Phimosis in boys treatment without surgery. Elimination of phimosis by a bloodless method. Paraphimosis as a severe complication of phimosis in adults

Almost all newborn male babies have such a disorder as phimosis. Before taking any action, you need to figure out what the nature of phimosis in boys is and what it threatens.

Physiological phimosis is the age norm in male babies of the first years of life and does not require special treatment. It is enough to follow the basic rules of hygiene, regularly change underwear, do not use detergents and hygiene products that can cause allergic reactions.

The fight against pathological phimosis

Pathological phimosis requires a completely different approach, here you can not do with herbs and clean linen alone. There are two main methods of getting rid of the disease: conservative (drug) and surgical.

In the case of hypertrophic forms of phimosis, the method of gradual stretching of the foreskin is used. It is possible to carry out manipulations at home, special skills are not required. Three times within seven days, the child should be bathed in decoctions of chamomile and string, which have anti-inflammatory and disinfectant properties. Then the flesh moves away, opening the head, until the child feels pain. After that, a few drops of vaseline oil should be sprinkled into the opened space. It must be sterile! The duration of such treatment is several months. The procedure must be carried out very carefully so as not to harm the baby.

Modern medicine offers a large number of hormonal ointments designed to treat phimosis. They are also placed in the opened preputial space. Such therapy should take place under the strict supervision of a physician.

The result of non-surgical therapies depends on the responsibility of the parents, the regularity of the procedure and the degree of the disease.

In the case of diagnosing cicatricial phimosis, this method of dealing with the disease will not work, it will not work. In case of scarring, surgical methods are used. The operation is prescribed only if the baby is in full health, colds and other diseases must first be cured.

Surgical intervention is indicated only in cases where other methods fail, or bring temporary relief (inflammatory processes occur again and again) and is carried out in the manner prescribed by the plan.

The work of surgeons takes place under general anesthesia and lasts about 15 minutes. The essence of the operation is to circumcise the foreskin, but with the preservation of the frenulum, the head always remains open as a result. Rehabilitation takes some time and requires compliance with certain hygiene standards, but after a few hours the boy is allowed to move and go to the toilet on his own.

Complications after surgical interventions are extremely rare and account for less than 0.3% of the total. More often they are associated with the fact that the head of the penis is deprived of natural protection and is exposed to all kinds of infections. As a result, inflammation appears, their chronic form is called meatitis.

In the future, the method of treatment does not affect the intimate life and its male viability.

Is phimosis dangerous if left untreated

Like any disease, phimosis should be treated. If the development of the disease is left to chance, then as the boy grows, it will lead to serious and sad consequences. Among them are complications such as the presence of constant inflammation, male failure, cancer, psychological problems, the development of complexes, sepsis, etc.

Prevention measures for phimosis in boys

Despite the seriousness of the consequences, the prevention of this problem is quite simple.

There are no measures to prevent the occurrence of physiological type phimosis. A person cannot influence his appearance. Enough elementary hygiene, preventing the occurrence of inflammation, infection of the foreskin.

There is nothing complicated in the prevention of hypertrophic phimosis. Boys who have reached the age of three must be shown to a surgeon or urologist.

If a child shows you with words or gestures that it hurts to write, be sure to visit a doctor.

The most effective method of preventing the problem is personal hygiene. Wash the penis along with the foreskin every time the boy went to the toilet. A “frivolous” at first glance, the procedure will avoid the accumulation of bacteria and will not allow inflammation to develop.

While bathing boys, special means for intimate care should be avoided. The components of such gels disrupt the natural microflora and reduce the natural level of protection.

It is very important to regularly change underwear, giving preference to panties made from natural fabrics. The material does not cause irritation.

Phimosis is an unpleasant problem, but it is completely removable. There is no need to give up if your son has been diagnosed with this. According to experts, physiological forms are not dangerous and are acceptable. These are just structural features of the boy's intimate organs.

Hypertrophic phimosis is more dangerous, but with proper and timely therapy, it completely disappears and leaves no traces behind.

It is important to understand: it is extremely difficult to independently diagnose phimosis and its type. If you have any doubts, it is better to consult a doctor. Remember, the foreskin in children is a very delicate and vulnerable area of ​​the skin. Any impact on it should be controlled by specialists, so as not to harm. Improper treatment or outside physical intervention can lead to injury, deformation and death of the head.

Do not disregard your child's complaints about discomfort in the intimate area, make sure that the foreskin is of a natural color and does not have swelling, contact specialists in time.

Every parent should be aware that the male strength and viability of their child in the future depends entirely on the state of health in childhood.

