Phimosis in children is a condition where the foreskin cannot be retracted from the head of the penis. This condition commonly occurs in some children and adults who have not been circumcised.
Having phimosis is not always problematic. Babies are born with phimosis, and their foreskin usually loosens on its own over time without treatment. However, phimosis can become an issue if it causes symptoms, such as the appearance of a tiny pinhole opening or difficulty cleaning under the foreskin.
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Causes of Phimosis in Children
In infants and children, phimosis is typically a condition present at birth and usually resolves naturally over time. This is called physiological phimosis. However, if phimosis is caused by other conditions, it is referred to as pathological phimosis.
Here are some causes of phimosis to be aware of:
- Scar Tissue: Infections can lead to scarring that damages the foreskin, reducing its elasticity and making it difficult to retract.
- Injury: Forcefully pulling or stretching the foreskin can cause injury. Such actions may result in tiny tears and inflammation, which can lead to phimosis.
- Skin Conditions: Skin conditions like penile lichen sclerosus or balanitis xerotica obliterans are major causes of phimosis, especially in adults. Other conditions that may contribute to phimosis include eczema and psoriasis.
- Certain Medical Conditions: People with diabetes are more likely to develop balanitis, an infection of the tip of the penis, which can trigger phimosis.
Symptoms of Phimosis in Children
The main symptom of phimosis is the inability to retract the foreskin from the head of the penis. However, other symptoms may also occur, such as:
- Changes in skin color (red, purple, dark brown, or black), often due to irritation or infection
- Swelling from irritation or infection
- Pain
- Painful urination (dysuria)
- Weak urine stream
- Blood in urine (hematuria)
- Smegma (a harmless combination of oils, skin cells, sweat, and other fluids that collects around the genitals)
How to Treat Phimosis
Physiological phimosis typically does not require treatment. In most cases, the condition resolves on its own as the child grows.
The first treatment option usually recommended by doctors for pathological phimosis is corticosteroid cream or gel. Parents can apply these medications to the child’s penis.
Doctors may also suggest gently stretching the foreskin about two weeks after starting corticosteroid treatment. This involves softly pulling back the foreskin as far as possible without causing pain. Apply the corticosteroid cream to the head of the penis during this stretching exercise.
If the child has an infection of the foreskin or glans, the doctor may also prescribe antibiotics.
Surgery may be necessary if corticosteroid creams are ineffective. This typically involves circumcision, a procedure to remove the foreskin and fully expose the head of the penis.
Doctors may recommend circumcision if:
- Lichen sclerosus causes the phimosis
- The phimosis is severe
- Corticosteroid creams do not yield the desired results
Complications of Phimosis
Phimosis can lead to complications, such as:
- Inflammation of the foreskin (posthitis), glans (balanitis), or both (balanoposthitis)
- Urinary tract infection (UTI)
- Tearing of the foreskin (adhesions)
- Paraphimosis – when the foreskin becomes trapped behind the glans and cannot be pulled forward
- Poor hygiene
Long-term phimosis may also increase the risk of penile cancer.
Phimosis Specialists at Mandaya Royal Puri Hospital
Mandaya Royal Puri Hospital has pediatric surgery specialists experienced in treating phimosis in children. They provide consultation and, if needed, circumcision procedures.
1. dr. Sastiono, Sp.B Subsp.Ped(K)
dr. Sastiono, Sp.B Subsp.Ped(K), is recognized as one of Indonesia’s most experienced pediatric surgeons. He is highly skilled and has an excellent reputation in pediatric surgery.
In addition to treating phimosis, dr. Sastiono can also handle various medical conditions in infants and children, such as:
- Congenital abnormalities in the digestive tract, abdominal wall, and diaphragm
- Appendicitis, hernia, hydrocele, and phimosis
- Jaundice due to liver and bile duct disorders
- Tumors in infants and children
- Liver transplantation
Practice schedule at Mandaya Royal Puri Hospital:
- Tuesday: 10:00 AM – 1:00 PM
- Thursday: 10:00 AM – 1:00 PM
2. dr. Flora Agustina, Sp.BA
dr. Flora Agustina, Sp.BA, is a pediatric surgery specialist also experienced in performing circumcisions to treat phimosis. She completed her general medical education at Christian University of Indonesia in Jakarta, and pursued her pediatric surgery specialization at Padjadjaran University, Bandung.
She has also actively participated in various medical trainings, including:
- Basic Surgical Skills Course (BSSC), Bali, 2012
- Basic Laparoscopic Surgery Course, Bali, 2015
- Definitive Surgery Course for Trauma and Acute Care Surgery, Bali, 2014
- Advanced Trauma Life Support (ATLS), Bandung, 2009
- Workshop on Upper & Lower GI Endoscopy, Bali, 2015
- Symposium “Complications in Pediatric Surgery” at the 24th PERBANI Annual Scientific Meeting, Bandung, 2016
Practice schedule at Mandaya Royal Puri Hospital:
- Monday: 5:00 PM – 7:00 PM
- Wednesday: 5:00 PM – 7:00 PM
- Thursday: 5:00 PM – 7:00 PM
- Saturday: 2:00 PM – 4:00 PM
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