Sinusitis

Treatment of physiological phimosis at home. Phimosis in boys: what is normal, how to prevent complications and how to care for it? Does phimosis go away?

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The vast majority of newborn male children are diagnosed with this pathology. Phimosis in boys is observed in 96% of cases; it provokes inflammation, disrupts hygiene, and causes discomfort in the baby. By 6 months, the baby is diagnosed with physiological phimosis in 80%; by the age of 3, all symptoms in 90% of newborns disappear, but in some cases this can happen closer to 6-7 years. Sometimes pathological phimosis requires surgery or medication.

What is phimosis in boys

Phimosis in children manifests itself as a narrowing of the opening of the foreskin on the head of the penis. This disease leads to the fact that the extreme half around the penis does not open completely, or this occurs with difficulty and severe painful sensations. Acquired phimosis may develop when injured or due to another disease. This type of pathology can have a permanent or temporary form. There are the following main types of this disease:

Physiological. This is always a congenital disease in boys; phimosis is a protective mechanism that is designed to protect the internal preputial space from the entry of pathogenic microorganisms and the development of balanoposthitis (inflammation).
Cicatricial (atrophic). This type of pathology is characterized by thinning of the foreskin. The elasticity of the tissue decreases and whitish scars appear. Develops as a result of injuries to the penis, infectious inflammation. Treatment of phimosis with cicatricial narrowing of this type is carried out without surgery, unless dangerous complications begin.

Causes of the disease

Phimosis in a child after birth is a protective mechanism against inflammatory processes. In some cases, it becomes a consequence of injury or pathology. There are the following cases in which phimosis can develop:

Injuries to the genital organ can cause narrowing of the foreskin. During healing, a large scar is formed, it consists of connective tissue. Because of this, tissue tightens and cicatricial stenosis forms.
The congenital form is more common than others; it becomes a consequence of a violation of the formation of the genital organs. This is associated with a genetic predisposition to a lack of the elastic component of the boy’s foreskin tissue.
Balanoposthitis. This is an inflammatory disease on the foreskin of the penis, which becomes a consequence of the action of pathogenic microorganisms. In the absence of adequate treatment, damage to a large number of penis tissues develops, which leads to the development of the disease in boys.

Symptoms of phimosis

The manifestation of this disease does not always indicate health problems. Often all adhesions resolve on their own with age, but if inflammation of the foreskin appears in boys or symptoms that will be described below, you should consult a doctor. Signs of phimosis:

The main symptom of the disease is the inability to open the head of the penis or serious difficulties when trying to do so.
Severe phimosis (the foreskin completely covers the head) causes urination problems. At the same time, a small child will worry, tense, and cry often. Urine will be released in droplets from the narrowed opening, the preputial cavity will swell like a bag.
Older boys may complain of pain when they get an erection. One of the main problems of this sign is that children are afraid to tell their parents about this problem. To do this, it is very important to establish a trusting relationship with the child.

Degree of development of pathology

Phimosis is not considered a disease in the direct sense of the word. Doctors characterize it as a condition that manifests itself due to physiological characteristics (age), heredity, or injury to the foreskin. The classification of phimosis is based on this:

pathological phimosis;
cicatricial phimosis;
physiological or congenital phimosis;
atrophic;
hypertrophic phimosis.

In addition to the types of the disease, there are also degrees that directly depend on the age of the boy. In newborn babies this is, as a rule, physiological phimosis, and in adult men it is cicatricial. The stage is determined by the severity of the process; pediatricians distinguish 4 degrees:

The head is completely released in a calm state; removal during an erection is difficult and painful.
At the second stage, exposure of the head occurs with difficulty; during an erection, it is completely covered by the foreskin and is not released.
At the next stage, you can only partially withdraw the head of the penis at rest.
The last degree is characterized by a completely hidden head, not displayed at all. When urinating, accumulation occurs in the preputial sac, and the liquid is excreted in drops.

Treatment of phimosis in children

Doctors try in every possible way to limit themselves to conservative treatment and avoid surgical therapy. Even the simplest operations pose certain risks to the boy’s health. With timely treatment of phimosis, it is possible to completely eliminate the problem without surgical manipulation. Medicinal, physiotherapeutic and surgical techniques are used for therapy.

Surgery

The urologist prescribes surgery only if all other methods of treating phimosis have not brought a positive result. The surgeon usually makes longitudinal incisions in the foreskin and then stitches it together. This manipulation helps to increase the diameter of the preputial ring, making it possible to expose the head. Some patients are prescribed Shkloffer surgery. It is carried out as follows:

The doctor administers local anesthesia.
A zigzag cut is made.
The edges of the wound are sutured to increase the area of flesh while preserving tissue.

Another option for surgery could be circumcision. With this method of surgical intervention, complete excision of the foreskin occurs, leaving the head constantly exposed. The disadvantages of this procedure include the fact that the exposed part of the penis becomes rough and sensitivity is slightly lost. Surgical techniques are the most effective and help the patient in 99-100% of cases.

Treatment without surgery

The foreskin in boys is elastic, so stretching can be done using special exercises. You can teach your child to do them on his own, or you can do them yourself if the boy is small. The following exercises are recommended:

Slow stretching of tissues by partial tension on the head of the penis. Next, perform stripping until a slight painful sensation appears. If the boy is very small, then you need to be extremely careful not to cause harm. This exercise should be done every day for 10 minutes.
You can stretch the preputial ring with two fingers; you need to move it between the head and the flesh. You need to move it apart to create tension, try to stretch it harder each time. It will be possible to get rid of the disease in 75% of cases if carried out conscientiously.
When bathing in the bath, warm water makes fabrics more elastic. The productivity of exercise increases at this time. It is important to observe moderation and not to apply too much effort so as not to cause paraphimosis.
Special rings that fit on the penis help fix the flesh in the desired position.