Types of the disease and the causes of its occurrence

Phimosis in a child is a pathology in which the head of the penis cannot open at all or opens with difficulty, accompanied by pain. The disease is of two types and appears for different reasons.

The first group of boys has physiological foreskin phimosis. It arises as a result of processes laid down by nature. Babies have adhesions on the foreskin that have a protective function. They prevent infection and infection of the genital organs. This type of pathology does not require any intervention, it goes away on its own as the child grows. The adhesions weaken and disappear, and the foreskin is freely retracted.

The other half of male newborns have pathological phimosis, it requires more serious therapy and does not allow any initiative. This phimosis is divided into two subspecies:

• cicatricial;
• hypertrophic.

Cicatricial phimosis is characterized by the appearance of keloids and scars on the penis that make it difficult to remove the head.

A characteristic sign of hypertrophic phimosis is excess skin that does not allow the glans penis to open freely.

Pathological phimosis is characterized by several stages, it is possible to determine them only after puberty. On average, 13-15 years. There are only four stages and they are classified as follows:

1. Phimosis manifests itself only at moments of sexual arousal, in a calm state, the foreskin almost completely opens, exposing the head.
2. There are some problems with the opening of the glans penis in an aroused state and some difficulty with exposure in a calm state.
3. The head of the penis does not open in any condition, but urination is painless and does not cause any discomfort.
4. The head of the penis remains closed by the foreskin in any condition, urination is accompanied by painful sensations. Before going out, a kind of bubble forms from the urine. Subsequently, urine comes out in a thin stream.

Causes of the disease

If a baby is diagnosed with phimosis, then the first question of parents is often related to where it came from and what to do next. The causes of the onset of the disease can be varied, but more often they are associated with such phenomena as: various inflammatory processes affecting the head and foreskin of the penis, failures at the genetic level during the formation of the genital organs, various external injuries of the head and penis.

Diagnosis of the disease, symptoms

A surgeon can diagnose the disease. As a rule, this diagnosis is made on the basis of an external examination, complaints of the crumbs and parents, and the presence of concomitant symptoms. In most cases, additional medical or instrumental examinations are not required. They are addressed only in cases where there are prerequisites or suspicions of more serious pathologies.

Quite often, people go to the doctor when the disease is quite advanced. To avoid unpleasant consequences, you should pay attention to the appearance of symptoms characteristic of phimosis. There are not very many of them, it will not be difficult to trace the occurrence of signs.

The main and most significant symptom is difficulty opening the glans penis. Children often become restless, constantly touching their reproductive organs (due to discomfort, itching, etc.). When the baby pees, he strains a lot, urine is excreted in a small amount, sometimes in the form of drops. Also, phimosis is sometimes accompanied by an increase in body temperature, an increase in lymph nodes, and the release of a certain amount of pus from the penis.

If you notice one or more signs of illness in your little man, immediately consult a doctor. He is able to refute suspicions or confirm them and prescribe adequate treatment.

Komarovsky's opinion

Phimosis in young boys is noticed by many parents, but not all adults know that it is important to constantly monitor the condition of the genitals. The head of the penis is closed by the foreskin, attempts to open it cause pain. Sometimes duplication of the skin is so dense that serious urological problems appear, inflammatory processes develop.

Parents of a newborn boy should know what to do if the baby does not expose the glans penis. Panic and confusion are bad helpers after identifying a delicate problem. According to statistics, physiological phimosis in children occurs in more than 90% of boys under 1 year old. The article describes the causes, types, methods of treatment of phimosis in boys of different ages.

general information

Disputes about the benefits and harms of the foreskin have been going on for a long time. The scientific community holds two opposing points of view:

• Proponents of circumcision believe that the duplication of skin covering the head of the penis is an area where bacteria accumulate. Uncircumcised men are more likely to suffer from inflammatory diseases. Excess tissue must be disposed of as an unnecessary rudiment;
• Opponents of circumcision are convinced that inflammation of the genital tissues is not associated with the presence of skin folds near the glans penis, but with insufficient hygiene of intimate places. Doctors believe that circumcision is inappropriate for two reasons. First - the foreskin protects the delicate mucous membrane of the head of the penis. The second - the sensitivity of an important area is preserved.

According to statistics, in 95-96% of newborn boys, the head of the penis opens poorly in the first months of life. Hypertrophic phimosis often develops when there is too much tissue. Many parents call this phenomenon "proboscis on the penis." The name is quite funny, but there is no reason to laugh: the phenomenon requires a serious attitude on the part of parents. Often "proboscis phimosis" occurs with a high degree of obesity.

