Phimosis

Question 1

What does phimosis involve?

Answer 1

The narrowing of the distal foreskin leading to an inability to retract it

Question 2

What other condition is phimosis commonly associated with?

Answer 2

Balanitis xerotica obliterans (BXO) - a chronic, sclerosing inflammatory condition of the glans penis and foreskin
Considered male genital form of lichen sclerosis.
Cause not fully understood, autoimmune basis.

Question 3

Is foreskin always retractile?

Answer 3

No, commonly at birth is naturally adheres to the glans and gradually becomes retractile. Normally spontaneously resolves by age 3-7 years.

Question 4

If phimosis is severe, it may require…

Answer 4

circumcision

Question 5

What are clinical features of phimosis?

Answer 5

Difficulty retracting foreskin
Ballooning during micturition (urine is trapped)
Irritation and dysuria
Recurrent infections
Sexual dysfunction

Question 6

What are complications of phimosis?

Answer 6

Recurrent balanitis
Paraphimosis

Question 7

How is physiological phimosis managed?

Answer 7

Most cases resolve naturally (reassurance and education)
Gentle retraction during bathing (don’t be forceful)
Emollients to aid natural separation.

Question 8

How is pathological phimosis managed?

Answer 8

Topical corticosteroids eg betamethasone
Applied BD for 2 weeks

Definitive treatment is circumcision
In selected cases, prepuceplasty

Question 9

When does paraphimosis typically occur?

Answer 9

When a patient’s foreskin is left retracted eg after catheterisation, causes impaired venous return, venous hypertension and then impaired arterial supply to the glans.

Question 10

What are typical features of paraphimosis?

Answer 10

Swollen, oedematous glans and foreskin with significant pain

Question 11

How is paraphimosis managed?

Answer 11

Urgent correction by manually replacing the foreskin to restore normal venous drainage and arterial supply.

Question 12

What should be done if a diabetic presents with recurrent balanitis?

Answer 12

Screen for uncontrolled blood sugar