Prevention of the disease

Pathology in boys is usually due to genetic predisposition. Radical measures to prevent phimosis are not required, and medicine cannot offer them. It is more important to prevent complications in the form of narrowing of the hole due to scar tissue. Personal hygiene plays a primary role in this matter. For a very young boy, it is limited to daily bathing and timely washing after changing diapers or diapers.

The secretion that accumulates under the foreskin is washed away with water during water procedures. At least once a week you should wash your scrotum and penis with soap. It is recommended to use special baby soap, ointments and bathing products. You should not use bactericidal gels or soaps every day. Frequent use leads to disruption of the normal microbial environment that ensures skin health.

Phimosis (from the Greek phimosis - tightening, compression) is a narrowing of the foreskin that prevents the removal of the head of the penis. This condition is the norm for the smallest representatives of the stronger sex, but it becomes a pathology if it lingers beyond the prescribed time. Let's try to figure out where the border between these states lies.

To clearly understand the problem of phimosis, let us recall the features of the anatomical structure of the foreskin of “manhood”.

The penis (aka penis) consists of a body, head and root. The head of the penis is hidden by skin - the foreskin (prepuce), which in an adult man is easily displaced, exposing the head. The foreskin consists of two layers: the outer one, which is no different from the skin of most other parts of the body, and the inner one, tender and soft, reminiscent of a mucous membrane. Between the head and the inner layer of the foreskin there is a preputial space (another name is the preputial sac). The secretion of glands located under the foreskin and forming a special lubricant (smegma) is secreted into this cavity, thanks to which the sliding of the head is facilitated. Along the lower surface of the penis, the foreskin is connected to the head by the frenulum of the foreskin - a fold of skin in which blood vessels and nerves are located. On the head there is an external opening of the urethra (meatus).

Physiological phimosis

In newborn cavaliers, the head of the penis is fused with the prepuce by peculiar adhesions (synechias), which do not allow the head to be freely withdrawn. This physiological feature is a kind of protective mechanism that reduces the likelihood of infection entering the preputial space and the development of inflammation - and is called physiological phimosis. For boys under 3-7 years old, physiological phimosis is a completely normal condition! Statistics show that at the age of 1 year the head of the penis opens in 50% of boys, and by 3 years of age - in 89%. The incidence of phimosis in 6-7 year old children is 8%, and in 16-18 year old boys it is only 1%.

As the head of the penis grows, it gradually moves apart the prepuce, and the physiological synechiae are destroyed. Well, during puberty, starting from 12-14 years, when male sex hormones are activated, making the tissue of the foreskin more elastic and stretchable, the head opens completely.

Physiological phimosis does not require any treatment, but obliges parents to pay close attention to the condition of the child’s external genitalia. The condition of the glans penis, foreskin and preputial sac (space) is most easily monitored during daily washing, as well as when the baby urinates. If the foreskin is swollen and red, and the child continually reaches out with his hands to the causal site (and even more so if urination is difficult), you must immediately consult a pediatric andrologist, and if there is no such specialist, a pediatric surgeon or urologist.

Pathological phimosis

People begin to talk about phimosis as a medical diagnosis (that is, a pathological narrowing of the foreskin) in the case when it is not possible to remove the head of the penis in a boy after 6-7 years.

Phimosis, depending on the condition of the foreskin, can be atrophic and hypertrophic. With atrophic phimosis, the skin of the foreskin is very thin and extremely susceptible to microtrauma, which results in scarring. With hypertrophic, the prepuce, on the contrary, is quite thick, and in the form of a “proboscis” protrudes far beyond the boundaries of the head of the penis.

In addition, phimosis is usually distinguished by degrees. Depending on the severity of the narrowing of the foreskin, there are 4 degrees of phimosis:

1st degree. In a calm (relaxed) state, the head of the penis is exposed without problems, and during an erection this requires little effort.
2nd degree. During an erection, the head does not open at all; in a calm state, it opens with effort.
3rd degree. The head of the penis either does not open at all, or this is only possible with considerable effort and only in a calm state of the penis, but phimosis does not cause problems with urination.
4th degree. When urinating, the preputial sac swells first, and only then urine (in a thin stream or drop by drop) is released out. The head of the penis cannot even be opened slightly.

The main causes of phimosis are:

Genetic predisposition to the formation of phimosis as a result of insufficiency of the elastic component of connective tissue in the body;
Trauma to the penis, which may result in the formation of scar tissue leading to narrowing of the foreskin;
Inflammation of the foreskin of the penis, also leading to scarring and phimosis.

It should also be noted that phimosis itself is a factor in the development of further narrowing of the foreskin. The fact is that in the presence of even a slight narrowing, constant injury to the leaves of the foreskin occurs when the head is exposed. This situation is especially typical during puberty and the appearance of erections. During an erection, the size of the head and body of the penis increases, which causes tension in the foreskin and the formation of microtears in it. During the healing process, scar tissue is formed in places of micro-tears, which is not capable of stretching, which leads to the progression of phimosis.

Why is phimosis dangerous?