Causes

Why does the foreskin of most babies tightly fit the head of the penis, does not open well? Parents often think that their child's problem is their fault. Most often, phimosis in newborns and young children is a physiological phenomenon. Sometimes congenital phimosis is caused by genetic disorders. Often, doctors cannot identify the exact cause of pathological changes.

The acquired form develops as a result of the transferred inflammatory processes of the genitourinary system:

• balanitis;
• fasting.

Diseases often develop with insufficient / improper hygiene of the baby's genitals. Urine residues, skin secretions, skin particles accumulate without timely removal, creating an excellent environment for the development of the inflammatory process. Bacteria thrive in the folds of the skin.

Parents should remember that the toilet of the genital organs in boys is carried out daily in compliance with the rules that the pediatrician will tell about. It is important to gently but thoroughly rinse the penis, but it is forbidden to pull back the foreskin sharply. To prevent inflammatory processes will help bathing the baby in water with the addition of a decoction of chamomile or string.

Other reasons:

• uncomfortable clothes, strongly squeezing, rubbing the genitals;
• insufficient amount of connective tissue in the body;
• penis injuries due to inept actions of parents while bathing a newborn boy.

Degree of illness

In most cases, the phenomenon is considered physiological (normal), after a certain period it disappears without a trace. If the foreskin has not become more elastic over time, they speak of pathological phimosis. After 4 years, surgery is performed to prevent problems with urination and erection in the future.

In the first degree of phimosis, the foreskin can only be opened when the penis is at rest. With the most severe, fourth degree of pathology, the head is completely hidden under the duplication of the skin, urine constantly accumulates under the folds, inflammation of the tissues develops.

Signs and symptoms

Parents should contact a urologist if they find the following signs of phimosis:

• problems with urination. During the process, the kids push hard, cry. Urine does not come out in an active stream, accumulates in the skin "pouch", gradually flows out drop by drop;
• the foreskin becomes inflamed, it itches a lot, with strong squeezing, swelling of the tissues turns blue;
• the head of the penis in an infant does not open at all during the toilet of the genitals;
• older boys complain of pain during erection.

Diagnostics

It is easy to identify the problem with a visual inspection. Analyzes, additional studies in most cases are not needed.

A pediatric urologist will examine the baby, determine the degree of phimosis. With a physiological form, treatment is not carried out. If after four years the elasticity of the foreskin has not returned to normal, an operation is performed to completely or partially remove the foreskin.

Important! When identifying problems with urination, complaints of pain in the genital area, be sure to show the boy to the doctor. Small children cannot describe negative sensations, but they will definitely show the problem area with their finger in response to the question: “Where does it hurt?”

Basic Treatments

How to treat phimosis? The approach to therapy depends on the form of phimosis. With a physiological phenomenon, doctors monitor the condition of the genital organs of a small patient, prescribe a local treatment to increase skin elasticity and prevent inflammation. The doctor will explain to parents how to treat phimosis in boys at home.

Even at 3 years old, only 20% of boys have the glans penis exposed without problems. If there is no progress by four years, surgical treatment is performed.

The main types of treatment:

• without the use of medicines. Parents twice a week, by a millimeter, pull the foreskin from the baby in compliance with certain rules. The procedure requires permission from a pediatric urologist;
• drug therapy. An ointment with glucocorticosteroids will help to increase the elasticity of the duplication of the skin. The use of a hormonal drug prevents inflammation, heals microcracks. Betameson, Clobetasol is suitable for young children;
• surgical intervention. Classical circumcision, separation of adhesions, operation according to the Schloffer method. With balanoposthitis, circumcision (traditional circumcision) is prohibited.

Only a pediatric urologist will choose the right method of treatment, taking into account the form and stage of phimosis in boys. The doctor will definitely take into account the age of a small patient, the presence / absence of an inflammatory process in the tissues. Parents must strictly follow the doctor's instructions, regularly bring the boy to an appointment to monitor the condition of the tissues of the penis.

Treatment of phimosis at home

In the absence of inflammatory processes, sufficient elasticity of the skin fold around the head of the penis, the doctor recommends that parents do not take medication. Adults are required to be careful, to strictly comply with the requirements of the urologist, and to comply with the frequency of procedures. Without the permission of a doctor, non-drug treatment is prohibited!

At home, parents perform a gradual opening of the head of the baby's penis. In one procedure, the skin fold should move no more than 2 mm.

Sharp jerks, simultaneous opening are not only extremely painful, but also dangerous to health. In addition to psychological trauma, there are negative consequences in the form of a rupture of the foreskin, the formation of a scar. Another dangerous complication is pinching the head of the penis with the foreskin (paraphimosis).

