From the Guidelines
Phimosis is a condition where the foreskin of the penis cannot be retracted over the glans, often requiring treatment to prevent complications such as recurrent infections or difficulty urinating. According to the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1, treatment for phimosis caused by lichen sclerosus (LS) involves the use of ultrapotent topical steroids, and if this fails, referral to an experienced urologist for circumcision may be necessary. The guidelines recommend offering all male patients with phimosis caused by LS who do not respond to an ultrapotent topical steroid after 1–3 months referral to an experienced urologist for circumcision.
Some key points to consider in the management of phimosis include:
- Gentle stretching exercises during bathing and application of topical steroid creams like betamethasone 0.05% twice daily for 4-6 weeks can help loosen the foreskin 1
- Keeping the area clean by gently washing with warm water
- Avoiding forcibly retracting the foreskin in young boys as this can cause scarring and worsen the condition
- Seeking medical attention if there is pain, swelling, discharge, or difficulty urinating, as these may indicate complications requiring prompt treatment
It's worth noting that phimosis is common in young boys and often resolves naturally by puberty, so intervention isn't always needed. However, in adults, phimosis is usually pathological and may require treatment. The condition occurs because the foreskin tissue becomes tight or scarred, preventing normal retraction.
In terms of treatment outcomes, a prospective study completed by 111 boys with phimosis using betamethasone for 1 month, documented that 80% had normal retractability of the foreskin after this time, 10% proceeded to circumcision as treatment failures and 10% required ongoing topical treatment 1. This suggests that topical corticosteroids can be an effective treatment for phimosis, especially in cases where the condition is caused by LS.
The most effective treatment approach for phimosis is to use ultrapotent topical steroids for 1-3 months, and if this fails, consider referral to an experienced urologist for circumcision. This approach is supported by the British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018 1, and is consistent with the goal of minimizing morbidity, mortality, and improving quality of life for patients with phimosis.
From the Research
Definition of Phimosis
- Phimosis is defined as the inability to completely retract the foreskin and expose the glans 2
- It can be characterized as unretractable foreskin without adherences or a circular band of tight prepuce preventing full retraction 3
Causes and Types of Phimosis
- Phimosis can be primary or secondary, with secondary phimosis often resulting from previous forcible foreskin retractions 4
- The condition can be classified into different grades, with grade 1 being the mildest and grade 5 being the most severe 5
Symptoms and Diagnosis
- Symptoms of phimosis may include difficulty retracting the foreskin, pain, and urinary tract infections 6
- Diagnosis is typically based on physical examination and medical history, with classification of the phimosis grade according to the Kikiros and Woodward classification system 5
Treatment Options
- Topical steroid therapy is a common treatment option for phimosis, with studies showing success rates of 69.4% to 90% 6, 5, 4
- Other treatment options include stretching exercises, preputioplasty, and circumcision, with the choice of treatment depending on the grade of phimosis, patient age, and other factors 3, 2