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Phimosis
Classification and external resources
ICD-10 N47.
ICD-9 605
DiseasesDB 10019
eMedicine emerg/423
MeSH D010688
An erect penis with phimosis
.
Phimosis (fī-mō'sĭs, fĭ-), from the Greek phimos (φῑμός ("muzzle")), is a condition where, in men, the male foreskin cannot be fully retracted from the head of the penis.
^ A foreskin covers the head of the penis (glans) and cannot be easily pulled back in most newborns.
  • Kids health info for parents 10 January 2010 20:15 UTC www.rch.org.au [Source type: General]

^ The foreskin is the hood of skin that covers the head of the penis.

^ Phimosis, or "the inability to freely retract the foreskin" - inhibits the relationship between the foreskin and the glans.
  • The circumcision taboos. Phimosis frenulum and foreskin conditions, phimosis and male initiation 10 January 2010 20:15 UTC members.multimania.co.uk [Source type: Academic]

.The term may also refer to clitoral phimosis in women, whereby the clitoral hood cannot be retracted, limiting exposure of the glans clitoris.^ Phimosis: Refers to a foreskin that won't retract.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Phimosis- A tight prepuce that cannot be retracted over the glans .
  • Male GU/Rectal Physical Exam Objectives 10 January 2010 20:15 UTC faculty.washington.edu [Source type: FILTERED WITH BAYES]

^ Phimosis: A tight prepuce that cannot be retracted over the glans.
  • Male GU/Rectal Physical Exam Objectives 10 January 2010 20:15 UTC faculty.washington.edu [Source type: FILTERED WITH BAYES]

[1]
In the neonatal period, it is rare for the foreskin to be retractable; Huntley et al. state that "non-retractability can be considered normal for males up to and including adolescence."[2] Rickwood, as well as other authors, has suggested that true phimosis is over-diagnosed due to failure to distinguish between normal developmental non-retractability and a pathological condition (a condition deemed a problem).[3] .Some authors use the terms "physiologic" and "pathologic" to distinguish between these types of phimosis;[4] others use the term "non-retractile foreskin" to distinguish this developmental condition from (pathologic) phimosis.^ Pathologic and physiologic phimosis .
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

^ Physiologic phimosis versus pathologic phimosis.
  • Phimosis and Paraphimosis: eMedicine Emergency Medicine 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ Previously retractile foreskin becomes non-retractile.
  • Clinical Practice Guidelines 10 January 2010 20:15 UTC www.rch.org.au [Source type: FILTERED WITH BAYES]

[3]
.Pathological (acquired) phimosis has several causes.^ Pathologic, or true, phimosis has several different etiologies.
  • Phimosis, Adult Circumcision, and Buried Penis: eMedicine Urology 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ Balanitis xerotica obliterans (BXO) is the most common cause of pathological phimosis requiring circumcision [Kiss et al., 2005].
  • Circumcision - Physical Problems 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]

^ If phimosis recurs after it was initially cleared up, it can be a more serious condition, acquired or pathological phimosis.
  • When to Treat Phimosis - Associated Content - associatedcontent.com 10 January 2010 20:15 UTC www.associatedcontent.com [Source type: General]

.Lichen sclerosus et atrophicus (thought to be the same condition as balanitis xerotica obliterans), is regarded as a common (or even the main[5]) cause of pathological phimosis.^ Balanitis xerotica obliterans (BXO) is the most common cause of pathological phimosis requiring circumcision [Kiss et al., 2005].
  • Circumcision - Physical Problems 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]

^ A common and distinctive cause of phimosis in boys.
  • Cost-effective Treatment of Phimosis -- Van Howe 102 (4): e43 -- Pediatrics 10 January 2010 20:15 UTC pediatrics.aappublications.org [Source type: Academic]

^ Phimosis can cause balanitis .
  • Phimosis: symptoms, cause, treatments, risks, complications, prevention, long-term outloo 10 January 2010 20:15 UTC www.mamashealth.com [Source type: General]

[6] .Other causes may include: scarring caused by forcible retraction of the foreskin,[4] and balanitis.^ This can cause a fibrous scar to form, which may prevent future retraction of the foreskin.
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.lpch.org [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - My Child Has - Children's Hospital Boston 10 January 2010 20:15 UTC www.childrenshospital.org [Source type: General]
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.chp.edu [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.childrens.com [Source type: Academic]
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.allkids.org [Source type: General]
  • Phimosis and Paraphimosis | CHOP | The Children's Hospital of Philadelphia 10 January 2010 20:15 UTC www.chop.edu [Source type: General]
  • Phimosis and Paraphimosis - Genitourinary and Kidney Disorders - Health Library - Children's Hospital of The King's Daughters 10 January 2010 20:15 UTC www.chkd.org [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - University of Chicago Comer Children's Hospital 10 January 2010 20:15 UTC www.uchicagokidshospital.org [Source type: General]
  • Phimosis and Paraphimosis - Carilion Clinic 10 January 2010 20:15 UTC www.carilionclinic.org [Source type: Academic]
  • CHOC Health Library - Genitourinary / Kidney: Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.choc.org [Source type: General]
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.childrenscentralcal.org [Source type: Academic]
  • Genitourinary and Kidney Disorders - Phimosis and Paraphimosis 10 January 2010 20:15 UTC children.musc.edu [Source type: FILTERED WITH BAYES]
  • Medical Center - Genitourinary and Kidney Disorders 10 January 2010 20:15 UTC www.mccg.org [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - Online Medical Encyclopedia - University of Rochester Medical Center 10 January 2010 20:15 UTC www.urmc.rochester.edu [Source type: FILTERED WITH BAYES]
  • Home | MCGHealth 10 January 2010 20:15 UTC www.mcghealth.org [Source type: FILTERED WITH BAYES]
  • Suburban Hospital Health Information 10 January 2010 20:15 UTC www.suburbanhospital.org [Source type: FILTERED WITH BAYES]
  • Genitourinary and Kidney Disorders - Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.schneiderchildrenshospital.org [Source type: FILTERED WITH BAYES]
  • Genitourinary/Kidney:Phimosis and Paraphimosis: Resurrection Health Care 10 January 2010 20:15 UTC www.reshealth.jobs [Source type: News]
  • OHSU Health Information: Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.ohsu.edu [Source type: Academic]
  • Genitourinary and Kidney Disorders - Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.musckids.com [Source type: FILTERED WITH BAYES]
  • Baptist Health of Northeast Florida - Genitourinary and Kidney Disorders-Phimosis and Paraphimosis 10 January 2010 20:15 UTC community.e-baptisthealth.com [Source type: FILTERED WITH BAYES]

^ The foreskin can become scarred and cannot be retracted.
  • Circumcision/�Ask the Doc� teen advice/Teens First for Health/GOSH 10 January 2010 20:15 UTC www.childrenfirst.nhs.uk [Source type: General]

^ What other problems can be caused by a foreskin narrowing?
  • maennergesundheit.info − Institut for Men�s Health 10 January 2010 20:15 UTC www.maennergesundheit.info [Source type: FILTERED WITH BAYES]

[7] .Beauge found that patients with phimosis had masturbation practices that differed from the usual pulling down of the foreskin that mimics sexual intercourse.^ I have found face down masturbation to give a different and stronger orgasm.
  • Healthy Strokes - Masturbation and More 10 January 2010 20:15 UTC www.healthystrokes.com [Source type: FILTERED WITH BAYES]

^ True pathologic phimosis: This involves fibrosis and scarring near the tip of the foreskin, usually from inflammation or trauma (e.g., trying to retract an unseparated foreskin).
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Either they never masturbated or they did so in a method that differed markedly from the usual-which is to mimic the dynamics of sexual intercourse, and so naturally push the foreskin back toward the base of the glans.
  • THE PARENTING EXPERIMENT - BREASTFEEDING ANYWAY-The Compleat Mother Magazine 10 January 2010 20:15 UTC www.compleatmother.com [Source type: FILTERED WITH BAYES]

[8] .Some studies found phimosis to be a risk factor for urinary retention[9] and carcinoma of the penis.^ Phimosis is a risk factor for penile carcinoma.
  • Phimosis and Paraphimosis | Doctor | Patient UK 10 January 2010 20:15 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ This situation hinders adequate penis hygiene, which favors the occurrence of foreskin infections, repeated urinary tract infections, sexually transmitted diseases and, in adults, carcinoma of the penis (2).
  • International braz j urol - Treatment of phimosis with topical steroids and foreskin anatomy 10 January 2010 20:15 UTC www.scielo.br [Source type: Academic]

^ Benefits of circumcision include prevention of penile carcinoma, phimosis, neonatal urinary tract infection and STD's later in life.