Procedure:

• during a visit to a pediatric urologist, listen carefully to the recommendations, clarify the details if you have any questions;
• twice a week, carry out the procedure for the gradual opening of the foreskin;
• First, prepare a bath with warm water. Adding a solution of potassium permanganate (necessarily, slightly pink), a decoction of chamomile, calendula or string will help prevent inflammation of the delicate tissue;
• the boy must take a bath for a quarter of an hour. Gently blot the genital area, apply Solcoseryl or Bepanten ointment to the dry foreskin, gently move the skin fold by 1–2 mm, no more. The drug softens the skin, prevents tissue rupture and inflammation;
• act carefully, do not violate the frequency of procedures. Move the skin fold on the penis only to the specified distance. Monitor the condition of the glans penis in the baby. In case of inflammation, swelling, stop the procedures, pay a visit to the urologist to find out the causes of negative reactions.

Possible Complications

Dangerous forms of phimosis in children of different ages often develop when parents do not pay attention to the problem. Some adults simply do not know what the consequences are of wrong actions or vice versa, inaction.

Sometimes parents try to cure the pathology with homeopathy, folk remedies. Most often, such measures do not bring results, they postpone the visit to the doctor for an indefinite time. Often, parents bring the boy to an appointment when the inflammatory process has gone too far.

Dangerous complications:

• cicatricial phimosis. The foreskin is narrowed to critical levels. The cicatricial ring does not allow the head of the penis to be removed from under the folds of the skin, serious problems with urination appear, balanoposthitis often develops, pain during erection. Normal sex life in adult men until the problem is eliminated is almost impossible;
• paraphimosis. Complication of advanced cicatricial form of phimosis. Often, the pathology appears due to the fault of the parents, after a sharp retraction of the foreskin, the development of the inflammatory process. With paraphimosis, the tight flesh infringes on the protruding head of the penis so much that the tissues swell. Without immediate treatment, the squeezed area turns blue, then blackens. Insufficient supply of tissues with blood worsens the condition of the penis.

Inflammation of the tissues of the penis, infringement of the glans penis may adversely affect the quality of intimate life in the future. Men suffer from psychological and physiological problems. Negative manifestations could have been prevented if the parents had shown the boy to the doctor in time for non-drug treatment or surgery.

Preventive measures

There are no specific methods for preventing genetic phimosis. Parents should regularly and properly toilet the genitals of a newborn boy. When identifying the negative symptoms described above, it is important to contact a pediatrician and a pediatric urologist without delay. Early treatment of the inflammatory process will save you from dangerous complications.

If you suspect the boy has phimosis, see an experienced doctor. A pediatric urologist will tell you which form is developing: physiological or pathological. Further treatment is prescribed by a doctor. At any stage, the problem has a solution. The task of parents is to abandon self-treatment, the use of unverified folk methods.

Primary phimosis, in which it is impossible to free the head of the penis from the foreskin in a child of 4-7 years old, is the norm. It does not require treatment or surgery. Attempts to forcibly displace the epithelium can cause the formation of cracks and ruptures, and subsequently provoke tissue necrosis.

Seeking medical help is necessary only with, that is, an inflammatory process of the head of the penis, and a violation of the function of urination.

By the age of 4-7, in 92-95% of boys, the symptoms of primary phimosis disappear, and the head is freely removed from under the foreskin. Otherwise, the child needs to consult a urologist and appropriate treatment.

Symptoms of pathological phimosis in children 5 years and older:

1. The epithelium completely hides the surface of the penis, it is difficult to remove the head from under the skin.
2. Hyperemia, soreness and swelling in the area of ​​the preputial sac. In a certain percentage of patients, purulent discharge is noted due to the development of the inflammatory process.
3. Urinary disorders. It is difficult for a child to urinate: urine first accumulates under the skin, after which it is excreted in a thin, interrupted stream.
4. Pain when trying to release the head of the penis in a calm state or in case of spontaneous erection.

ATTENTION! Hyperthermia, weakness, malaise, headache and other symptoms of general intoxication, which developed against the background of urinary outflow retention, indicate the development of infectious processes in the child's body and require urgent medical intervention.

There can be several reasons for the development of phimosis pathologies in boys of 5 years old.:

1. Scleroderma of the penis, deficiency of elastic tissue in the patient's body.
2. Infectious and bacterial diseases of the genitourinary system.
3. Injuries and burns of the penis, as a result of which the epithelial tissue is replaced by connective tissue, forming scars.
4. Non-compliance with personal hygiene, which can lead to the development of inflammation and the development of balanitis.
5. Genetic predisposition to the development of pathology.

The answer to the question: “Phimosis in a 7-year-old boy, what should I do?” There can be only one answer - take him to the doctor.

