Description

• Phimosis is the inability to retract the prepuce (foreskin) after puberty due to a narrow preputial opening.
• Infants and prepubertal children rarely have true phimosis but rather a normal physiologic phimosis.
• Paraphimosis is the entrapment of the prepuce in a retracted position.

Epidemiology

The incidence of phimosis is 0.4 cases per 100 boys per year.

Risk Factors

• Phimosis
  • Forced retraction of the prepuce
  • Lichen sclerosis
• Paraphimosis
  • Prolonged retraction of the prepuce

Pathophysiology

• Phimosis
  • As the constriction of the phimosis worsens, urine is trapped in the foreskin and ballooning of the prepuce occurs. In severe cases, urine will fill the entire preputial space and extend down the shaft.
• Paraphimosis
  • Prolonged retraction of the prepuce around the glans causes edema of the prepuce and the glans. The edema makes it harder to correct the phimosis and causes significant pain for the child.

General Prevention

Boys should be instructed to return the foreskin to covering the glans after cleaning to prevent paraphimosis.