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"Understanding Phimosis and Paraphimosis: Causes, Symptoms, and Treatment Options"

Updated: Mar 23

What Is Phimosis And Paraphimosis In Children?



Phimosis and paraphimosis are problems with the foreskin of the penis. Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the penis. This is a common problem in young boys. Paraphimosis is when the foreskin is retracted but can’t move back up. This can prevent normal blood flow in the penis and may cause serious problems.


What Causes Phimosis And Paraphimosis In A Child?


  • Phimosis is caused by a tightening of the opening of the foreskin. This is normal in a newborn baby. Over time the foreskin loosens and can be pulled down more easily. By age 17, most boys will be able to fully retract their foreskin. Phimosis can also occur if the foreskin is forced back before it is ready. This can cause a fibrous scar to form. This can stop the foreskin from retracting in the future. In younger children upto the age of 3 years (For 10% of kids it might still persist beyond 3 years of age too), Phimosis is considered physiological and nothing needs to be done for it.

  • True pathologic phimosis exists when failure to retract is secondary to distal scarring of the prepuce. This scarring often appears as a contracted white fibrous ring around the preputial orifice. In contrast, physiologic phimosis consists of a pliant, unscarred preputial orifice.


Grades of Phimosis in terms of severity

  • Paraphimosis is caused when the foreskin is retracted behind the crown (corona) of the penis. The foreskin is too tight to be moved back to the tip of the penis.




What Are The Symptoms Of Phimosis And Paraphimosis In A Child?


The most common symptoms of phimosis include:

  • Bulging of the foreskin when urinating

  • Not able to fully retract the foreskin by age 3. In some boys this may take longer.

  • Thinning of urinary stream

  • Repeated Urinary Tract Infections.


The most common symptoms of paraphimosis include:

  • Swelling of the tip of the penis when the foreskin is pulled back

  • Pain

  • Not able to pull the foreskin back over the tip of the penis

  • Tip of the penis is dark red or blue in color

  • Pain when urinating

  • Decreased urinary stream


REMEMBER: A paraphimosis is an emergency medical condition. Seek medical care right away if you think your child has paraphimosis.


How Are Phimosis And Paraphimosis Diagnosed In A Child?


The Paediatric Urologist will ask about your child’s symptoms and health history. They will give your child a physical exam. The physical exam will include examining the penis and foreskin.


How Are Phimosis And Paraphimosis Treated In A Child?


Treatment will depend on the child’s symptoms, age, and general health. It will also depend on how bad the condition is.


Treatment for repeated phimosis may include:

  • Putting a steroid cream (like Clobetasol/Mometasone) on the foreskin up to 3 times a day for 1 month. This is to loosen the skin.

  • Having surgery to remove all or part of the foreskin (circumcision) for a child age 3 or older who still has bulging of the foreskin when urinating.


Treatment for paraphimosis may include:

Dorsal slit for paraphimosis
  • Lubricating the foreskin and tip of the penis, then gently squeezing the tip of the penis while pulling the foreskin forward

  • Making a small cut (incision) in the foreskin (dorsal slit)

  • Having surgery to remove all or part of the foreskin (circumcision)


What Are Possible Complications Of Phimosis And Paraphimosis In A Child?


Possible complications can include:

  • Pain

  • Infection

  • Trouble urinating

  • Death of tissue (necrosis) in the tip of the penis.

  • Priapism (painful erections), later on in life; if too much skin is cut.


Key Points To Remember About Phimosis And Paraphimosis In Children


  • Phimosis and paraphimosis are problems with the foreskin/prepuce of the penis.

  • Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the penis. This is a common problem in young boys. In the initial few years of life it is considered physiological and watchful waiting is recommended.

  • Paraphimosis is when the foreskin is retracted over the glans head but can’t move back up. This can prevent normal blood flow to the penis and may cause serious problems. It is a surgical emergency.

  • Treatment for either problem may include steroid creams, lubrication, or surgery to remove, cut or dilate the foreskin (Circumcision, Dorsal Slit or Preputioplasty).

  • Possible complications can include infection, trouble urinating and in rare cases death of tissue (necrosis) in the tip of the penis.

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