[10] .Common treatments include steroid creams, Preputioplasty, manual stretching, and circumcision.^ The most common of these is treatment with steroid cream.
  • Phimosis and paraphimosis | Circinfo.org 10 January 2010 20:15 UTC www.circinfo.org [Source type: Academic]

^ In Europe, the first treatments involve gentle stretching, sometimes combined with steroid creams.
  • Complete, As Nature Intended 10 January 2010 20:15 UTC www.math.missouri.edu [Source type: FILTERED WITH BAYES]

^ Topical corticosteroids Manual stretching Circumcision or a slit in the dorsal side of the foreskin (preputial plasty).

[11]

Contents

Natural development of the foreskin

.At birth, the inner layer of the foreskin is sealed to the glans of the penis.^ It is normal for the foreskin to adhere to the glans (head) of the penis at birth.
  • Modern Love: Sex, Relationships & Your Health: Phimosis: The Ins and Outs of a Difficult Foreskin 10 January 2010 20:15 UTC blogs.webmd.com [Source type: Original source]

^ At birth, the foreskin and the glans penis are joined.

^ Normally the inner layer of the foreskin ( prepuce ) adheres to the glans (tip of the penis) at birth.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

.This attachment forms "early in fetal development and provide[s] a protective cocoon for the delicate developing glans."^ It is thought to develop in the early stages of fetal development.
  • Posterior Urethral Valves (PUV) 10 January 2010 20:15 UTC www.chp.edu [Source type: FILTERED WITH BAYES]

^ The prepuce is designed to be non-retractile in infancy and early childhood when the developing glans needs complete protection from the mechanical trauma of the clothing and the chemical trauma of ammoniacal urine.
  • ISPUB - Bilateral Lateral Slit Preputial Plasty: A Technique Preferred over Circumcision in Primary Phimosis 10 January 2010 20:15 UTC www.ispub.com [Source type: Academic]

^ It has a funnel-shaped chamber which fits over the glans and is worn inside the developing foreskin and a larger, cylinder-shaped body which extends beyond the penis to provide the necessary weight.
  • NORM - Restoration Devices 10 January 2010 20:15 UTC www.norm.org [Source type: FILTERED WITH BAYES]

[12] .The foreskin is usually non-retractable in infancy and early childhood, when the developing glans needs complete protection from the mechanical trauma of clothing, and the chemical trauma of ammoniacal urine.^ The foreskin protects the glans from getting irritated by urine and from rubbing against diapers or clothes.
  • Foreskin Care | Causes, Symptoms, Treatment | PDRHealth 10 January 2010 20:15 UTC www.pdrhealth.com [Source type: General]
  • Foreskin Care Care Guide Information 10 January 2010 20:15 UTC www.drugs.com [Source type: General]

^ The foreskin is not retractable at birth and doesn't need to be retracted.
  • How is phimosis acquired? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

^ The retracted foreskin and glans become swollen.
  • Paraphimosis - Scripps Health - San Diego 10 January 2010 20:15 UTC mobile.scripps.org [Source type: Academic]

[12]
.Until recently, knowledge of the development of the foreskin has been a neglected subject.^ During development in the womb the foreskin is not differentiated from the glans penis until a late stage.
  • Glossary of Circumcision Related Terms - Circumcision Centre 10 January 2010 20:15 UTC www.circumcisioncentre.co.uk [Source type: FILTERED WITH BAYES]

^ Fact: At birth, the foreskin is normally attached or fused to the glans (like the fingernail to the finger), and slowly separates as part of normal development until the child reaches puberty.
  • Circumcision Myths 10 January 2010 20:15 UTC www.nocircmn.org [Source type: Original source]
  • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: Original source]

^ If this is a recent development, it can be because you jerked the foreskin to hard.
  • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

.Physicians often saw the natural unretractability of the foreskin in infancy as pathological and recommended circumcision.^ Lately, the trend has been for fewer circumcisions 2 because of medical and cultural concerns, 3 greater understanding of the natural history of the foreskin 4 , 5 and modern treatment alternatives.
  • Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons -- Huntley et al. 96 (9): 449 -- JRSM 10 January 2010 20:15 UTC jrsm.rsmjournals.com [Source type: Academic]

^ If the child has ballooning of the foreskin during urination after the age of 10, a circumcision (surgical removal of all or part of the foreskin) may be recommended.
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.healthsystem.virginia.edu [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - Genitourinary and Kidney Disorders - Health Library - Children's Hospital of The King's Daughters 10 January 2010 20:15 UTC www.chkd.org [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - University of Chicago Comer Children's Hospital 10 January 2010 20:15 UTC www.uchicagokidshospital.org [Source type: General]
  • CHOC Health Library - Genitourinary / Kidney: Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.choc.org [Source type: General]
  • OHSU Health Information: Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.ohsu.edu [Source type: Academic]
  • Baptist Health of Northeast Florida - Genitourinary and Kidney Disorders-Phimosis and Paraphimosis 10 January 2010 20:15 UTC community.e-baptisthealth.com [Source type: FILTERED WITH BAYES]

^ These uninformed doctors immediately recommend circumcision for any problem involving the foreskin.
  • Risk of Adult Circumcision | Health & Fitness Blog 10 January 2010 20:15 UTC health-fitness-blog.com [Source type: FILTERED WITH BAYES]

.Often it was used as justification for routine infant circumcision.^ Stitches (sutures) are not used for infant circumcision.
  • WellSpan Health Library 10 January 2010 20:15 UTC www.wellspan.org [Source type: FILTERED WITH BAYES]

^ Discussion While infant circumcision has been a common practice in North America, about 80% of the world population does not practice routine neonatal circumcision 13 .
  • Bioline International Official Site (site up-dated regularly) 10 January 2010 20:15 UTC www.bioline.org.br [Source type: Academic]

^ Indeed, the position of the American Academy of Pediatrics since 1975 has been that there are no valid or absolute medical indications for routine circumcision of newborn male infants.
  • Circumcision - All About Turkey 10 January 2010 20:15 UTC www.allaboutturkey.com [Source type: FILTERED WITH BAYES]

[12] .Patients with phimosis can develop into adulthood without any complications.^ A recently developed technique known as preputioplasty may be effective in some cases of phimosis without balanitis or frenulum breve.
  • Questions Young People Ask About Male Circumcision 10 January 2010 20:15 UTC www.circinfo.com [Source type: Original source]

^ Physiologic phimosis is common in male patients up to 3 years of age, but often extends into older age groups.
  • Pathologic and physiologic phimosis 10 January 2010 20:15 UTC www.cfpc.ca [Source type: Academic]

^ Dr Singal has developed a new non-surgical treatment algorithm for patients having tight foreskin- a condition called phimosis.
  • Welcome to the Pediatric Urology Portal 10 January 2010 20:15 UTC www.pediatricurology.in [Source type: FILTERED WITH BAYES]

.During the 20th century studies were released which furthered our understanding of the normal development of the foreskin.^ Yes, this is normal during stretching of the foreskin.
  • Glansie.com - cure phimosis - Questions 10 January 2010 20:15 UTC www.glansie.com [Source type: FILTERED WITH BAYES]

^ A well-known Chinese sexologist professor Shi CY believes that both men and women should have a further understanding of foreskins problems.
  • The harm of phimosis and redundant prepuce (endangering the physical development and sexual life)-Department of Redundant Prepuce and Phimosis-index 10 January 2010 20:15 UTC www.80666666.com [Source type: FILTERED WITH BAYES]

^ During neonatal development the prepuce is normally non-retractile, as the inner epithelial lining of the foreskin and the glans adhere to one another.
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

[13][14][15]
.The American Academy of Pediatrics and the Canadian Pediatric Society state that no attempt should be made to retract the foreskin.^ The foreskin should never be retracted forcibly.
  • Circumcision - St. Louis Children's Hospital 10 January 2010 20:15 UTC www.stlouischildrens.org [Source type: FILTERED WITH BAYES]

^ Journal of the American Academy of Pediatrics, 5, 110.
  • To Circ or Not to Circ: Indications, Risks, & Alternatives to Circumcision: Physiologic or Pathologic Phimosis? 10 January 2010 20:15 UTC www.medscape.com [Source type: Academic]

^ The foreskin should not be forceably retracted.