Since phimosis somewhat complicates hygienic procedures, if the baby is not carefully cared for, stagnation of smegma is possible. Unfortunately, it serves as an excellent breeding ground for bacteria, which, in turn, can cause the development of inflammatory processes. Moreover: with prolonged stagnation, the formation of dense formations - smegmolites (literally “smegma stones”) is even possible.

Phimosis of the 4th degree is especially dangerous, in which there are obstacles to the outflow of urine. Increased pressure in the preputial sac at the end of urination, when pressure in the bladder decreases, leads to reverse flow of urine and dissolved smegma through the urethra. This leads to the development of infectious complications in the urethra.

Complications of phimosis

Generally speaking, the main danger is not phimosis itself, but its complications. The most formidable of them is paraphimosis- pinching of the head of the penis by the narrowed foreskin as a result of its forced opening. This can happen when relatives or the child himself, as they say, “finished the game” - they exposed the head, but were unable to return the foreskin to its place. Paraphimosis can also occur later in life, during sexual intercourse or masturbation. Pinching leads to swelling of the head of the penis, which at a certain stage makes its reverse reduction impossible. As a result of poor circulation, the head turns blue and becomes sharply painful. And if emergency assistance is not provided, necrosis (necrosis) of the head may occur, leading to its amputation.

As you yourself understand, only a specialist doctor can provide assistance in this case. Call an ambulance immediately! Delay, as well as an attempt to cope with this problem on your own, is fraught with the loss of precious time and serious consequences.

A dangerous complication of phimosis can be balanoposthitis- inflammation of the foreskin and glans penis. It develops due to poor genital hygiene and infection of the preputial space. The chance of developing balanoposthitis increases in children with reduced immunity or against the background of other infectious diseases. Inflammation of the foreskin is characterized by swelling, redness (hyperemia), pain, and purulent discharge from the preputial space. The result of inflammation can be cicatricial degeneration of the skin of the foreskin and, as a consequence, the further development of phimosis. Balanoposthitis is a disease that requires emergency medical attention. The doctor inserts a special probe between the head of the penis and the skin of the foreskin, which carefully separates the existing synechiae, thereby creating conditions for the outflow of accumulated pus.

Another complication of phimosis that requires immediate medical attention is acute urinary retention. This condition is more common in young children and is reflexive in nature, as a reaction to pain. The child cannot urinate for a long time, becomes restless, complains of pain in the abdomen and above the womb, where an enlarged bladder can be felt. During the treatment process, the baby is given painkillers, a cleansing enema is given (so that the intestines, filled with feces, do not additionally put pressure and impede the outflow of urine), and then a warm bath with potassium permanganate is given, during which the child tries to urinate. If this does not help, urine is removed using a catheter.

A complication of phimosis of degrees 3 and 4 can also be accretion of the foreskin to the glans. As a rule, at first a small area grows, then the area of fusion expands and eventually the foreskin grows to the head of the penis along its entire length. In this case, attempts to open the head are accompanied by severe pain and bleeding. This condition is not an emergency, but it should not be started. For foreskin accretion, only surgical treatment is possible. But, since with a large area of fusion, intervention can be difficult, the earlier the problem is detected, the easier it is to eliminate it.

Treatment of phimosis

When treating phimosis, both conservative and surgical methods can be used.

Conservative methods of treating phimosis

For hypertrophic phimosis, if there are no complications, conservative treatment is possible, which consists of gradual stretching of the foreskin. The manipulation can be performed by parents at home. Three times a week, while bathing with herbal decoctions (chamomile, chamomile), the foreskin is displaced until the child begins to feel pain, after which a few drops of sterile vaseline oil are injected into the preputial space. The duration of treatment is several months. The procedure should be performed very carefully to avoid paraphimosis. Success depends on the persistence of the parents and the severity of phimosis.

In recent years, correction of phimosis has been used with hormonal ointments, which are placed in the preputial space. They make the fabric easier to stretch. Treatment is carried out by parents with mandatory medical supervision.

For atrophic (cicatricial) phimosis, conservative treatment is not very effective. In this case, surgical methods are used.

Surgical methods for treating phimosis

Indications for surgery are paraphimosis, severe cicatricial changes in the prepuce, repeated repetitions of balanoposthitis, and urinary disturbances.

Circumcision (circumcision)

The fastest and most effective way to treat phimosis is an operation called circumcision, or circumcision. With this intervention, the foreskin is removed, which completely eliminates any problems with exposing the head of the penis. This operation lasts 10-15 minutes and is usually performed under general anesthesia. The foreskin is cut off circularly (in a circle), while preserving the frenulum. The inner and outer layers of the foreskin are sewn together with catgut (a suture material that does not require the removal of sutures in the future, as it dissolves on its own). After the operation, a bandage with Vaseline oil is applied. A few hours after this surgical intervention, the child can walk and independent urination is restored. Circumcision is indicated for any degree of phimosis.

Contraindications for circumcision surgery are balanoposthitis and paraphimosis.

Longitudinal incision of the foreskin

This operation is used in cases where full circumcision cannot be performed. As a rule, her help is sought for two types of complications of phimosis - acute balanoposthitis and paraphimosis. In the first case, longitudinal dissection of the foreskin is resorted to because circumcision cannot be performed to open the inflamed glans penis, since infection can lead to failure of the sutures. Well, in case of paraphimosis, when acute circulatory disorders do not allow for full circumcision, longitudinal dissection of the foreskin remains the only way to “separate” the ring compressing the head of the penis.

