Phimosis in children

What is phimosis in children? 

Phimosis is defined as the inability to retract the foreskin back over the head of the penis (glans) due to tightness of the skin. The condition is completely normal in uncircumcised babies, and most children will not need treatment. 

Physiologic phimosis 

Physiologic phimosis is present in baby boys at birth. Virtually all baby boys will be born with physiological phimosis, which usually resolves itself between the ages of 5 to 7 years old, and nearly always before puberty starts.  

Pathologic phimosis

Pathologic phimosis occurs due to scarring, infection or inflammation. Less than 1% of children have pathologic phimosis, but treatment is often needed to restore normal foreskin retractability.  

What are the symptoms of phimosis in children? 

The foreskin is the thin layer of skin that covers the end of the penis. If your child has phimosis, it will be difficult for you to pull their foreskin back from the end of the penis when cleaning it.  

Fortunately, most children with psychologic phimosis don’t have symptoms and are healthy. 

It’s normal for a child with physiological phimosis to have slight ballooning of the foreskin while peeing. This usually goes away once they finish urinating. 

In most cases, children have physiological phimosis (which doesn’t cause problematic symptoms) but some children may have pathologic phimosis and experience: 

• a foul smell coming from the foreskin 
• a weak pee flow 
• bleeding or a thick discharge under the foreskin 
• blood in their pee 
• frequent urinary tract infections (UTIs) 
• pain when peeing 
• skin discolouration 
• swelling and tenderness 

What causes phimosis in children? 

Physiologic phimosis is normal in a newborn baby and, over time, the foreskin will loosen, allowing it to be pulled back without causing discomfort. 

The most common causes of pathologic phimosis are infection and scarring (such as balanitis xerotica obliterans, also known as lichen sclerosus).  

Other causes of phimosis, which are more common in older children, include: 

• injuries 
• penile adhesions (scar tissue that keeps the foreskin attached to the tip of the penis) 
• skin conditions, including eczema, psoriasis and lichen planus 

If you think your child has phimosis that is causing uncomfortable symptoms, contact our specialist team at Evelina London for an appointment.

Diagnosing phimosis in children 

If your child is starting to experience symptoms of phimosis, it’s important to seek a diagnosis from one of our specialist urologists.

If left undiagnosed and untreated, phimosis can cause complications, including: 

• inflammation of the foreskin (posthitis), glans (balanitis) or both (balanoposthitis) 
• urinary tract infections (UTIs) 
• foreskin tears (adhesions) 
• the foreskin getting stuck behind the glans (paraphimosis) 
• poor hygiene 

At Guy’s and St Thomas’ Specialist Care, our urology specialists can diagnose your child with phimosis and recommend the best course of treatment by reviewing their symptoms and performing a physical examination. 

Treating phimosis in children 

Physiologic phimosis often doesn’t need treatment, as in most cases, your child will grow out of it. However, there are some things you can do to ease the tightness of their foreskin and keep them clean: 

• wash their penis regularly with plain warm water or warm water with non-perfumed soap 
• don’t pull the foreskin back forcefully, as this can be painful and may cause damage that can lead to complications as your child gets older 

As your child gets older, it’s important to teach them how to pee and wash properly on their own. Explain that they need to pull back their foreskin, as comfortably as is possible, in order to stay clean. 

When they wash, they should pull their foreskin back, wash it gently and dry their penis well before pulling their foreskin back down. It’s important that they return their foreskin to the normal position, as leaving it pulled back can cause swelling.  

If your child is experiencing pathologic phimosis, their specialist will talk you through the best treatment for them, which may include: 

• topical corticosteroid cream or gel – you apply these medications daily directly onto your child’s penis to help soften the foreskin. After around 2 weeks, you can begin to gently pull back the foreskin little by little each day. Eventually, the foreskin will go all the way back over the head of the penis without causing pain 

• antibiotics – your child’s urologist will prescribe these if tests have identified an infection in the foreskin or head of their penis 

• surgery – if a corticosteroid cream hasn’t worked to loosen the foreskin, or if the medical management is not suitable, your consultant may recommend circumcision. This is a surgical procedure to remove the foreskin and completely expose the head of the penis 

Your child’s specialist will talk you through how each of these treatments works and any risks involved. Contact our team to make an appointment with our children’s urology specialists.