[16][17] .Age is reportedly a factor in non-retractability: according to Huntley et al. the foreskin is reportedly retractable in approximately 50% of cases at 1 year of age, 90% by 3 years of age, and 99% by age 17. These authors argue that, unless scarring or other abnormality is present, non-retractibility may "be considered normal for males up to and including adolescence."^ At birth, 5% of boys have a retractable foreskin, whereas at 5 years of age most boys will have a retractable foreskin.
  • Posthitis, Balanitis and Circumcision 10 January 2010 20:15 UTC www.urologyweb.com [Source type: Academic]

^ Gairdner 1 and Øster 7 found that the prepuce is retractable in only 4% of newborn males, 20% at age 6 months, 50% at 3 years and 99% at 17 years of age.
  • Dewan: Phimosis: Is Circumcision Necessary? 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]

^ By age 17, 97 to 99 percent of males will be able to completely retract their foreskin.
  • Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.lpch.org [Source type: FILTERED WITH BAYES]
  • Phimosis and Paraphimosis - Genitourinary and Kidney Disorders - Health Library - Children's Hospital of The King's Daughters 10 January 2010 20:15 UTC www.chkd.org [Source type: FILTERED WITH BAYES]
  • CHOC Health Library - Genitourinary / Kidney: Phimosis and Paraphimosis 10 January 2010 20:15 UTC www.choc.org [Source type: General]

[2] .Hill states that full retractability of the foreskin may not be achieved until late childhood or early adulthood.^ Actually, true phimosis can't be diagnosed until adulthood, but a non-retractable foreskin is natural, normal, and desired.

^ Over time, the foreskin separates and is able to be moved back from the tip of the penis. In many boys this happens by about 2 years of age, but in some it may not happen until puberty.
  • Kids health info for parents 10 January 2010 20:15 UTC www.rch.org.au [Source type: General]

^ There is no deadline for this and often full retractability does not occur until well into the teenage years.
  • How should phimosis be treated? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: Academic]

[18] .Cantu states that acquired phimosis may be caused by forceful retraction, due to the formation of scar tissue.^ Difficulty in retracting, due to tightness, is phimosis.
  • Foreskin pushed back while having sex >> Medical Questions, Weight Loss, Pregnancy, Drugs, Health Insurance 10 January 2010 20:15 UTC www.steadyhealth.com [Source type: General]

^ Forcing the foreskin to retract can cause cuts or lacerations, which can cause phimosis.

^ It also can be caused by an infection or scar tissue from an injury.

[19]
.Although the rate of surgical treatment of phimosis (usually circumcision) is falling, some pediatric urologists have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis, and that phimosis is overdiagnosed.^ A surgical incision or circumcision is the treatment of choice for phimosis.
  • AfraidtoAsk.com » DISEASE 10 January 2010 20:15 UTC www.afraidtoask.com [Source type: FILTERED WITH BAYES]

^ Uncomplicated pathologic phimosis is usually amenable to conservative medical treatment.
  • Phimosis, Adult Circumcision, and Buried Penis: eMedicine Urology 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ A.   The best treatment for a non-retractile prepuce is circumcision, in which the prepuce is removed.
  • Do I need surgery for treating phimosis? » DoctorNDTV Queries 10 January 2010 20:15 UTC doctor.ndtv.com [Source type: General]

[3][20][21]
.Phimosis is sometimes used as a justification for circumcision,[21][22] so that it will be covered by a national health system or insurance plan.^ If you may allow me to also quote from the same website, this is what is written of circumcision: "Circumcision is a relatively simple surgical technique which is sometimes appropriate as a solution to phimosis".
  • New Vision Online : Discussion Board 10 January 2010 20:15 UTC www.newvision.co.ug [Source type: Original source]

^ The quality of the hospital administrative data used to compile the Hospital Morbidity Data System is regularly validated by 21 different quality checks and periodic audits.
  • eMJA: Circumcision for phimosis and other medical indications in Western Australian boys 10 January 2010 20:15 UTC www.mja.com.au [Source type: Academic]

^ If a Plastibell device was used for the circumcision, call your health professional if the ring has not fallen off after 10 to 12 days.
  • WellSpan Health Library 10 January 2010 20:15 UTC www.wellspan.org [Source type: FILTERED WITH BAYES]

.The definition may be stretched by a physician for an older child; particularly where (as in North America), post-neonatal circumcision is usually outpatient surgery by a pediatric urologist, more expensive than the neonatal procedure.^ As with any surgery, circumcision is very traumatic to a child.
  • How should phimosis be treated? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: Academic]

^ Adult circumcision is usually performed in the outpatient setting by urologists.
  • Adult Circumcision - March 15, 1999 - American Academy of FamilyPhysicians 10 January 2010 20:15 UTC www.aafp.org [Source type: Academic]

^ Discussion While infant circumcision has been a common practice in North America, about 80% of the world population does not practice routine neonatal circumcision 13 .
  • Bioline International Official Site (site up-dated regularly) 10 January 2010 20:15 UTC www.bioline.org.br [Source type: Academic]

[21] .Most pediatricians do not consider it a compelling argument for routine neonatal circumcision.^ Discussion While infant circumcision has been a common practice in North America, about 80% of the world population does not practice routine neonatal circumcision 13 .
  • Bioline International Official Site (site up-dated regularly) 10 January 2010 20:15 UTC www.bioline.org.br [Source type: Academic]

^ The position of the American Academy of Pediatrics is that there are potential medical benefits of newborn male circumcision, but these benefits are not sufficient for the academy to recommend routine neonatal circumcision for all boys.
  • Pediatric Services - Circumcision 10 January 2010 20:15 UTC www.csmc.edu [Source type: FILTERED WITH BAYES]

^ As a result of the declining neonatal circumcision rate in the United States, pediatricians are seeing more uncircumcised males than in the past.
  • To Circ or Not to Circ: Indications, Risks, & Alternatives to Circumcision: Physiologic or Pathologic Phimosis? 10 January 2010 20:15 UTC www.medscape.com [Source type: Academic]

[23] .While circumcision prevents phimosis, at least 10 to 20 healthy infants must be circumcised for each prevented case of potential phimosis according to some incidence statistics[citation needed].^ In some cases, it can't be and a circumcision is in order.
  • Phimosis Sufferer? - Yahoo! Answers 10 January 2010 20:15 UTC answers.yahoo.com [Source type: General]

^ Prevention is better than cure and in the case of phimosis a cure which was not even needed.
  • Phimosis | Which Penis Enlargement Products Work? Don’t Get Ripped Off 10 January 2010 20:15 UTC penis-enhancement-secrets.com [Source type: Original source]

^ Conservative treatments include steroid creams, but in some rare cases, circumcision may be necessary.
  • When to Treat Phimosis - Associated Content - associatedcontent.com 10 January 2010 20:15 UTC www.associatedcontent.com [Source type: General]

Pathological/Acquired phimosis

.Pathological phimosis (as opposed to the natural non-retractability of the foreskin) in childhood is rare and the causes are varied.^ Phimosis: Refers to a foreskin that won't retract.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Non-retractability of the foreskin in childhood does not constitute phimosis.
  • How should phimosis be treated? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: Academic]

^ Phimosis is a condition where the foreskin cannot retract.
  • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

.Some cases may arise from balanitis (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to separate and retract an infant foreskin.^ The foreskin cannot retract over the head of the penis.
  • Kids health info for parents 10 January 2010 20:15 UTC www.rch.org.au [Source type: General]

^ Balanitis: Inflammation of the glans penis , it is usually associated with phimosis .
  • Male GU/Rectal Physical Exam Objectives 10 January 2010 20:15 UTC faculty.washington.edu [Source type: FILTERED WITH BAYES]

^ Balanitis is inflammation of the glans and Balanoposthitis is inflammation of the foreskin and penis.

.Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve, which prevents retraction.^ In uncircumcised men, the foreskin should be retracted to expose the glans penis.
  • Overcoming Hematuria Recovery from a common urologic condition : Urology News Texas 10 January 2010 20:15 UTC www.uant.com [Source type: Academic]

^ As the foreskin widens it may become apparent that the frenulum is restricting retraction.
  • Can foreskin problems be treated without circumcision? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: FILTERED WITH BAYES]

^ May be caused by phimosis , or an abnormal tightness of the foreskin preventing retraction over the glans.
  • balanoposthitis - Wordsmith.org 10 January 2010 20:15 UTC wordsmith.org [Source type: FILTERED WITH BAYES]

.In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort.^ If ballooning of the foreskin occurs during urination at any age then a phimosis exists.
  • Glossary of Circumcision Related Terms - Circumcision Centre 10 January 2010 20:15 UTC www.circumcisioncentre.co.uk [Source type: FILTERED WITH BAYES]

^ Pathologic and physiologic phimosis .
  • Pathologic and physiologic phimosis 10 January 2010 20:15 UTC www.cfpc.ca [Source type: Academic]
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

^ Physiologic phimosis versus pathologic phimosis.
  • Phimosis and Paraphimosis: eMedicine Emergency Medicine 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

.However, even ballooning does not always indicate urinary obstruction.^ Treatment of phimosis Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction.
  • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

^ Circumcision is only medically indicated for neonatal phimosis when the foreskin causes urinary obstruction or pain.
  • When to Treat Phimosis - Associated Content - associatedcontent.com 10 January 2010 20:15 UTC www.associatedcontent.com [Source type: General]

^ Ballooning Ballooning of the foreskin (rarely seen with true phimosis) is usually asymptomatic and does not damage the urinary tract.
  • CHILDHOOD CIRCUMCISION a paediatric surgical perspective 10 January 2010 20:15 UTC www.familymedicine.co.uk [Source type: Academic]

[24]
.Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ("relative phimosis"), and some completely unable to retract their foreskin even in the flaccid state ("full phimosis").^ Phimosis: Refers to a foreskin that won't retract.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Exacerbating factors Several factors might prevent full retraction of a foreskin.
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

^ Several factors might prevent full retraction of a foreskin.
  • Pathologic and physiologic phimosis 10 January 2010 20:15 UTC www.cfpc.ca [Source type: Academic]

.When phimosis develops in an uncircumcised adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.^ Phimosis: Refers to a foreskin that won't retract.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Phimosis The foreskin of an uncircumcised child should not be forcefully retracted.
  • Phimosis, Adult Circumcision, and Buried Penis: eMedicine Urology 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ What other problems can be caused by a foreskin narrowing?
  • maennergesundheit.info − Institut for Men�s Health 10 January 2010 20:15 UTC www.maennergesundheit.info [Source type: FILTERED WITH BAYES]

.Beaugé noted that unusual masturbation practices, such as lying face down on a bed and rubbing the penis against the mattress, may cause phimosis.^ Beaugé M. The causes of adolescent phimosis .
  • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]

^ Treatment of phimosis Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction.
  • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

^ Phimosis is a condition that causes a dog to be unable to retract its penis back in to the sheath.
  • Inability to Protrude or Retract Penis in Dogs | PetMD 10 January 2010 20:15 UTC www.petmd.com [Source type: FILTERED WITH BAYES]

.Patients are advised to stop the exacerbating masturbation techniques and are encouraged to masturbate by moving the foreskin up and down so as to mimic more closely the action of sexual intercourse.^ It the foreskin cannot be retracted easily when the penis is erect, sexual intercourse can be painful or disturbed.
  • Urology - Telki Kórház - Diagnosztika, Járóbeteg-, Fekvőbeteg ellátás, Szűrések, Laborvizsgálatok 10 January 2010 20:15 UTC www.telkihospital.hu [Source type: FILTERED WITH BAYES]

^ In most cases, men should refrain from sexual intercourse or masturbation for about six weeks after circumcisionuntil the incisions are healed and the sutures are removed.
  • Adult Circumcision: A Difficult Decision ; Seattle Washington WA 10 January 2010 20:15 UTC www.swedish.org [Source type: FILTERED WITH BAYES]

^ Either they never masturbated or they did so in a method that differed markedly from the usual-which is to mimic the dynamics of sexual intercourse, and so naturally push the foreskin back toward the base of the glans.
  • THE PARENTING EXPERIMENT - BREASTFEEDING ANYWAY-The Compleat Mother Magazine 10 January 2010 20:15 UTC www.compleatmother.com [Source type: FILTERED WITH BAYES]

.After giving this advice Beaugé noted not once did he have to recommend circumcision.^ However, the AAP did not find enough information to recommend circumcision for all babies as a routine procedure.
  • Circumcision - St. Louis Children's Hospital 10 January 2010 20:15 UTC www.stlouischildrens.org [Source type: FILTERED WITH BAYES]

[8][25]
.One cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans (BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce.^ When the phimosis is caused by a rigid ring at the tip, removal of that ring may be enough to cure the condition.
  • Penis development products. About narrow foreskin. 10 January 2010 20:15 UTC www.abicana.com [Source type: FILTERED WITH BAYES]

^ True phimosis has been defined as scarring of the tip of the prepuce, and is usually due to Balanitis Xerotica Obliterans (BXO) [ 7 ].
  • How should phimosis be treated? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: Academic]

^ Balanitis xerotica obliterans more causes...» Read more about causes of Phimosis .
  • Phimosis Symptoms, Diagnosis, Treatments and Causes - WrongDiagnosis.com 10 January 2010 20:15 UTC www.wrongdiagnosis.com [Source type: General]

.This inelastic tissue prevents retraction.^ The hardening of the tissue prevents retraction of the foreskin."
  • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

^ The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.
  • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

^ A ring of white tissue develops at the tip of the foreskin, tightening the foreskin at the tip, and this may prevent the foreskin from retracting (phimosis).

.Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females.^ Wallace HJ. Lichen sclerosus et atrophicus.
  • Arch Dermatol -- Circumcision and Genital Dermatoses, March 2000, Mallon et al. 136 (3): 350 10 January 2010 20:15 UTC archderm.ama-assn.org [Source type: Academic]

^ Lichen sclerosus et atrophicus in children with phimosis and hypospadias.
  • bmj.com Rapid Responses for Rickwood et al., 321 (7264) 792-793 10 January 2010 20:15 UTC www.bmj.com [Source type: Academic]

^ [Lichen sclerosus et atrophicus in children.
  • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]

[26] Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors.
.Phimosis may occur after other types of chronic inflammation (e.g., balanoposthitis), repeated catheterization, or forceful foreskin retraction.^ Phimosis: Refers to a foreskin that won't retract.
  • Your baby son's foreskin - managing the foreskin - Family and Child Health - Body & Health 10 January 2010 20:15 UTC bodyandhealth.canada.com [Source type: FILTERED WITH BAYES]

^ Chronic inflammation of the foreskin may result in a secondary phimosis caused by scarring.
  • http://yenoh93.medceu.com/index/courses/circum.htm 10 January 2010 20:15 UTC yenoh93.medceu.com [Source type: Academic]

^ This occurs when the foreskin is left in the retracted position.
  • Clinical Practice Guidelines 10 January 2010 20:15 UTC www.rch.org.au [Source type: FILTERED WITH BAYES]

[19]
.Phimosis may also arise in diabetics due to the presence of glucose in their urine giving rise to infection in the foreskin.^ Phimosis begins with an infection of the foreskin.
  • Phimosis - Symptoms, Treatment and Prevention 10 January 2010 20:15 UTC www.healthscout.com [Source type: FILTERED WITH BAYES]
  • Phimosis- Health Encyclopedia and Reference 10 January 2010 20:15 UTC www.healthcentral.com [Source type: FILTERED WITH BAYES]

^ If the foreskin is not washed, infection may occur.
  • Foreskin Care Care Guide Information 10 January 2010 20:15 UTC www.drugs.com [Source type: General]

^ Infections may occur under the foreskin.

