Health and Fitness

Phimosis: everything you need to know!

Phimosis is a very common problem that affects men of all ages. Despite being more commonly referred to as a childhood problem (congenital), this disease can appear in adulthood, being known as adult or acquired phimosis.

In this post I explain details about phimosis, from the concept to its treatment. Check out!

What is phimosis?

The concept of phimosis comes from the Greek phimos, which means “gag”, “caimo” or “mouthpiece”, which represents a narrowing or fibrotic ring of the skin that covers the penis, the foreskin, preventing the exposure of the head of the penis, the glans.

A great deal of confusion is created when phimosis is compared with the “excess skin” of the foreskin. Phimosis is a clinical condition with an exact, anatomical diagnosis. On the contrary, the redundant foreskin presents itself in a variety of ways and does not represent a clinical problem in most patients.

The most common and known form of phimosis occurs in childhood, when it is not possible to retract the foreskin in the baby. At this age, only preputial adhesion is very common, which is treated through simple measures, combining cleaning and topical treatments, including steroid ointments.

True or physiological phimosis will be diagnosed from 3 to 5 years of age, in more than 70% of children it will resolve after 5 years of age.

When the phimosis ring remains, making it difficult to expose the head of the penis, the chances of spontaneous resolution decrease and clinical measures will no longer be effective. At this point, a more invasive approach should be considered.

There are a few ways to grade phimosis, among them the most common classifies into 4 degrees:

  1. full exposure of the glans and retraction of the foreskin without difficulty. It only has a ring on the base.
  2. partial exposure of the glans.
  3. exposure of the urethral meatus only.
  4. it is not possible to expose the glans or meatus.

Does physiological phimosis require treatment?

The well-known physiological phimosis does not lead to major problems for the child. There is no difficulty urinating, it does not predispose to urinary tract infections.

Foreskin retraction is complete with a discreet fibrotic ring. Because it does not generate complications, this type of phimosis does not usually need treatment.

In the case of pathological phimosis, correction is necessary in most cases.

When a patient asks “why to have phimosis surgery”, the main arguments point to the possible implications of this condition: urine infection, recurrent balanoposthitis, scattered jet and pain when urinating and pain during sexual intercourse.

In addition, some factors induce the onset of acquired phimosis, especially chronic penile inflammation (with evolution to its most severe form – balanitis xerotica obliterans).

These conditions are predisposed in decompensated immunosuppressed patients, such as poorly controlled diabetic patients.

The main forms of treatment are:

  • reamer ring
  • Surgery (postectomy)

The reamer ring is still widely used in children, especially in milder cases that do not want surgical treatment. The result is slightly inferior and its use has been discouraged.

Postectomy is a small surgical procedure to remove the foreskin. Widely used, one of the main surgeries performed in urology. The results are excellent, both in terms of functionality and aesthetics. Many operating patients ask themselves “why didn’t I have phimosis surgery before?”

How is a postectomy performed?

The surgery is performed in a simple way, in a hospital environment. It became popular due to the culture of some peoples who perform circumcision, which is nothing more than the same surgery performed on newborns and children.

The surgery is performed with local anesthesia and sedatives, which allows for early hospital discharge. The period of hospitalization varies from 4 to 6 hours.

Regarding post-operative care, the dressing must be removed 24 hours after the procedure. The surgical wound should be cleaned daily and medication used as prescribed by the urologist. There is no restriction on food.

Greater efforts should be avoided in the first days, allowing a return to physical activities in an average of 20 days or until completely healed. It is important to maintain sexual rest for 40 to 60 days.

In addition to phimosis, indications for postectomy include:

– Balanoposthitis (infections)

– Potential for prevention of sexual diseases (STD) and HIV**

– aesthetics

Frequently asked questions by patients undergoing phimosis surgery

Postectomy is one of the most performed urological procedures in the world. It is mainly done due to phimosis, but other indications are also common.

Therefore, there are a large number of doubts that we notice when the patient goes to the urologist (which many know as a prostate doctor) and on the internet, with phimosis being the main term sought by patients.

The following are the main doubts of patients about phimosis:

– Does phimosis surgery reduce the size of the penis?

  • No, postectomy is not a penis enlargement or reduction surgery. It only touches the skin tissue. The cavernous bodies are the real responsible for the size of the penis, and in phimosis surgery we don’t touch them.

– Does the surgery to correct phimosis make the penis lose sensitivity?

  • No, the postectomy is unable to affect the sensitivity of the organ. The surgery is done on the skin tissues (skin of the penis). The nerves responsible for the sensation of pleasure are located in a deeper region, not accessed in this surgery.

– Does phimosis impair the growth of the penis?

  • Not. Despite the sensation of impairment in the potential for rigidity, penile erection is satisfactory and depends on sensory stimulation and the contractile capacity of the corpora cavernosa.

– How long do I need to be without intercourse after phimosis surgery?

  • Ideally, no sexual stimulation or masturbation should be performed during surgical recovery. At least 40 days is necessary for the return to sexual activities.

– What to do to avoid erections after surgery?

  • Night and morning penile erections are involuntary and there is no way to avoid them. The stitches performed in postectomy are strong enough to hold the vast majority of erections without damaging the suture.
  • Any voluntary sexual stimulation should be avoided. In some cases, one or two stitches will come loose but it shouldn’t be a cause for concern. See your urologist and he will clarify.

– Does the skin grow back after having the phimosis surgery?

  • Not. Once phimosis is corrected, the skin will no longer exist. In some cases phimosis can come back, especially if there are episodes of inflammation for any reason or in cases of diabetics with inadequate control of the disease.

Now that you understand a little more about phimosis, its diagnosis, classification and treatment, don’t be afraid to go ahead and solve your problem once and for all.

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