Phimosis: Childhood normal phimosis or normal tight foreskin

Found this link quite by accident, talks about normal and abnormal (physiologic and pathologic phimosis,) non-retractible foreskins in male children.

http://www.cfp.ca/content/53/3/445.full

Excerpt: click link for full page

Pathologic and physiologic phimosis
Approach to the phimotic foreskin
Thomas B. McGregor, MD
Resident in the Department of Urology at Queen’s University in Kingston, Ont
John G. Pike, MD FRCSC
Pediatric urologist
Michael P. Leonard, MD FRCSC FAAP
+ Author Affiliations

Chief in the Division of Pediatric Urology at the Children’s Hospital of Eastern Ontario at the University of Ottawa
Correspondence to: Dr Michael P. Leonard, Division of Pediatric Urology, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1; telephone 613 737-7600, extension 1353; fax 613 738-4271; e-mail mleonard@cheo.on.ca

Next Section
Abstract
OBJECTIVE To review the differences between physiologic and pathologic phimosis, review proper foreskin care, and discuss when it is appropriate to seek consultation regarding a phimotic foreskin.

SOURCES OF INFORMATION This paper is based on selected findings from a MEDLINE search for literature on phimosis and circumcision referrals and on our experience at the Children’s Hospital of Eastern Ontario Urology Clinic. MeSH headings used in our MEDLINE search included “phimosis,” “referral and consultation,” and “circumcision.” Most of the available articles about phimosis and foreskin referrals were retrospective reviews and cohort studies (levels II and III evidence).

MAIN MESSAGE Phimosis is defined as the inability to retract the foreskin. Differentiating between physiologic and pathologic phimosis is important, as the former is managed conservatively and the latter requires surgical intervention. Great anxiety exists among patients and parentsregarding non-retractile foreskins. Most phimosis referrals seen in pediatric urology clinics are normal physiologically phimotic foreskins. Referrals of patients with physiologic phimosis to urology clinics can create anxiety about the need for surgery among patients and parents, while unnecessarily expanding the waiting list for specialty assessment. Uncircumcised penises require no special care. With normal washing, using soap and water, and gentle retraction during urination and bathing, most foreskins will become retractile over time.

CONCLUSION Physiologic phimosis is often seen by family physicians. These patients and their parents require reassurance of normalcy and reinforcement of proper preputial hygiene. Consultation should be sought when evidence of pathologic phimosis is present, as this requires surgical management.

Family physicians represent the front line in health care, and, hence, are most likely to make the initial discovery of a phimotic foreskin. Being able to distinguish between pathologic and physiologic phimosis would greatly reduce unnecessary, costly referrals. It would also help primary care physicians recognize and treat these cases more appropriately and help reassure patients and their families.

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