Varieties of the disease

The physiological deficiency in the development of the epithelial tissue of the penis is caused by synechia, that is, embryonic adhesions preserved between the epithelium of the head of the penis and the inner leaf of the prepuce. As the penis grows, the head pushes the synechiae apart, and its release occurs without difficulty..

Physiological phimosis at 5 years old can be the norm, it usually disappears by 6-7 years, but in some cases it can persist up to 9-10 years. It does not require treatment, however, it involves observing especially careful hygiene of the penis and observation by a urologist in order to exclude the development of secondary, that is, pathological, phimosis.

phimosis classification

1. According to the nature of the occurrence, congenital (primary) and acquired (secondary) phimosis are distinguished. Congenital phimosis is diagnosed in children at the age of 10-11 years, if, due to physiological phimosis, the head of the penis still does not open completely. This case does not require surgical intervention, but the child must be registered with a surgeon or urologist and, if necessary, receive treatment.

   Acquired phimosis in a 5-year-old child usually develops as a result of an injury to the penis and is characterized by the presence of scar formations on the epithelium of the prepuce. be sure to seek medical attention.

2. According to the type of pathology development, the disease is divided into hypertrophic and atrophic. With hypertrophy of the prepuce, excess epithelial tissue hangs from the head, as a result of which it can only be partially opened, or it is not exposed at all.

   In the atrophic form, phimosis in a boy at the age of 4 develops due to the fact that the thinned epithelium of the foreskin is too tightly adjacent to the surface of the penis.

3. According to the severity, phimosis is divided into 4 stages:
   • at rest, the head is exposed without difficulty. During an erection, the prepuce moves with difficulty, the child may be disturbed by pain;
   • it is difficult to remove the penis from the skin fold in a calm state and it is impossible when an erection occurs;
   • the head of the penis does not open at all or is only partially exposed in a calm state. Urine before excretion may accumulate under the skin;
   • the child is experiencing pain. Removing the head is not possible. Urine is excreted drop by drop or by an interrupted stream. Before urination, the preputial sac seems swollen from overflowing fluid. The foreskin is edematous, hyperemic, covered with cracks.

ATTENTION! With the development of phimosis of the 4th degree, the child urgently needs the help of a surgeon, since such conditions are dangerous with acute urinary retention and the development of intoxication of the body.

A photo

We present to your attention a photo of phimosis in boys 5 years old:

Consequences for the health of the child

Until the age of 12-13, physiological phimosis, like phimosis in a 7-year-old boy, which does not cause pain and does not interfere with the outflow of urine, does not pose a danger to the child's health.

1. Observe hygiene. Accumulations of smegma and urine in the preputial sac can provoke stagnation and, in the most severe cases, the formation of smegmolites - stones formed from accumulations of smegma.
2. You can not try to forcefully expose the head of the penis manually. Such methods can lead to tears and cracks in the foreskin and, as a result, to scarring.
3. It is necessary to control the condition of the foreskin: if redness or swelling appears on the skin, then you should consult a doctor.

In adolescents over 11-13 years old, pathological phimosis can cause a number of unpleasant consequences.:

1. Paraphimosis - infringement of the head of the penis by a narrowed foreskin.
2. Inflammatory diseases of the genitourinary system, which developed due to the impossibility of proper hygienic care. The urine accumulated in the preputial sac serves as a favorable environment for the reproduction of pathogenic microorganisms, and the increased pressure in the cavity of the foreskin causes the reverse flow of urine and the spread of bacteria along the urinary tract.
3. With phimosis of 3-4 degrees, fusion of the foreskin with the skin of the head of the penis develops - synechia is formed. For the treatment of such pathologies resort to surgical intervention.

ATTENTION! Paraphimosis provokes swelling of the head of the penis and causes its subsequent necrosis. In case of infringement of the head of the penis by the prepuce, it is urgent to seek medical help.

When should treatment be started?

If a child under 6-7 years old has phimosis phenomena that do not cause inconvenience to the boy, you should seek advice from a urologist. He will monitor the condition of the child and will be able to notice signs of pathology in time.

In addition, the doctor may recommend that the mother carry out special exercises with the boy, aimed at stretching the foreskin by hand. In some cases, the use of corticosteroid ointments and gels that increase skin elasticity is also prescribed. You can find an overview of the various ointments prescribed for a child with phimosis.

If phimosis persists after 12-14 years or passes into stage 3-4, then the patient needs surgical treatment. In this case, circumcision is performed - an operation to remove the foreskin. It takes an average of 10-15 minutes and has minimal risks of complications. 3-4 hours after circumcision, the boy begins to urinate independently.