By the way, in both cases, after the end of the acute period (that is, when the worst is over), doctors may recommend circumcision, which will no longer have a therapeutic, but a cosmetic value.

Prevention of phimosis

The development of phimosis is largely due to genetic predisposition, so medicine cannot offer radical measures to prevent this disease. But we can talk about preventing complications of phimosis. Here hygiene plays the first and main role.

During infancy, proper hygiene care is limited to daily bathing of the child and washing after the baby soils diapers or diapers. During bathing, water gets under the foreskin, which naturally washes away the accumulated secretions. You should wash your penis and scrotum with soap at least once a week. To do this, it is better to use baby soap or special baby bathing products. Daily use of bactericidal soaps or gels is not recommended. If used frequently, they can disrupt the balance of the normal microbial environment necessary for healthy skin.

To avoid urinary tract infections, children should be washed from front to back. For boys, the penis is washed without moving the foreskin. If you still try (on the advice of some doctors) to gradually move the skin of the penis and expose the head, then this procedure should be performed very carefully, without causing the slightest pain to the child. It should be remembered that the area of the glans penis contains a large number of pain nerve endings, and rough manipulation of the penis can lead to mental trauma and fear. Immediately after toileting the glans, the foreskin should be returned to its place to avoid the development of paraphimosis.

Genital hygiene should become the same daily habit for a boy as washing or brushing his teeth. Later, and especially at the beginning of puberty, the future man needs to undergo regular medical examinations. Take care of your health!

During a preventive examination of boys under three years of age, doctors often diagnose phimosis. For some, this incomprehensible word sounds like a sentence and a call for immediate surgery. Parents in a panic begin to look for specialists who can cure this “disease”. Is this a disease and should it be treated?

Male anatomy

First, let's take a quick look at the normal anatomy of the foreskin.

The penis consists of a body, a head and a root. On the head there is an external opening of the urethra (meatus). Through it, urine is released during urination, and sperm is released during ejaculation. The head of the penis is hidden by skin - the foreskin (prepuce), which in an adult man is easily displaced, exposing the head. The foreskin consists of two layers: the outer one, not different from the skin, and the inner one, tender and soft, reminiscent of a mucous membrane. Between the head and the inner layer of the foreskin there is a space - the cavity of the foreskin. Into this space (preputial space) the secretion of glands located under the foreskin is secreted and forms a special lubricant (smegma), which facilitates the displacement of the skin from the glans. Along the lower surface of the penis, the foreskin is connected to the head by the frenulum of the foreskin - a fold of skin in which blood vessels and nerves are located.

U newborn boy the skin of the foreskin, as a rule, is fused to the head of the penis through synechiae, a kind of adhesions that prevent or completely eliminate the free removal of the head. This temporary anatomical structure is called physiological phimosis(phimosis, from the Greek phimosis - tightening, compression, - narrowing of the foreskin, preventing the removal of the head of the penis), which is a normal condition for boys under 3-6 years old and does not require any treatment. Only 10% of children have the glans penis fully or partially open in the first year of life.

Moreover, the fusion of the head with the foreskin can be considered as a protective mechanism to reduce the likelihood of infection entering the preputial space and the development of inflammation.

Gradually, in the process of growth of the penis, the glans spreads the foreskin, a slow independent separation of the synechiae and opening of the glans occurs. This process can continue until the boy reaches puberty, when sex hormones are activated, which make the foreskin tissue more elastic and stretchable.

Sometimes smegma accumulates in the preputial space, limited by synechiae, in the form of a dense formation similar to a tumor. In case of a large accumulation of smegma, minimal medical assistance is required: - a special probe, similar to a thin stick, is used to separate the synechiae that prevent the discharge of secretions.

Boy hygiene

During infancy, correct hygiene care limited to daily cleaning and washing after the baby poops. During bathing, water gets under the foreskin, which naturally washes away the accumulated secretions. You should wash your penis and scrotum with soap at least once a week. To do this, it is better to use baby soap or special baby bathing products. Daily use of bactericidal (germ-killing) soaps or gels is not recommended. If used frequently, they can disrupt the balance of the normal microbial environment on the skin.

To avoid urinary tract infections, children should be washed from front to back. When washing the penis, you should do not move the foreskin. If you still try (on the advice of some doctors) to gradually move the skin of the penis and expose the head, then this procedure must be performed very carefully, without causing the slightest pain to the child. It should be remembered that the area of the glans penis contains a large number of pain nerve endings, and rough manipulation of the penis can lead to mental trauma and fear. Immediately after toileting the head, the foreskin should be returned to its place, in order to avoid the development of paraphimosis - pinching of the head in the foreskin (see below).

Pathological phimosis

Some boys may develop pathological phimosis- a disease that most often requires surgical intervention. It is customary to distinguish atrophic (cicatricial) and hypertrophic pathological phimosis. The first is characterized by the presence of rough scars that narrow the foreskin; in the second case, there is an excess of foreskin that prevents the removal of the head. There are two main reasons for the development of pathological phimosis:

Inflammation of the foreskin and glans penis - balanoposthitis.
Complication after rough manipulation of the penis associated with the removal of the head.

Rough, immediate removal of the head of the penis is one of the most common causes of the development of phimosis.

Pathological phimosis can lead to violation of the act of urination, which will flow in a thin stream, swelling the foreskin. This condition requires surgery.