[27]

Potential complications of acquired phimosis

.Chronic complications of acquired (pathological) phimosis can include discomfort or pain during urination or sexual intercourse.^ Other complications include difficulty in urinating and pain during erections.
  • Phimosis- Causes, Symptoms, Diagnosis, Risk Factors, and Treatment Options for Phimosis 10 January 2010 20:15 UTC www.peoples-health.com [Source type: FILTERED WITH BAYES]

^ Encyclopedia II - Phimosis - Potential complications of acquired phimosis Chronic complications of acquired (pathologic phimosis) can include discomfort or pain during urination or sexual intercourse.

^ Phimosis can lead to problems ranging from mild discomfort to persistent urinary tract infections and pain during intercourse.
  • The Foreskin- Useless…Or Not? New Program Fights to End Circumcision After Discovering Side Effects Of Getting Circumcised for Phimosis 10 January 2010 20:15 UTC www.prweb.com [Source type: General]

.The urinary stream can be impeded, resulting in dribbling and wetness after urination.^ The urinary stream can be impeded, resulting in dribbling and wetness after urination.

^ Adolescents may report dysuria, dribbling between voids, trouble directing their urinary stream because of difficulty holding the penis, or embarrassment in the locker room.
  • Phimosis, Adult Circumcision, and Buried Penis: eMedicine Urology 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ They should also be made aware of the complications that may result from an acquired phimosis such as paraphimosis, obstructed urinary stream and hematuria.
  • HealthNet 10 January 2010 20:15 UTC www.hsbc.com.hk [Source type: FILTERED WITH BAYES]

.Harmful urinary obstruction is possible but uncommon.^ Harmful urinary obstruction is possible but uncommon.

.Pain may occur when a partially retractable foreskin retracts during intercourse and chokes the glans penis.^ Phimosis The foreskin cannot be retracted proximally over the glans penis.
  • Phimosis and Paraphimosis: eMedicine Emergency Medicine 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

^ This occurs when the foreskin is left in the retracted position.
  • Clinical Practice Guidelines 10 January 2010 20:15 UTC www.rch.org.au [Source type: FILTERED WITH BAYES]

^ BXO commonly occurs on the foreskin and glans penis (Keogh 2005).

.A totally non-retractable foreskin is rarely painful.^ A totally non-retractable foreskin is rarely painful.

^ Retracting the foreskin caused pain and embarrasment.

^ A paraphimosis develops when a tight foreskin has been forcibly retracted and forms a constricting ring around the coronal groove of the glans causing venous engorgement and painful swelling of the glans and the foreskin.
  • KidsDoc.at - Vorhautverengung, Phimose, Vorhautverklebung, Kinder- und Jugendchirurgie Wien, Donauspital SMZ Ost, Kinderchirurgie Prof. Rokitansky 10 January 2010 20:15 UTC www.kidsdoc.at [Source type: FILTERED WITH BAYES]

.There is some evidence that phimosis may be a risk factor for penile cancer.^ A history of phimosis is also associated with a dramatically increased risk of penile cancer.
  • bmj.com Rapid Responses for Rickwood et al., 321 (7264) 792-793 10 January 2010 20:15 UTC www.bmj.com [Source type: Academic]

^ The exact cause of penile cancer is not known, but there are certain risk factors for the disease.
  • Penis disorders - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]
  • Disorders of the Penis 10 January 2010 20:15 UTC www.cidpusa.org [Source type: Academic]
  • Disorders of the Penis 10 January 2010 20:15 UTC my.clevelandclinic.org [Source type: Academic]
  • Disorders of the Penis - Bedroom barriers - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]
  • Penis disorders - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ There is some evidence that circumcision may reduce the risk of urinary tract infections.

[28]
The most acute complication is paraphimosis (Paraphimosis image). .In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position.^ This occurs when the foreskin is left in the retracted position.
  • Clinical Practice Guidelines 10 January 2010 20:15 UTC www.rch.org.au [Source type: FILTERED WITH BAYES]

^ In this painful condition the foreskin strangulates the glans and emergency treatment is necessary.
  • Circumcision Guide - Indications For Circumcision 10 January 2010 20:15 UTC www.circinfo.com [Source type: Original source]

^ In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position.
  • HealthNet 10 January 2010 20:15 UTC www.hsbc.com.hk [Source type: FILTERED WITH BAYES]

.The proximal penis is flaccid.^ Flaccidity of the penile shaft proximal to the area of paraphimosis is seen (unless there is accompanying balanoposthitis or infection of the penis).
  • Phimosis and Paraphimosis: eMedicine Emergency Medicine 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

Treatment of phimosis

.Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction.^ Treatment of phimosis Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction.
  • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

^ Phimosis causes obstruction of normal urinary flow.
  • KidsDoc.at - Vorhautverengung, Phimose, Vorhautverklebung, Kinder- und Jugendchirurgie Wien, Donauspital SMZ Ost, Kinderchirurgie Prof. Rokitansky 10 January 2010 20:15 UTC www.kidsdoc.at [Source type: FILTERED WITH BAYES]

^ Encyclopedia II - Phimosis - Treatment of phimosis Phimosis in infancy is nearly always physiologic, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction.

.In older children and men, phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.^ In older children and adults phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.

^ Bleeding is more common in older children.
  • KidsDoc.at - Vorhautverengung, Phimose, Vorhautverklebung, Kinder- und Jugendchirurgie Wien, Donauspital SMZ Ost, Kinderchirurgie Prof. Rokitansky 10 January 2010 20:15 UTC www.kidsdoc.at [Source type: FILTERED WITH BAYES]

^ I'll detail two exercises for phimosis, and one for frenulum breve.
  • Tight Foreskin - The Student Room 10 January 2010 20:15 UTC www.thestudentroom.co.uk [Source type: FILTERED WITH BAYES]

.If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective.^ If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective.

^ Circumcision - risks in adults & older children .
  • Circumcision - Physical Problems 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]
  • Circumcision - Inflammatory Dermatoses 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]

^ Severe phimosis was defined as phimosis requiring surgery owing to dysuria, a weak stream, preputial ballooning, pain on urination, a retrograde urinary tract infection, recurrent balanoposthitis or other urological problems caused by the phimosis.
  • Bone Marrow Transplantation - Severe phimosis as a notable sequela of allogeneic stem cell transplantation in boys 10 January 2010 20:15 UTC www.nature.com [Source type: Academic]

.Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course.^ Doctors were telling their patients circumcision is the ONLY option, when in fact it wasn't!

^ We are unopposed to circumcision as a treatment of last resort for disease or injury.
  • NOHARMM Position Statement on Non-Therapeutic Circumcision of Male Children 10 January 2010 20:15 UTC www.noharmm.org [Source type: Academic]

^ Circumcision is a last resort - to be avoided, whenever possible .
  • bmj.com Rapid Responses for Rickwood et al., 321 (7264) 792-793 10 January 2010 20:15 UTC www.bmj.com [Source type: Academic]

.Some men with nonretractile foreskins have no difficulties and see no need for correction.^ A few men, will need a referral to a urologist or surgeon with expertise in foreskin surgery.
  • Phimosis 10 January 2010 20:15 UTC phimosis.com.au [Source type: FILTERED WITH BAYES]

^ If any boy who reads this cannot retract his foreskin with ease for any reason, then it is advisable to see a pediatrician or a urologist to correct the condition.
  • Penis Information - Teenage Boys' Sexuality 10 January 2010 20:15 UTC boysunderattack.com [Source type: Original source]

^ Some men say circumcision resulted in no loss of sensation for them, but others deeply regret what they've lost.
  • Modern Love: Sex, Relationships & Your Health: Phimosis: The Ins and Outs of a Difficult Foreskin 10 January 2010 20:15 UTC blogs.webmd.com [Source type: Original source]