With development, circumcision is impossible. Therefore, the intervention takes place in 2 stages: during the first operation, a longitudinal dissection of the prepuce is performed, and during the second, its removal.

What to do during an exacerbation?

If the child has pain when trying to urinate, purulent discharge from the urethra or sediment in the urine, contact a specialist. All of these symptoms are indicative of a urinary tract infection..

This condition requires medical supervision, antimicrobial therapy and careful hygiene of the child's genitals. The urologist deals with the treatment of the disease.

The surgeon should be contacted if the child complains of pain, cracks in the prepuce, the need to strain during urination. This symptomatology indicates the development of secondary, pathological phimosis and is an indication for a disease or surgical intervention.

And adolescents up to 13-14 years old are a physiological condition that, as a rule, does not require medical or surgical treatment. However, a child with a similar diagnosis should be registered with a urologist in order to prevent the development of pathologies and, if necessary, start therapy on time.

Useful video

Tips for parents from a urologist about this problem:

phimosis- a condition characterized by the narrowness of the foreskin, which leads to a limitation of its mobility. Thus, the first, and often the only, sign of phimosis is the inability to expose the glans penis at rest and / or during an erection.

The foreskin or prepuce in men is called the skin fold covering the glans penis. The preputium is a specialized tissue, the structure of which in many ways resembles the structure of the eyelids of the eyes and labia in women.

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

Additional fixation of the prepuce provides bridle, located on the underside of the head and limiting the shift 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.

As a rule, during an erection, the foreskin moves towards the base of the penis and exposes the glans penis. In the 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 in the treatment of 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 during fetal development are formed from the same tissue. The development of the external genital organs 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 glans penis opens only in 20% of babies, and by the beginning of the third - in 50%. As a rule, spontaneous elimination of physiological phimosis occurs at preschool age (3-6 years).

However, cases are far from unique when the glans penis opens for the first time during puberty, due to an increase in the level of sex hormones that help soften and stretch the skin of the foreskin.

In many peoples of the world, a gene of predisposition to the preservation of physiological childhood phimosis in adulthood is common. So, for example, in some countries of Southeast Asia, phimosis in adult men is considered the norm, except in cases where the narrowing of the foreskin leads to painful symptoms.

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

phimosis classification

• associated with developmental features 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 a 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 with both metabolic disorders and 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. At the same time, the preputial opening is narrowed and does not pass the head.

Causes of phimosis

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

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

In children, a common cause of the development of pathological phimosis are injuries, including those received during gross violent attempts by parents to “fix” physiological phimosis in young boys.

In such cases, adhesions are formed 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 is infectious and inflammatory processes in the preputial sac, leading to the formation of a characteristic cicatricial phimosis.

Degrees of pathological phimosis

With phimosis first degree possible free removal of the glans penis in a calm state, during an erection, the exposure of the glans is difficult or painful.

O second degree phimosis is said when difficulties with exposing the head occur 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 bring the glans penis beyond the preputial ring.

fourth degree phimosis is characterized by such a sharp narrowing of the foreskin, which causes difficulty in urination.

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

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

Symptoms of pathological phimosis in adults

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


• premature ejaculation;


• decrease in the 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 male. The fact is that the cells of the mucous membrane of the inner leaf of the prepuce secrete a special secret that has a rather complex composition (fats, bactericidal substances, pheromones (exciting substances), etc.). This secret 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 by the period of puberty (the maximum smeg 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 intercourse.

However, the secret of the glands of the mucous membrane of the inner leaf of the foreskin is an excellent living environment for many pathogens. Therefore, smegma stagnation 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 form and accumulate in it, which contributes to the development of oncological diseases in men (papillomas of the glans penis, penile cancer) and their sexual partners (cervical cancer).

In childhood, the cleansing of the prepuce sac occurs independently, since the amount of smegma secreted is small. Adult men, in order to prevent the development of complications, must follow the rules of hygiene, that is, make a toilet every day, which consists in 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 is not manifested by any unpleasant symptoms, doctors advise taking care of eliminating the pathology, since, in addition to the risk 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

Caught in a tight ring of the narrowed foreskin, the head swells, while the pressure of the ring increases. Thus, a vicious circle is created: the violation of blood circulation 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 intercourse or masturbation. It should be noted that such a 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 acquires a bluish tint. 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 (necrosis) of the tissues of the foreskin and the 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 care. In the early stages of the development of paraphimosis, doctors can manually reduce the glans penis (this manipulation is very painful, therefore, it is performed after the administration of narcotic analgesics). In more severe cases, they resort to dissection of the ring of the foreskin.