Also, pathological phimosis sometimes leads to acute urinary retention. This condition is reflexive in nature and is more common in young children, as a reaction to pain due to pinching of soft tissues. The child cannot urinate for a long time, becomes restless, and often complains of pain in the abdomen and above the womb, where an enlarged bladder can be felt.

Acute urinary retention is an emergency and requires immediate medical attention. In this case, the baby is given a cleansing enema (so that the intestines with feces do not put additional pressure on the bladder and impede the outflow of urine), and then a warm bath with potassium permanganate, during which the child tries to urinate. If unsuccessful, urine is removed using a catheter.

Conservative (non-surgical) treatment of phimosis

At hypertrophic phimosis(excess of foreskin, preventing the removal of the head), when there are no complications (repeated inflammation of the foreskin, urinary disorders), conservative treatment is possible, which consists of gradual stretching of the foreskin. The manipulation can be performed by parents at home. Three times a week, while bathing with herbal decoctions (chamomile, chamomile), the foreskin is displaced until the child begins to feel pain, after which a few drops of sterile vaseline oil are injected into the preputial space. The duration of treatment is several months. The procedure should be performed very carefully to avoid paraphimosis. Success depends on the persistence of the parents and the severity of phimosis. If there is a scar zone of narrowing, conservative treatment is not very effective.

In the absence of complications and gross scar changes, treatment of phimosis should begin with conservative measures that preserve the foreskin with its protective, sensitive (sensory) and sexual function, and only if conservative treatment fails, surgery should be resorted to.

Surgical treatment of phimosis

Indications for surgery:

pronounced changes in the foreskin due to scars;
repeated repetitions of balanoposthitis;
urinary disorders.

The operation is performed at any age, immediately after diagnosis, as planned, i.e. if the child is in full health: there are no infectious diseases during the last month before the operation and after the examination, if the tests are normal.

Most often performed circumcision of the foreskin - circumcision- circular excision of the foreskin. This operation lasts 10-15 minutes and is usually performed under general anesthesia. The foreskin is cut off circularly (in a circle), while preserving the frenulum. The inner and outer layers of the foreskin are sutured with catgut (a suture material that dissolves on its own and does not require further removal of sutures). After the operation, a bandage with Vaseline oil is applied. A few hours after surgery, the child can walk and independent urination is restored.

In some countries, the so-called hygienic circumcision is quite popular - the removal of a healthy foreskin in order to avoid, as supporters of the procedure claim, possible complications in the future (penile cancer, sexually transmitted diseases, inflammation of the foreskin, etc.). Parents should know that no none medical, confirmed indication for preventive circumcision, which was decided by the American Academy of Pediatrics back in 1975.

Complications after surgery performed in a hospital setting by an experienced surgeon are rare and do not exceed 0.1-0.2%. If they do appear, they are divided into spicy(bleeding, acute urinary retention, suppuration of the postoperative wound) occurring immediately after surgery and chronic. Bleeding occurs when stitching is poorly performed, blood vessels are damaged during excision of the foreskin (this complication is especially common when the operation is performed at home for religious purposes) and when diseases of the blood coagulation system are not identified. In most cases, applying a tight bandage to the postoperative suture is sufficient to stop bleeding. If bleeding continues, it is necessary to suture the bleeding vessel.

Chronic complications include meatite(inflammation of the meatus - the external opening of the urter), meatostenosis(narrowing of the external opening of the urethra), excessive retention of foreskin.

After the operation, the mucous membrane of the external opening of the urethra is deprived of the protection of the foreskin, as a result of which local inflammation may occur - meatite. This complication is characterized by redness of the meatus, sometimes painful urination, and changes in urine tests indicating inflammation. Treatment: baths with a solution of potassium permanganate and antibacterial drugs, the most effective in treating urinary tract infections (as prescribed by a doctor).

As a result of inflammation of the meatus, its cicatricial narrowing may develop - meatostenosis, when urination is performed in a thin stream, with straining, for a long time. The diagnosis is confirmed by examination by a urologist-andrologist with uroflowmetry, a special study that determines the rate of urine flow. For a child, this procedure is no different from regular urination, only into a special toilet connected to a computer. Meatostenosis requires surgical treatment - dissection or formation of the correct contours of the external opening of the urethra (meatus plastic).

Excessive retention of foreskin It is diagnosed when there are uneven flaps of the foreskin left by the surgeon in excess. In this case, repeated circumcision is indicated to achieve a cosmetic effect. Sometimes, especially if the foreskin is left excessively around the entire circumference, a recurrence of phimosis is possible. At the request of the parents, plastic surgery of the foreskin can be performed. In this case, the narrowing is eliminated, but most of the foreskin is preserved. This operation is somewhat more technically complex and is accompanied by a large number of complications (mainly relapse of phimosis).

Congenital anomalies of the penis

Even before circumcision of the foreskin, the surgeon must make sure that the meatus is located correctly - at the top of the glans penis. If an abnormal location of the external urethral opening is detected - hypospadias(a congenital disease, occurs in 1 in 150 boys), the operation of circumcision of the foreskin is not performed, since the issue of tactics for surgical treatment of hypospadias must first be decided.

Phimosis is often combined with short frenulum of the foreskin, which deforms the meatus and bends the head of the penis. In this case, simultaneously with circumcision, dissection and plastic surgery of the frenulum are performed.

Advice for parents. It is advisable after birth (in the first week of life) to consult a boy with an andrologist who deals with issues of the male reproductive system, who will examine the child and determine whether he has any pathology or not. If it is not possible to see an andrologist, the baby should be examined by a urologist or pediatric surgeon. In the future, it is necessary to undergo regular medical examinations, especially during the onset of puberty.