Non surgical methods include:
.
  • Application of topical steroid cream, such as betamethasone, for 4-6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective.^ Application of topical steroid creams: 0.05% betamethasone cream should be used twice daily for 2 to 4 weeks.
    • Clinical Practice Guidelines 10 January 2010 20:15 UTC www.rch.org.au [Source type: FILTERED WITH BAYES]

    ^ Application of steroid cream to the tip of the foreskin is often very efficient.
    • Penis development products. About narrow foreskin. 10 January 2010 20:15 UTC www.abicana.com [Source type: FILTERED WITH BAYES]

    ^ Treatment of phimosis with topical steroids and foreskin anatomy .
    • International braz j urol - Treatment of phimosis with topical steroids and foreskin anatomy 10 January 2010 20:15 UTC www.scielo.br [Source type: Academic]

    [21][29][30] .It has replaced circumcision as the preferred treatment method for some physicians in the British National Health Service.^ According to the National Center for Health Statistics (NCHS), 64.1% of male infants were circumcised in the United States during 1995 (unpublished data, 1997).
    • http://yenoh93.medceu.com/index/courses/circum.htm 10 January 2010 20:15 UTC yenoh93.medceu.com [Source type: Academic]

    ^ Some children circumcised for BXO may have residual lesions which require treatment with topical steroids.
    • bmj.com Rapid Responses for Rickwood et al., 321 (7264) 792-793 10 January 2010 20:15 UTC www.bmj.com [Source type: Academic]

    ^ Males are only circumcised as treatment because it is socially acceptable and far more profitable for the physician.

    [31][32]
  • .
  • Stretching of the foreskin can be accomplished manually, with balloons[33] or with other tools[34].^ The stretching can also be accomplished with balloons placed under the foreskin skin under anaesthesia,[20]or with a tool.
    • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

    ^ Conservative treatment options include manual stretching, topical medications, and conservative surgical procedures to loosen the opening of the foreskin.
    • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

    ^ In such cases - and if your foreskin is very tight - NORM recommends the use of a specially designed tool called a Glansie to stretch foreskin openings.
    • Penis Problems: Phimosis 10 January 2010 20:15 UTC www.altpenis.com [Source type: FILTERED WITH BAYES]

    .Skin that is under tension expands by growing additional cells.^ The skin that is under tension expands by growing additional cells.

    ^ Skin that is under tension expands by growing additional cells.
    • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]

    ^ A natural secretion of skin cells and oils that collects under the foreskin in both males and females.
    • Penis Information - Teenage Boys' Sexuality 10 January 2010 20:15 UTC boysunderattack.com [Source type: Original source]

    .A permanent increase in size occurs by gentle stretching over a period of time.^ A permanent increase in size occurs by gentle stretching over a period of time.
    • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]
    • Tight Foreskin In Boys & Adult Circumcision Patient Advice in Essex, UK 10 January 2010 20:15 UTC www.vascularsurgicalexpertise.co.uk [Source type: FILTERED WITH BAYES]

    ^ Treatment of phimosis may include gentle, manual stretching of the foreskin over a period of time.
    • Penis disorders - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]
    • Disorders of the Penis 10 January 2010 20:15 UTC www.cidpusa.org [Source type: Academic]
    • Disorders of the Penis 10 January 2010 20:15 UTC my.clevelandclinic.org [Source type: Academic]
    • Sexual Health: Male Reproductive Problems: Penis Disorders 10 January 2010 20:15 UTC www.webmd.com [Source type: General]
    • Disorders of the Penis - Bedroom barriers - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]
    • Penis disorders - Revolution Health 10 January 2010 20:15 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

    ^ Remember that two conditions must exist for the foreskin to become retractable: 1) the glans and foreskin must have separated and 2) the foreskin opening must have increased in size so it can stretch over the glans.
    • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

    The treatment is non-traumatic and non-destructive. .Manual stretching may be carried out without the aid of a medical doctor.^ Manual stretching may be carried out without the aid of a medical doctor.
    • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]
    • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

    ^ Conservative treatment options include manual stretching, topical medications, and conservative surgical procedures to loosen the opening of the foreskin.
    • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

    ^ Thirdly many men with tight foreskins complain that sex without a condom is painful as the foreskin may be forced back during sex causing painful over-stretching of the foreskin opening.
    • Phimosis Sufferer? - Yahoo! Answers 10 January 2010 20:15 UTC answers.yahoo.com [Source type: General]

    .The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.^ The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.
    • Phimosis problem? - Yahoo!7 Answers 10 January 2010 20:15 UTC au.answers.yahoo.com [Source type: General]

    ^ The hardening of the tissue prevents retraction of the foreskin."
    • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

    ^ The skin that is under tension expands by growing additional cells.

    .Beaugé treated several hundred adolescents by advising them to change their masturbation habits to closing their hand over their penis and moving it back and forth.^ Sexual: During intercourse, the intact penis glides back and forth inside its skin sheath, greatly reducing the friction between the penis and vaginal walls.
    • Circumcision Information Resource Center of Colorado 10 January 2010 20:15 UTC www.coloradonocirc.org [Source type: FILTERED WITH BAYES]

    ^ In sexual intercourse , your foreskin plays an important role and is designed to move back behind the head of your penis during sex.

    ^ Adolescents who present with buried penis are usually obese, and weight loss should be advised.
    • Phimosis, Adult Circumcision, and Buried Penis: eMedicine Urology 10 January 2010 20:15 UTC emedicine.medscape.com [Source type: Academic]

    .Retraction of the foreskin was generally achieved after four weeks and he stated that he never had to refer one for surgery.^ The foreskin should never be retracted by force.

    ^ In just ONE WEEK, I could fully retract my foreskin!

    ^ Once this has healed (2-3 weeks) the foreskin can usually be retracted fully and the only change in appearance is a notch that becomes visible in the skin as it is retracted.
    • Can foreskin problems be treated without circumcision? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: FILTERED WITH BAYES]

    [8][25]
.Some may opt for surgery treatment straight away.^ Treatment is available, but may include surgery.
  • Penis Problems And Conditions | LIVESTRONG.COM 10 January 2010 20:15 UTC www.livestrong.com [Source type: General]

^ There is no standard treatment for clitoral phimosis, although some women have undergone surgery to increase the exposure of the clitoral glans.
  • Anatomy and Sexual Dysfunction: Scientific American 10 January 2010 20:15 UTC www.scientificamerican.com [Source type: FILTERED WITH BAYES]

^ And straight away I was booked in for surgery to amputate my foreskin!

This consists of the removal of the foreskin or a minor operation to let out the foreskin:
.
  • Circumcision is sometimes performed for pathological phimosis, and is effective.
  • Dorsal slit is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.
  • Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin[35][36] can be an effective alternative to full circumcision.^ It is slit along its upper surface and then all around so that it can be removed.
    • Phimosis - Symptoms, Treatment and Prevention 10 January 2010 20:15 UTC www.healthscout.com [Source type: FILTERED WITH BAYES]

    ^ Preputioplasty entails longitudinal incision of the phimotic band and transverse closure with no tissue resection.
    • Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons -- Huntley et al. 96 (9): 449 -- JRSM 10 January 2010 20:15 UTC jrsm.rsmjournals.com [Source type: Academic]

    ^ In a dorsal slit, the foreskin is split at the top to expose the glans, but no skin is removed.
    • Health 24 - Common conditions - A to E 10 January 2010 20:15 UTC health.mweb.co.za [Source type: FILTERED WITH BAYES]

    [21] It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects.

Incidence

.A number of medical reports of phimosis incidence have been published over the years.^ The reported incidence of phimosis varies.
  • Cost-effective Treatment of Phimosis -- Van Howe 102 (4): e43 -- Pediatrics 10 January 2010 20:15 UTC pediatrics.aappublications.org [Source type: Academic]

^ Recent reports in the medical literature indicate that medical doctors are not trained to distinguish between normal developmental foreskin tightness and pathological phimosis.