Physiological phimosis in children

At such a tender age, in most boys, the inner layer of the foreskin is soldered to the glans penis. It is for this reason that in no case should you try to forcefully 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 pediatrician Komarovsky rightly claims that in 99 cases out of 100, the complications of physiological phimosis in babies are associated with rude and illiterate intervention carried out by the parents themselves on the advice of relatives, neighbors and even, sadly, doctors.

If the boy is not bothered by anything (no problems with urination, pain, itching, etc.), no additional measures to correct phimosis should be taken. It is only necessary to make a regular toilet every day, washing the perineum and genitals with water. Soap is best used no more than once every three to four days, avoiding 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 rather slow process that should not be artificially stimulated.

Desquamated 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 danger in terms of developing infections and oncological diseases.

Physiological phimosis in itself performs an important protective function, it protects the delicate yet 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 approach until 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 blood level of male sex hormones, which have a beneficial effect on the process of softening and stretching 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 observed the opening of the glans penis, and then there was a narrowing of the foreskin, 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, anxiety of the child), you can try to fix the problem yourself. Many pediatricians recommend washing the preputial cavity with a warm solution of furacilin using a conventional ten-millimeter syringe.

The procedure is as follows:

• Draw a warm solution of furacilin or an 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 pulls the foreskin, and the other performs actions with the syringe);


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

With an increased tendency of the child 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 alleged agent (revise the menu, medications taken, antibiotics, vitamins, used diapers, household chemicals, etc.);
• avoid exposure to chemicals on the skin;
• increase the amount of fluid you drink to speed up the “washing out” of allergens from the body.

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

• there are problems with urination (difficulty urinating, soreness, etc.);


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

Complications of phimosis in children requiring specialized medical care

• balanoposthitis;
• paraphimosis;
• urinary retention.

Balanitis, fasting and balanoposthitis in children

Balanoposthitis- combined infectious and inflammatory lesions of the glans penis and foreskin.

These diseases in boys are several times more common than in adult men. The latter circumstance is connected precisely with the physiological features of the structure of the children's male genital organ.

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

• diabetes mellitus (high sugar in the urine contributes to the development of infection in the preputial cavity);
• obesity (violation of metabolic processes, deterioration of conditions for personal hygiene measures);
• avitaminosis (decrease in the overall resistance of the body).

• trauma resulting from a rough 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 uncomfortable clothing (too tight panties with a seam in the middle, snake injury, etc.).

Symptoms of the disease are quite typical:

• redness and swelling in the foreskin (fasting);
• through the hole you can see the hyperemic area of ​​the head (balanitis);
• pain aggravated by urination (irritating 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.

In case of recurrence of the disease, as well as in the case of the formation of secondary phimosis, the question of surgical treatment may arise.

Paraphimosis in children

The clinic and complications of phimosis in boys are the same as in adult men. A very strong pain syndrome, redness and rapidly progressive swelling of the glans penis is characteristic. Untimely or inadequate medical care can lead to irreparable consequences in the form of necrosis of the foreskin and penis.

First aid for paraphimosis in children. There are a lot of tips on the net for resetting the head on your own (applying cold to reduce swelling, using oil, etc.). Of course, much depends on the severity of paraphimosis (the severity of edema and pain) and the state of the child's mentality.

But it is wiser not to follow such advice. The reduction of the glans penis with paraphimosis is a very painful procedure that is performed under anesthesia in medical institutions (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 mock the child, but to seek medical help as soon as possible. Transportation of patients in such cases is carried out in the 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 (day and night).
Difficulties urinating in infants are 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 in urination 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 (the use of steroid ointments that help soften and stretch the tissue of the foreskin).

Such a dismissive attitude was greatly facilitated by the fact that many patients self-medicate without consulting with professionals and often make gross mistakes that lead 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 in advance.

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 treatments for phimosis is the “naturalness” of their impact, since they actually repeat the mechanism of physiological self-elimination of age-related phimosis.

In addition, conservative treatments for phimosis allow you to fully preserve the unconditionally 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 physician.

However, in cases where it is necessary to achieve a quick 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 the method of gradual stretching of the foreskin and special methods for the conservative elimination of pathology were developed.

The general rules for these methods are:

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

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

Method stretching of the foreskin consists in the daily tension of the foreskin on the head of the penis during the morning shower, as well as after urination until pain occurs.

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

Method digital stretching consists in the careful introduction of the fingers into the preputial cavity and their gradual dilution.

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

Treatment of phimosis with ointments (drug treatment of phimosis)

• softening and increasing the elasticity of the foreskin;


• a decrease in 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 Pediatricians), since it is at this age that the most likely to achieve the elimination of congenital phimosis by conservative methods.

However, it should be borne in mind that such ointments are far from being shown to 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, systemic effects of corticosteroids may occur, which is fraught with dangerous complications.