Oleg Staroverov
pediatric urologist-endrologist, Children's City Clinical Hospital No. 9 named after. G.N. Speransky, Ph.D.

Discussion

We have cicatricial phimosis

09/23/2016 09:01:17, Elena

Each case is individual - some need surgery, others don’t.

We had very severe phimosis from birth, the urethral opening was 1 mm. the child peed on the side. They simply washed it with water from a syringe without a needle, of course. At the age of 7, phimosis was completely gone!!! Before this I had inflammation several times and was treated with levomekol. The doctors did not perform any manipulations; they did not want to injure the child. And it turned out that no surgery was needed! I turned 7 and a half years old and the head opened painlessly.

10/22/2015 11:41:57 pm, masheryl

Dear mothers. Do not agree to circumcision under any circumstances. For a long time there has been an American method of surgery with a disposable plastic ring. It is performed not under anesthesia, but under LOCAL anesthesia. After the operation, no problems! It was recommended to us by a urologist from the Semashko Children's Center for Diagnostics and Treatment named after Semashko Braev Alan Taimurazovich. My child was then 8 months old We are very pleased! There were no complications after the operation. Call him - he will always help with advice. 8-903-233-48-07.

In case of a large accumulation of smegma, minimal medical assistance is required: - a special probe, similar to a thin stick, is used to separate the synechiae that prevent the discharge of secretions. This minimal medical care is extremely painful for the child and is accompanied by significant mental trauma.
Believe me from your own experience, the injury will remain for life, and will cause even more pain to the child, and the division of the synechia helps only temporarily, believe me, then it will all come back again. Parents, please do not take your children to this brutal operation.

09.11.2010 11:11:32, Erasmus

Grandson 1 year 11 months. From birth, pay attention to the fact that the hole on the penis is very small, the foreskin hangs down like a proboscis. The boy wrote in small portions - 2-3 portions at a time. Now the hole has become a little larger (about 2 mm in diameter, he also pees in portions. Sometimes he complains of pain during erections and before urination. The head is not exposed and the hole does not increase. Previously, all the doctors to whom we told about this answered that it was nothing terrible, everything is fine. And today we had an appointment with the urologist, he said that now only surgical treatment. And the boy has an allergy, no one knows how he will react to anesthesia. We read your article - and now we are wondering whether it is worth it. surgery now, or wait another year or two... What if it gets worse during this time? Besides, his penis bothers him, he has pain, there are problems with urination... Tell me what kind of examination is still worth undergoing? There is no andrologist in the city. There is only an adult urologist, who is also an oncologist and surgeon...
Thanks in advance for your answer.

04/15/2009 20:35:45, welfen

This is a sore subject for me. My eldest son had to be circumcised at 2.5 years old. There was phimosis and accretion of flesh to the head. I wouldn’t want my youngest to have this problem either. Does anyone know how to properly stretch the hole? My son has a very small hole, the head of his penis is not even visible.

10.03.2009 14:21:16, Katerina Okuneva

I read it with interest. We have been diagnosed with this since we were a year old, but the surgeon said not to touch it for up to five or six years if there is no inflammation. We don’t care about circumcision, but dad wants it to be like him, when he already understood everything, at the age of six.

My son was circumcised at 4.5 years old - long foreskin, phimosis. Although this did not bother him and did not inflame him, the surgeon sent us for surgery, saying that the sooner the better. This is a strong shock for my son, and a real test for mother. My boy was in great pain and scared. 6 months have passed, and every time he shudders nervously if you touch his head with your hands (when washing) or underpants. Now, after reading the article, I regret that I agreed to the operation. On the other hand On the other hand, the surgeon said that the head would not open on its own, no matter how you look at it.

Thanks for the complete article!
My son, when he was little, also did not expose his head. But little by little, over the course of probably a year, we did not begin to pull back the skin much. And it gradually stretched out. This happened after we, at the age of 2, in the hospital, saw how often phimosis occurs in boys, which requires surgery. After the operation, I must say it was very painful, the children walked around without panties, only in loincloths. I really don’t know how quickly everything heals, from the hospital checked out quickly.

27.11.2008 10:49:18, Valentina

Very good, extensive article, thank you.

11/10/2008 10:24:35, Svetlana

When my son was examined at 9 months. They diagnosed me with phimosis. They told me to open my head every time I bathe, but I was afraid that I might get some kind of infection. After reading your article, I decided to rely on nature, everything should happen on its own. Thank you very much!:)

02.10.2008 06:32:30, Alenka

We generally have problems with this. Until two years, not a single doctor examined my son’s genitals. After we went to a paid doctor who examined our son completely, we learned that we should see a surgeon, because... a “bubble” formed on the tip of my son’s head. So we went with him, but then our doctors began diagnosing phimosis and twice already forcibly opened his head alive (they tore off the skin). I don’t want to take my baby to these flayers anymore, especially after reading this article.

01.10.2008 10:52:34, Anastasia

My son is 1 year and 2 months old, the urologist diagnosed Phimosis, said to force him to open it every day and the more the better, but after reading your article I decided that I won’t do that! Let everything take its course, but I don’t want to injure my son.

04/04/2008 15:31:10, Evgenia

Phimosis, or narrowing of the foreskin, is a fairly common disease, which can be either a normal variant in newborn babies or an acquired condition in adult men. According to some studies, up to 3% of adult men suffer from phimosis.

