at this age that there is the greatest chance of eliminating congenital phimosis using conservative methods.

However, it should be borne in mind that such ointments are not suitable for everyone. So, for example, a contraindication to the local use of corticosteroid drugs is the presence of a bacterial, viral or fungal infection - both acute and chronic.

Long-term use of drugs can cause unpleasant side effects (thinning of the skin, hyperpigmentation, disruption of the structure of superficial vessels), and with uncontrolled use, the systemic effect of corticosteroids may occur, which is fraught with dangerous complications.

Therefore, ointments with corticosteroids can be used only after a thorough examination and consultation with a specialist who has sufficient experience in treating congenital phimosis with this method.

Of course, individual selection of the drug and dose of the drug is necessary, as well as constant medical monitoring of the results of therapy.

Traditional methods of treating phimosis

However, some favorite remedies of traditional healers are widely used as an aid. We are talking about herbal decoctions that have anti-inflammatory, bactericidal and softening effects, such as:

• chamomile;
• calendula;
• series.

Steaming the skin of the foreskin in a bath with a decoction of medicinal herbs for 15-20 minutes promotes effective, painless and safe stretching.

This kind of preliminary procedures is especially recommended for children and adolescents.
During the treatment of phimosis, you can alternate decoctions of various medicinal herbs or use a collection of medicinal plants for decoction.

The only contraindication to the use of traditional medicine as an adjuvant in the treatment of phimosis may be individual intolerance or allergies (which are extremely rare).

Surgical treatment of phimosis

Elimination of phimosis using a bloodless method

First, a special probe is inserted into the prepuce cavity, which is used to separate the synechiae (adhesions) formed between the head of the penis and the inner layer of the foreskin. To do this, carefully move the probe inward to the coronary sulcus and make slow movements clockwise.

Then the opening of the foreskin is expanded using a Pean clamp: the ends of the clamp are inserted into the hole and the jaws are separated.

Often two or three such manipulations are enough to completely eliminate phimosis. In cases where no positive dynamics are observed, more invasive surgical intervention is indicated.
After sessions of bloodless elimination of phimosis, it is necessary to follow all the surgeon’s recommendations in order to prevent fusion of the mucous membranes of the foreskin and the head of the penis.

Anti-relapse measures are indicated for a month: daily manual opening of the foreskin and washing of the preputial cavity with a weak solution of potassium permanganate. If this manipulation is too painful or unpleasant for the child, it can be performed once every two to three days, but not less often.

Surgical interventions for phimosis

Surgical interventions for phimosis are most often performed under local anesthesia; indications for the use of general anesthesia may be:

• the patient’s age is too young;
• increased emotional lability;
• individual intolerance to drugs used for local anesthesia;
• personal desire of the patient.

After surgery, you may experience discomfort in the area of ​​the surgical wound for several days, but, as a rule, you can manage without taking additional painkillers.

In cases where there is a need to remove sutures, this manipulation is performed 7-10 days after surgery. Before removing the sutures, it is necessary to change the dressings every other day and ensure that urine does not come into contact with the postoperative wound.

As a rule, the patient can have sex within two weeks after the operation. Until this time, it is advisable to wear tight underwear that provides additional support for the penis.

Circular excision of the foreskin

Circular excision of the foreskin, which in medicine is more often called circumcision, and “in the world” - circumcision, is the most common operation to eliminate pathological phimosis.

Important positive aspects of this surgical intervention are the speed of elimination of all unpleasant symptoms and the absence of relapses (this is the only surgical intervention for phimosis that provides 100% effectiveness).

The only but significant drawback of the method is the complete elimination of the foreskin, and, consequently, the irreversible loss of all the functions it performs. However, it should be taken into account that millions of men in the world undergo circumcision every year for religious reasons and do not suffer at all.

Circumcision is the only method for cicatricial phimosis, as well as for the fourth degree of phimosis, paraphimosis and recurrent balanoposthitis (the operation is performed after the elimination of the acute process).

Foreskin plastic surgery for pathological phimosis

So, with prepucioplasty, unlike circular excision of the foreskin, the foreskin is not completely removed, since a much smaller incision is made.

Another common method of foreskin plastic surgery is called the Schloffer method. During the operation, the surgeon makes not a straight, but a zigzag incision, and then stitches the edges in such a way as to significantly widen the hole while preserving the foreskin.

In addition, methods of foreskin plastic surgery according to Roser, spiral foreskin plastic surgery, etc. are quite widely used.

The general disadvantages of this type of operation include a longer recovery period, the possibility of relapses and a relatively short list of indications. So, for example, operations with partial preservation of the foreskin cannot be performed on patients with severe cicatricial forms of phimosis.

Laser treatment of phimosis

With the help of a laser, it is possible to perform both operations for circular excision of the foreskin (laser circumcision) and plastic surgeries that preserve the foreskin.

Laser surgery is characterized by high precision incisions, so that damage to surrounding tissue is minimal.

In addition, laser beams cut tissue, simultaneously cauterizing blood vessels, and have a bactericidal effect.
Thus, laser surgery has the following advantages:

• safety (there is no risk of bleeding or infection of the surgical wound);
• less severe pain syndrome;
• short recovery period.

Compared to conventional surgery, the postoperative period with laser correction of phimosis is more comfortable (there is virtually no tissue swelling, there is no need for dressings, suture removal, etc.) and lasts only three to four days. However, doctors do not advise starting sexual activity earlier than two weeks after the operation.