Phimosis – Wait & Watch or Treat?

Dr. Hall’s Answer:

Concerns about a boy’s penis are often troubling to parents, as are concerns about the use of steroids. You are unfortunately having to deal with both issues at once!

There is a common condition called phimosis, which is a constriction of the opening of the foreskin so that it cannot be drawn back over the tip of the penis. Usually this goes away on its own at some point during early childhood, with no lasting problems at all. But it is important to understand that there are two types of phimosis, physiologic and pathologic.

Pathologic phimosis is typically described as a foreskin that cannot be pulled back over the head of the penis, due to scarring or stricture of the foreskin. On the other hand, physiologic phimosis is a nautrally-occurring phenomenon in uncircumcised male infants. It is caused by adhesions, which are connections of tissue between the foreskin and the skin of the head of the penis. Typically, as the child begins to grow, these adhesions disappear due the natural occurrence of erections during sleep or by manipulation with washing.

Steroid cream may be recommended in the case of pathologic phimosis as a first option, before considering a surgical repair. Steroid cream may also be recommended for the child with physiologic phimosis that persists beyond three years of age. The steroid creams acts to help loosen the adhesions and break down scar tissue and most children experience no side effects or unwelcome consquences. The cream is usually used in combination with gentle attempts to retract the foreskin during bath-time. It is important to stress gentle attempts at retraction, as forceful retraction can cause tears and scarring, which lead to further phimosis.

The natural resolution of physiologic phimosis is highly variable, so an approach of watchful waiting could also be considered. However, if there is already scarring present, or the cause of the phimosis is due to infection and inflammation (pathologic phimosis), time alone will not lead to resolution. It can be valuable to discuss the issue, including your concerns, with your pediatrician at your next visit, and determine which treatment option is best for your family.