^ Amongst 13 year-old Japanese boys the incidence of phimosis was 16% [Kayaba et al., 1996].
  • Circumcision - Physical Problems 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]

.They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised.^ In addition, most of the problems reported were minor.
  • http://yenoh93.medceu.com/index/courses/circum.htm 10 January 2010 20:15 UTC yenoh93.medceu.com [Source type: Academic]

^ Pathologic and physiologic phimosis .
  • Pathologic and physiologic phimosis 10 January 2010 20:15 UTC www.cfpc.ca [Source type: Academic]
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

^ They have no more penile problems than circumcised males.
  • NORM - National Organization of Restoring Men 10 January 2010 20:15 UTC www.norm.org [Source type: Original source]

.A commonly cited incidence statistic for pathological phimosis is 1% of uncircumcised males.^ When it is not done routinely, the incidence of pathological phimosis is increased (1).
  • International braz j urol - Treatment of phimosis with topical steroids and foreskin anatomy 10 January 2010 20:15 UTC www.scielo.br [Source type: Academic]

^ The incidence of pathological phimosis in boys has been recently reported as 0.4 cases/1000 boys per year, or 0.6% of boys affected by their 15th birthday [ 8 ].
  • How should phimosis be treated? 10 January 2010 20:15 UTC www.norm-uk.org [Source type: Academic]

^ An incidence rate of 1% to 2% of the uncircumcised adult male population is often cited, though some studies of older children or adolescents have reported higher rates.2 Relative phimosis is more common, with estimates of its frequen ...

[19][37],[20] .When phimosis is simply equated with nonretractility of the foreskin after age 3 years, considerably higher incidence rates have been reported.^ The reported incidence of phimosis varies.
  • Cost-effective Treatment of Phimosis -- Van Howe 102 (4): e43 -- Pediatrics 10 January 2010 20:15 UTC pediatrics.aappublications.org [Source type: Academic]

^ Topical steroid application to the preputial ring to treat ‘phimosis’ has reported success rates between 33% – 95%.
  • Phimosis and Paraphimosis | Doctor | Patient UK 10 January 2010 20:15 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Amongst 13 year-old Japanese boys the incidence of phimosis was 16% [Kayaba et al., 1996].
  • Circumcision - Physical Problems 10 January 2010 20:15 UTC www.circinfo.net [Source type: Academic]

[14][38] .Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.^ In older children and adults phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.

^ B) In many cases of pathologic phimosis, the glans and meatus are visible without any attempt at retraction, as the scarred ring holds the preputial outlet open.
  • Pathologic and physiologic phimosis: Approach to the phimotic foreskin -- McGregor et al. 53 (3): 445 -- Canadian Family Physician 10 January 2010 20:15 UTC www.cfp.ca [Source type: Academic]

^ Many guys don't have their foreskin retract until well after 10, so phimosis is not technically a diagnosis except in adults.
  • Phimosis Sufferer? - Yahoo! Answers 10 January 2010 20:15 UTC answers.yahoo.com [Source type: General]

[39]

Phimosis in history

.
  • According to some accounts, phimosis prevented Louis XVI of France from impregnating his wife, Marie Antoinette, for the first seven years of their marriage.^ Historians agree that the marriage of Louis XVI and Marie Antoinette was only consummated seven years after the official ceremony.

    ^ In the latest rewrite of his familiar list of compelling reasons as to why boys must not be allowed to keep their foreskins [1], Brian Morris makes the daring claim that Louis XVI, King of France 1754-93, was prevented from consummating his marriage to Marie Antoinette by his tight foreskin, and was obliged to submit to circumcision so that he could perform his marital duties.

    ^ Could the phimosis of Louis XVI (1754-1793) have been responsible for his sexual difficulties and his delayed fertility?

    .She was 14 and he was 15 when they married in 1770. However, the presence and nature of his genital anomaly is not considered certain, and some scholars (Vincent Cronin and Simone Bertiere) assert that surgical repair would have been mentioned in the records of his medical treatments if it had occurred.^ A biopsy is mandatory to exclude SCC. In fact, some consider this a premalignant condition and recommend complete surgical excision even if frank malignancy is not seen on biopsy.
    • White : Diseases of the Skin - Oral and Genital Disorders 10 January 2010 20:15 UTC www.merckmedicus.com [Source type: Academic]

    ^ The marriage remained unconsummated until 7 years later owing to a genital deformation, usually considered phimosis, which was however corrected with minor surgery, perhaps circumcision.
    • balanoposthitis - Wordsmith.org 10 January 2010 20:15 UTC wordsmith.org [Source type: FILTERED WITH BAYES]

    ^ Lately, the trend has been for fewer circumcisions 2 because of medical and cultural concerns, 3 greater understanding of the natural history of the foreskin 4 , 5 and modern treatment alternatives.
    • Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons -- Huntley et al. 96 (9): 449 -- JRSM 10 January 2010 20:15 UTC jrsm.rsmjournals.com [Source type: Academic]

    .February 2007" style="white-space:nowrap;">[citation needed]
  • US President James Garfield was assassinated by Charles Guiteau in 1881. The autopsy report for Guiteau indicated that he had phimosis.^ Recent reports in the medical literature indicate that medical doctors are not trained to distinguish between normal developmental foreskin tightness and pathological phimosis.

    ^ A 2007 CDC report found that 79% of US males are circumcised (86% of non-Hispanic whites).
    • Medicirc.org: Circumcision Information Site - A Lifetime of Medicial Benefits 10 January 2010 20:15 UTC www.medicirc.org [Source type: FILTERED WITH BAYES]

    ^ A number of reports in the medical literature of the United Kingdom indicate that medical doctors are not trained to distinguish between normal developmental tight prepuce in boys and pathological phimosis.
    • Conservative Contemporary Treatment of Phimosis 10 January 2010 20:15 UTC www.cirp.org [Source type: Academic]

    .At the time, this led to the simplistic speculation that Guiteau's murderous behavior was due to phimosis-induced insanity.^ At that time, deaths attributed to phimosis and circumcision were grouped together, but Gairdner stated that the deaths were more likely due to circumcision.
    • the real reason why people cet cercumsized - Page 3 - Xbox 360 & Xbox Forums 10 January 2010 20:15 UTC forum.teamxbox.com [Source type: General]

    [40]
  • Josef Fritzl had this condition when he was a child, according to a court psychologist. [41]

