Not every foreskin narrowing requires therapy

Foreskins often go back by themselves in young boys
Foreskins (phimosis) are relatively common in newborns and small boys, and usually no treatment is required, according to the Institute for Quality and Efficiency in Health Care (IQWiG) information on its Patient Information Portal. Many parents are not aware that around nine out of ten boys are born with a foreskin or gluing between foreskin and glans.

The gluing of foreskin and glans respectively the natural foreskin constriction after birth protects the sensitive glans according to the IQWiG "in the first months of life against friction, dehydration and harmful influences such as viruses or bacteria." Most of the time they dissolve during the first three years of life Even and the foreskin is stretched so far that they can withdraw easily and painlessly. Treatment is only recommended if a foreskin narrowing does not recede in later life years or even persists until adulthood.
Foreskin constrictions affect nine out of ten boys at birth. (Image: Coloures-pic / fotolia.com)

With a foreskin narrowing, the foreskin can only retract over the glans under pain or not at all. Adolescents and adults can also be plagued with pain during an erection or during sexual intercourse. Occasionally, as a result of the narrowing, a balloon-like swelling forms under the foreskin, because the urine builds up in the toilet because of the too narrow opening. In addition, bacteria or fungi can accumulate under the narrowed foreskin, which promotes acornitis.

96 percent of boys born with foreskin constriction
According to the IQWiG, an estimated 96 percent of boys with a natural foreskin constriction are born. At the age of one year, around 50 percent of the boys were affected, at about three percent about ten percent and at the age of 16 only one out of every 100 adolescents showed a foreskin shrinkage. The figures make it clear that especially in children under the age of three often no treatment is required. However, certain forms of phimosis require treatment, which is why in case of doubt consult a specialist.

Do not push the foreskin back by force
If there is a narrowing of the foreskin, the experts should by no means try to force the foreskin back with force. Because this could lead to tears, small injuries and in rare cases also to a so-called "paraphimosis", which represents a medical emergency. In infants a treatment of the natural foreskin constriction is "not necessary", reports the IQWiG. The cleaning can be done from the outside with warm water and mild soap or shower cream. However, if the foreskin narrowing has not receded after the age of three, medical advice is important. The doctor examined whether "the foreskin narrowing is a primary phimosis or whether scarring or skin diseases are the cause" (secondary phimosis), according to the IQWiG. Depending on the diagnosis it will be decided to what extent the phimosis has to be treated and which method is recommended.

Cortisone-containing ointment usually leads to success
In most of the affected children, a phimosis is treated with cortisone-containing ointment, whereby the ointment is applied to the foreskin twice daily for four to eight weeks, according to the IQWiG. From the third week onwards, parents may try to push back the child's foreskin very carefully to continue stretching. Injuries should be avoided urgently. Then add the ointment to the area of ​​the glans, which is exposed when the foreskin is pulled back and the foreskin is gently brushed forward again. This treatment already leads to success in most cases. However, it often has to be repeated after some time in order to permanently eliminate the foreskin constriction, reports the IQWiG.

Surgical treatment of phimosis
If the foreskin constriction can not be resolved with the mentioned method, a small operation should be considered. In this so-called circumcision, the foreskin is either only partially or completely removed. However, a partial circumcision may threaten a renewed narrowing, which is excluded in the complete removal, explains the IQWiG. The surgical removal of a foreskin constriction is now a routine intervention. This is basically "useful if a boy has problems urinating or recurrent inflammation" and imperative "in a sclerosis resulting from scarring (secondary phimosis) as well as a foreskin constriction (paraphimosis)," reports the IQWiG. (Fp)