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In infancy, phimosis is considered physiological (normal). [11] At birth, the foreskin is naturally adhered to the glans, and cannot be retracted. As the child ages, in most cases, the foreskin will naturally detach. In young boys, it is normal not to be able to pull back the foreskin at all. [7]
Phimosis is an inability to retract the foreskin fully. It is normal and harmless in infancy and pre-pubescence, occurring in about 8% of boys at age 10. According to the British Medical Association, treatment (topical steroid cream and/or manual stretching) does not need to be considered until age 19.
The natural foreskin is composed of smooth dartos muscle tissue (called the peripenic muscle [16]), large blood vessels, extensive innervation, outer skin, and inner mucosa. [ 17 ] The process of foreskin restoration seeks to regenerate some of the tissue removed by circumcision, as well as provide coverage of the glans.
Dorsal slit has a long history as a treatment for adult phimosis, [1] since compared with circumcision it was relatively easy to perform, did not risk damage to the frenulum, and before the invention of antibiotics was less likely to become infected.
Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three. [59] Less than one percent are still having problems at age 18. [59] If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.
Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis. [1] However, some topical antibiotic and fungal ointments may be used for treatment for mild cases. Depending upon severity, hydrocortisone and other steroidal creams may be used upon consultation.
Application of a typical restoration device, the TugAhoy, called a "Chinese puzzle" by its inventor. A restoration device is a device used for applying tension to skin during the process of non-surgical foreskin restoration. [1]
Phimosis (both pathologic and normal childhood physiologic forms) is a risk factor for paraphimosis; [5] physiologic phimosis resolves naturally as a child matures, but it may be advisable to treat pathologic phimosis via long-term stretching or elective surgical techniques (such as preputioplasty to loosen the preputial orifice or circumcision ...