Therefore, it is possible to use ointments with corticosteroids only after a thorough examination and consultation with a specialist who has sufficient experience in the treatment of congenital phimosis by this method.

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

Alternative methods of treating phimosis

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

• chamomile;
• calendula;
• succession.

Steaming the skin of the foreskin in a bath with a decoction of 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 the decoctions of various medicinal herbs or use a collection of medicinal plants for the decoction.

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

Surgical treatment of phimosis

Elimination of phimosis by a bloodless method

First, a special probe is inserted into the preputial cavity, which separates the synechia (adhesions) formed between the glans penis and the inner leaf of the foreskin. To do this, the probe is carefully advanced inward to the coronary sulcus and slow movements are made in a clockwise direction.

Then the opening of the foreskin is expanded with the help of a Pean clamp: the ends of the clamp are inserted into the hole and the branches are parted.

Often two or three such manipulations are enough to completely eliminate phimosis. In cases where positive dynamics is not observed, more invasive surgical intervention is indicated.
After sessions of bloodless elimination of phimosis, it is necessary to follow all the recommendations of the surgeon in order to prevent fusion of the mucous membranes of the foreskin and the glans penis.

Within a month, anti-relapse measures are shown: daily manual opening of the foreskin and washing 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, an indication for the use of general anesthesia may be:

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

After the operation, discomfort in the area of ​​​​the surgical wound is possible for several days, however, as a rule, it is possible to do without additional pain medication.

In cases where there is a need to remove sutures, this manipulation is performed 7-10 days after surgery. Before removing the stitches, it is necessary to make dressings every other day and make sure that urine does not get on the postoperative wound.

As a rule, within two weeks after the operation, the patient can have sex. 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 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 rapid elimination of all unpleasant symptoms and the absence of relapses (this is the only surgical intervention for phimosis that provides 100% efficiency).

The only but significant drawback of the method is the complete elimination of the foreskin, and, consequently, the irretrievable loss of all its functions. However, it should be taken into account that millions of men in the world annually circumcise for religious reasons and do not suffer at all.

Circumcision is a non-alternative 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).

Operations for plastic surgery of the foreskin in pathological phimosis

So with preputioplasty, in contrast to the circular excision of the foreskin, the foreskin is not completely removed, since a much smaller incision is made.

Another common method of foreskin plasty is called the Schloffer method. During the operation, the surgeon does not make a straight, but a zigzag incision, and then stitches the edges in such a way as to significantly expand the opening, while preserving the foreskin.

In addition, Roser's methods of foreskin plasty, spiral foreskin plasty, etc. are widely used.

The general disadvantages of such operations 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 in patients with severe cicatricial forms of phimosis.

phimosis laser treatment

With the help of a laser, it is possible to perform both circular excision of the foreskin (laser circumcision) and plastic surgery that preserves the foreskin.

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

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

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

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

Physiological phimosis in boys is a common problem for many male children. The child has a narrowed foreskin on the genitals, which is why can't open head.

In most cases, pathology does not cause concern and passes with time. However, there is a risk of developing other disorders, so you should know how to behave in certain cases.

Possible Complications

In case of violation of hygiene or for other reasons, there is a risk of developing complications against the background of physiological phimosis:

1. paraphimosis- excessive narrowing of the foreskin, which leads to squeezing of blood vessels and impaired blood circulation in the organ. Possible tissue necrosis and amputation of the penis without medical assistance.
2. - inflammatory processes on the glans penis under the foreskin. It develops when personal hygiene is not observed or an organ injury. In this case, the head swells, pain and itching appear, as well as problems with urination.
3. Fusion of the foreskin with the head- appears in the absence of any treatment. The tissues grow together, and the head can no longer open. The child needs an operation.

When observing these diseases, you should immediately seek medical help.

Prevention

Physiological phimosis develops from birth, so there are no specific measures to prevent the disease.

It is only possible to reduce the likelihood of complications in the future. For this you need to follow the following rules:

• regularly wash the genitals of the child;
• use only children's hygiene products (soap, shampoo, creams and ointments);
• timely process any, even minor, injuries of the head and foreskin;
• periodically visit a urologist or pediatrician for a routine preventive examination.

Physiological phimosis not dangerous for health, if you know how to deal with this pathology.

Over time, the problem should go away on its own, but this does not mean that it should be left to chance. A child with phimosis needs special care, especially personal hygiene.

A massage and, of course, a visit to a doctor will not be superfluous, who will be able to give an objective assessment of the boy's condition and, if necessary, select a treatment.

Until what age is phimosis normal? Komarovsky about phimosis in boys in this video:

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