See also

References

  1. ^ The prevalence of phimosis of the clitoris in women presenting to the sexual dysfunction clinic: Lack of correlation to disorders of desire, arousal and orgasm
  2. ^ a b Huntley JS, Bourne MC, Munro FD, Wilson-Storey D (September 2003). "Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons". J R Soc Med 96 (9): 449–51. doi:10.1258/jrsm.96.9.449. PMID 12949201.& PMC 539600. http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=12949201. 
  3. ^ a b c Rickwood AM, Walker J (1989). "Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence?". Ann R Coll Surg Engl 71 (5): 275–7. PMID 2802472. "Authors review English referral statistics and suggest phimosis is overdiagnosed, especially in boys under 5 years, because of confusion with developmentally nonretractile foreskin.". 
  4. ^ a b McGregor TB, Pike JG, Leonard MP (March 2007). "Pathologic and physiologic phimosis: approach to the phimotic foreskin". Can Fam Physician 53 (3): 445–8. PMID 17872680.& PMC 1949079. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17872680. 
  5. ^ Bolla G, Sartore G, Longo L, Rossi C (2005). "[The sclero-atrophic lichen as principal cause of acquired phimosis in pediatric age]" (in Italian). Pediatr Med Chir 27 (3-4): 91–3. PMID 16910457. 
  6. ^ Buechner SA (September 2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2002&volume=90&issue=5&spage=498. 
  7. ^ Edwards S (June 1996). "Balanitis and balanoposthitis: a review". Genitourin Med 72 (3): 155–9. PMID 8707315. 
  8. ^ a b c Beaugé M (1997). "The causes of adolescent phimosis". Br J Sex Med 26 (Sept/Oct). http://www.cirp.org/library/treatment/phimosis/beauge2/. 
  9. ^ Minagawa T, Murata Y (June 2008). "[A case of urinary retention caused by true phimosis]" (in Japanese). Hinyokika Kiyo 54 (6): 427–9. PMID 18634440. 
  10. ^ Daling JR, Madeleine MM, Johnson LG, et al. (September 2005). "Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease". Int. J. Cancer 116 (4): 606–16. doi:10.1002/ijc.21009. PMID 15825185. 
  11. ^ Steadman B, Ellsworth P (June 2006). "To circ or not to circ: indications, risks, and alternatives to circumcision in the pediatric population with phimosis". Urol Nurs 26 (3): 181–94. PMID 16800325. 
  12. ^ a b c J.E. Wright (february 1994). "Further to 'the further fate of the foreskin'". The Medical Journal of Australia 160. PMID 8295581. http://www.cirp.org/library/normal/wright2/. 
  13. ^ Gairdner D (1949). "The fate of the foreskin, a study of circumcision". Br Med J 2 (4642): 1433–7, illust. doi:10.1136/bmj.2.4642.1433. PMID 15408299. 
  14. ^ a b Oster J (1968). "Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys". Arch. Dis. Child. 43 (228): 200–3. doi:10.1136/adc.43.228.200. PMID 5689532. 
  15. ^ Kabaya, Hiroyuki; Hiromi Tamura,Seiichi Kitajima, Yoshiyuki Fujiwara, Tetsuo Kato, Tetsuro Kato (November 1996). "Analysis of shape and retractability of the prepuce in 603 Japanese boys". Journal of urology 156 (5): 1813–1815. doi:10.1016/S0022-5347(01)65544-7. PMID 8863623. http://www.cirp.org/library/normal/kayaba/. 
  16. ^ "Care of the Uncircumcised Penis". Guide for parents. American Academy of Pediatrics. September 2007. http://www.aap.org/publiced/br_uncircumcised.htm. 
  17. ^ "Caring for an uncircumcised penis". Information for parents. Canadian Paediatric Society. November 2004. http://www.caringforkids.cps.ca/pregnancy&babies/Circumcision.htm. 
  18. ^ George Hill (2003). "Circumcision for phimosis and other medical indications in Western Australian boys". The Medical Journal of Australia 178 (11): 587. PMID 12765511. http://www.mja.com.au/public/issues/178_11_020603/matters_arising_020603-1.html. 
  19. ^ a b c Cantu Jr. S. Phimosis and paraphimosis at eMedicine
  20. ^ a b Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD (2003). "Circumcision for phimosis and other medical indications in Western Australian boys". Med. J. Aust. 178 (4): 155–8. PMID 12580740. http://www.mja.com.au/public/issues/178_04_170203/spi10278_fm.html. . Recent Australian statistics with good discussion of ascertainment problems arising from surgical statistics.
  21. ^ a b c d e Van Howe RS (1998). "Cost-effective treatment of phimosis". Pediatrics 102 (4): E43. doi:10.1542/peds.102.4.e43. PMID 9755280. http://pediatrics.aappublications.org/cgi/content/full/102/4/e43.  A review of estimated costs and complications of 3 phimosis treatments (topical steroids, praeputioplasty, and surgical circumcision). The review concludes that topical steroids should be tried first, and praeputioplasty has advantages over surgical circumcision. This article also provides a good discussion of the difficulty distinguishing pathological from physiological phimosis in young children and alleges inflation of phimosis statistics for purposes of securing insurance coverage for post-neonatal circumcision in the United States.
  22. ^ Dewan PA (2003). "Treating phimosis". Med. J. Aust. 178 (4): 148–50. PMID 12580737. http://www.mja.com.au/public/issues/178_04_170203/dew10610_fm.html. 
  23. ^ "Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision". Pediatrics 103 (3): 686–93. 1999. PMID 10049981. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=10049981.  Although not directly focusing on phimosis, this American Academy of Pediatrics report provides a synopsis of circumcision statistics and benefits, with noncommittal final recommendation. "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."
  24. ^ Babu R, Harrison SK, Hutton KA (2004). "Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?". BJU Int. 94 (3): 384–7. doi:10.1111/j.1464-410X.2004.04935.x. PMID 15291873. 
  25. ^ a b Beaugé, Michel (1991). "Conservative Treatment of Primary Phimosis in Adolescents". Faculty of Medicine, Saint-Antoine University. http://www.cirp.org/library/treatment/phimosis/beauge/. 
  26. ^ Laymon CW, Freeman C (1944). "Relationship of Balanitis Xerotica Obliterans to Lichen Sclerosus et Atrophicus". Arch Dermat Syph 49: 57–9. http://www.cirp.org/library/treatment/BXO/laymon1/. 
  27. ^ Bromage, Stephen J.; Anne Crump and Ian Pearce (2008). "Phimosis as a presenting feature of diabetes". BJU International 101 (3): 338–340. doi:10.1111/j.1464-410X.2007.07274.x. http://www3.interscience.wiley.com/journal/118508219/abstract?CRETRY=1&SRETRY=0. 
  28. ^ Willcourt RJ. Discussion of Rickwood et al. (2000) BMJ.com e-letters, 30 June 2005.
  29. ^ Topical steroid application versus circumcision in pediatric patients with phimosis: a prospective randomized placebo controlled clinical trial, World Journal of Urology, 2008, 26, pp.187-190
  30. ^ Phimosis and topical steroids: new clinical findings, Pediatric Surgery International, 2007, 23, pp.331-335
  31. ^ Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C (2001). "Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect". BJU Int. 87 (3): 239–44. doi:10.1046/j.1464-410x.2001.02033.x. PMID 11167650. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2001&volume=87&issue=3&spage=239. 
  32. ^ Chu CC, Chen KC, Diau GY (1999). "Topical steroid treatment of phimosis in boys". J. Urol. 162 (3 Pt 1): 861–3. doi:10.1097/00005392-199909010-00078. PMID 10458396. 
  33. ^ He Y, Zhou XH (1991). "Balloon dilation treatment of phimosis in boys. Report of 512 cases". Chin. Med. J. 104 (6): 491–3. PMID 1874025. http://www.cirp.org/library/treatment/phimosis/he-zhou/. 
  34. ^ The Glansie glansie.com
  35. ^ Cuckow PM, Rix G, Mouriquand PD (1994). "Preputial plasty: a good alternative to circumcision". J. Pediatr. Surg. 29 (4): 561–3. doi:10.1016/0022-3468(94)90092-2. PMID 8014816. http://linkinghub.elsevier.com/retrieve/pii/0022-3468(94)90092-2. 
  36. ^ Saxena AK, Schaarschmidt K, Reich A, Willital GH (2000). "Non-retractile foreskin: a single center 13-year experience". Int Surg 85 (2): 180–3. PMID 11071339. http://www.cirp.org/library/treatment/phimosis/saxena1/. 
  37. ^ Shankar KR, Rickwood AM (1999). "The incidence of phimosis in boys". BJU Int. 84 (1): 101–2. doi:10.1046/j.1464-410x.1999.00147.x. PMID 10444134. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=1999&volume=84&issue=1&spage=101.  This study gives a low incidence of pathological phimosis (0.6% of uncircumcised boys by age 15 years) by asserting that balanitis xerotica obliterans is the only indisputable type of pathological phimosis and anything else should be assumed "physiological". Restrictiveness of definition and circularity of reasoning have been criticized.
  38. ^ Imamura E (1997). "Phimosis of infants and young children in Japan". Acta Paediatr Jpn 39 (4): 403–5. PMID 9316279.  A study of phimosis prevalence in over 4,500 Japanese children reporting that over a third of uncircumcised had a nonretractile foreskin by age 3 years.
  39. ^ Ohjimi T, Ohjimi H (1981). "Special surgical techniques for relief of phimosis". J Dermatol Surg Oncol 7 (4): 326–30. PMID 7240535. 
  40. ^ Hodges FM (1999). "The history of phimosis from antiquity to the present". in Milos, Marilyn Fayre; Denniston, George C.; Hodges, Frederick Mansfield. Male and female circumcision: medical, legal, and ethical considerations in pediatric practice. New York: Kluwer Academic/Plenum Publishers. pp. 37–62. ISBN 0-306-46131-5. http://www.circumstitions.com/Absurd.html#assassin. 
  41. ^ http://www.guardian.co.uk/world/2009/mar/19/fritzl-psychiatrist-verdict

External links

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Pictures


Citable sentences

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