It is believed that the foreskin is a vestigial structure that, at birth, is almost always tightly attached to the head of the penis and is not retractable. This is the result of the fact that between the glans and the inner surface of the foreskin there is a layer of squamous epithelium. In this way, the foreskin completely covers the head during the years when the child is still incontinent, protecting it from injury and minimizing contact with dirty clothes or diapers.

Phimosis is a condition when the head of the penis cannot be completely exposed due to the narrowness of the foreskin, and all attempts are painful.

The reason is the discrepancy between the width of the foreskin and the diameter of the glans penis.

Typical symptoms and consequences of phimosis are chronic inflammation of the glans penis and foreskin due to limited genital hygiene. Difficulty urinating and, in adulthood, pain during erection and sexual intercourse may also occur.

So, in our article we will look at what forms of the disease occur and how you can get rid of it.

Why does phimosis occur?

Phimosis can occur naturally or it can be the result of scarring of the foreskin.

Phimosis most often occurs naturally. It is not clear why this happens in some boys, but in others everything is fine. Phimosis can also occur if the foreskin is forcibly retracted before it is ready for it. This can harm the skin and lead to scarring, which is the second cause of phimosis. It is for this reason that doctors categorically do not recommend forcibly exposing the head of the penis in young boys. At the age of 4-6 years they will do this on their own and without negative consequences.

Inflammation or infection of the foreskin or glans penis can cause scarring and phimosis in boys or men.

As we said above, phimosis is divided into 2 main types - physiological (primary) and pathological (secondary, acquired).

Primary, or physiological phimosis.

With physiological phimosis, we are talking about a congenital narrowing of the foreskin, which occurs in 96% of all newborn boys.

It occurs as a result of gluing of the foreskin to the head of the penis. In most cases, phimosis disappears on its own within the first 5 years of life.

Remember - physiological phimosis IS NOT a pathology in children under 5-6 years of age and there is NO NECESSITY to treat it.

At the age of 3 years, this problem is resolved in 80-90% of children, and in the seventh year of life, phimosis can occur in 10-18% of boys.

In the age group of young people 16-18 years old, narrowing of the foreskin occurs in 1% of people.

Physiological phimosis, which has not resolved during the first 7 years of life, takes on a pathological character. In this regard, circumcision is not recommended for boys under 3-5 years of age, since the head is difficult to expose, except for medical reasons.

The transition of primary phimosis to secondary is possible if, during the first years of life, crude attempts were made to push back the foreskin, which provoked the growth of scars as a result of cracks in the mucous membrane.

With physiological phimosis, which, we recall, occurs in the vast majority of little boys and gradually goes away with age, no treatment or special precautions are required. The foreskin does not require special care during infancy. In the first few years of life, you can very carefully expose the foreskin for hygienic procedures during diaper changes. But usually a simple bath is enough for hygiene. As the child gets older and the foreskin is completely exposed, he will learn how to care for it during hygiene procedures. After exposure, the foreskin should be pulled back on the head of the penis and returned to its normal position. This will prevent inflammation and scarring - that is, acquired phimosis.

Secondary, acquired or pathological phimosis.

Pathological phimosis is diagnosed in adult men. It is acquired during life and is often the result of posthitis (inflammation of the foreskin) and (inflammation of the glans penis). Basically, these 2 conditions complement each other and it is difficult to say which is the cause and which is the effect. Therefore, they are combined into one name - . The inflammatory process leads to the formation of scars and at the same time to a narrowing of the foreskin.

In addition to inflammatory processes, the following reasons can lead to phimosis:

Violent injuries and cracks of the glans penis (pictured below - cicatricial phimosis),

A number of diseases, for example lichen sclerosis. This is a skin condition that can be caused by an abnormal immune response or hormonal imbalance. Symptoms may include white spots or patches on the foreskin. The skin may become itchy and easily bruised. The impetus for the occurrence of phimosis can be eczema- a long-term condition in which the skin becomes itchy, red, dry and cracked, and psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered in silvery scales.

Genetic predisposition, expressed in insufficient elasticity of connective tissue,

Uneven development of the foreskin and glans during puberty. Thickening of the foreskin, making it impossible to expose the head of the penis.

Phimosis can also be complete or incomplete.

They speak of incomplete phimosis when it is impossible to retract the foreskin with an erect penis; with complete phimosis, the foreskin does not retract even when it is completely calm.

What types of phimosis are there?

Doctors distinguish 4 degrees of narrowing of the foreskin:

1st degree - opening of the head of the penis is possible only in a calm state, and pain may occur; slight effort is required during erection.

This problem worries a man, as it is quite difficult for him to have sexual activity due to discomfort and pain during sex. In this case, the man is not in danger - only the intimate side of his life suffers. However, it is still advisable to consult a doctor. After all, once you expose your foreskin, you may not be able to get everything back. And this is really dangerous.

2nd degree - opening of the head in a calm state is somewhat difficult, and in an erect state it is completely impossible.

3rd degree - the head of the penis in a calm state does not open completely or opens with significant effort, during an erection it does not open, urination is not impaired.

You cannot release the head yourself, as this can lead to negative consequences.

Stage 4 - the head does not open in any of the two states, urination is difficult. Urine is released in drops or a weak stream.

The foreskin does not move at all, which does not allow the man to even perform genital hygiene. As a result, smegma accumulates under the foreskin, which is a favorable environment for many pathogenic organisms. This can lead to the development of infection and various inflammatory processes. Naturally, in this case, a man cannot have sex at all, since even with the slightest attempt to move the flesh, he feels pain and discomfort. As the disease progresses, urination becomes impaired and acute pain appears. The patient may also experience burning and itching.

How does a man with phimosis feel?

A characteristic symptom of phimosis is that the narrowed foreskin cannot be retracted completely. Since hygiene in this case is difficult, secretions secreted by the glands, remains of urine and sperm, and skin cells accumulate under the foreskin. All this forms whitish deposits, the so-called smegma, in which bacteria accumulate and which can cause inflammation of the glans penis and foreskin.

Also, when the foreskin narrows, the following symptoms may occur:

Difficulty urinating due to obstruction of urine flow. It is expressed in most cases by a weakened, thin and strongly deviated stream of urine, as well as swelling of the foreskin in the form of a “balloon” during urination. Impaired urine outflow can subsequently lead to infectious and inflammatory processes in the genital organs and urinary tract.

Pain during erection and sexual intercourse, sometimes it is completely impossible. During an erection, there may be a feeling of tension in the foreskin, as well as its cracks.

A painful tight ring around the head of the penis (paraphimosis, or Spanish collar), which occurs when a forceful attempt is made to retract the foreskin. Failure to provide medical care in a timely manner in this case can lead to necrosis (death) of the glans penis.

With the development of the inflammatory process, pain occurs in the area of the foreskin and glans penis, increased body temperature, and in advanced cases, purulent discharge.

Diagnosis of phimosis.

Diagnosis of narrowing of the foreskin occurs mainly through a physical examination and questioning of the patient. As a rule, patient complaints are typical and we wrote about them above.

During a physical examination, the doctor cannot retract the foreskin and withdraw the head of the penis, or it is partially withdrawn. This suggests that there is a discrepancy between the width of the foreskin and the diameter of the glans penis, i.e. phimosis Also, the head and foreskin may be inflamed, painful to the touch, and have purulent discharge. If paraphimosis develops, the head may be bluish, swollen, and sharply painful.

If phimosis occurs in an adult man, then it is advisable to do a blood test to check blood sugar levels: diabetes mellitus often causes a narrowing of the foreskin.

What complications threaten you as a result of phimosis?

Like any disease, narrowing of the foreskin has its complications, ignoring which can lead to serious consequences for a man. So, the most well-known complications of phimosis:

Paraphimosis, or “Spanish collar”. It occurs, as a rule, with phimosis of 3-4 degrees and is a consequence of an independent attempt to open the head of the penis. May occur during masturbation or sexual intercourse. In this case, the foreskin infringes on the head of the penis and forms a painful, tight ring that disrupts the blood supply to the head. This leads to swelling of the head of the penis, it becomes bluish in color and sharply painful.

Gradually, if medical care is ignored, necrosis (death) of the glans penis develops. Help consists of straightening the head, and if that doesn’t work, cutting the foreskin longitudinally.

- fusion of the glans penis with the foreskin. Occurs with 3-4 degrees of phimosis, when low mobility leads to the formation of synechiae (areas of fusion) between the head of the penis and the foreskin, which gradually grow, leading to complete fusion. All attempts to move it away turn out to be sharply painful with the appearance of bleeding. Treatment is only surgical.

- balanoposthitis - inflammation of the glans penis and foreskin. As we wrote above, the reason is the difficulty of carrying out hygiene measures, which leads to an inflammatory process.

How to avoid pathological phimosis?

It is important to regularly carry out hygiene procedures with the genitals to avoid problems with acquired phimosis.

You should do the following:

Gently wash your penis with warm water every day while taking a bath or shower
carefully expose the foreskin (if any) and wash underneath; do not retract the foreskin of a baby or boy because this may be painful and cause harm
If you don't properly wash under the foreskin, a substance called smegma can begin to collect there. And not only does this put you at risk of complications due to poor hygiene,
use mild or unscented soap (if you choose to use soap) to reduce the risk of skin irritation,
do not use talcum powder and deodorants on your penis as they can cause irritation by collecting under the foreskin,
circumcised men should also wash their penis regularly with warm water and soap (if you choose to use soap).

Phimosis is diagnosed in 96% of boys at birth. The disease appears because when a boy develops in the womb, the genital organ most often does not fully develop. This form of the disease is physiological in nature, so it is not dangerous for newborns and older children.

If, in a normal condition, a child’s foreskin, similar to a fold of skin, can easily move and open the head, then in the presence of phimosis, the skin of the head is fused with the flesh. Adhesions, or synechiae, do not allow the foreskin to move freely and freely bring the head out when the foreskin is diseased.

Is the disease dangerous and does it require treatment?

Many parents, when making this diagnosis, wonder whether this disease is dangerous. If mom or dad don’t try to push back the boy’s foreskin on their own to expose his head, there won’t be any problems. Everything will recover on its own without medical intervention.

The International Association of Pediatricians strongly advises parents not to take any measures to make the child's foreskin begin to move.

Any careless movement on the contrary can lead to dire consequences. Phimosis will go away on its own sooner or later. According to statistics, the problem is completely resolved in 99% of boys when puberty begins.

IMPORTANT. The only treatment method is circumcision, which is performed when any pathologies arise or the disease does not go away on its own during puberty.

Parents should not worry if their child has phimosis. Even pathological phimosis or circumcision does not threaten the health and development of the child in the future and will not affect his sex life.

Useful video

The urologist talks about the problem of phimosis in boys, including physiological: