Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2007 Mar;53(3):445-8.

Pathologic and physiologic phimosis: approach to the phimotic foreskin

Thomas B McGregor  1 , John G Pike, Michael P Leonard
Affiliations
Review

Pathologic and physiologic phimosis: approach to the phimotic foreskin

Thomas B McGregor et al. Can Fam Physician. 2007 Mar.

Abstract
in English, French

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 parents regarding 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.

OBJECTIF: Revoir les différences entre les phimosis normal et pathologique, rappeler les soins appropriés du prépuce et discuter des cas de prépuces phimotiques qui requièrent une consultation.

SOURCE DE L’INFORMATION: Cet article est fondé sur les résultats d’une recherche dans MEDLINE concernant les demandes de consultation pour phimosis et circoncision, et sur l’expérience des auteurs à la Clinique d’urologie du Centre hospitalier pour enfants de l’est de l’Ontario. Les rubriques MeSH utilisées pour la recherche dans MEDLINE incluaient «phimosis», «referral and consultation» et «circumcision». La plupart des articles sur les demandes de consultation pour phimosis et prépuce étaient des revues rétrospectives et des études de cohorte (preuves de niveaux II et III).

PRINCIPAL MESSAGE: Le phimosis se définit comme l’incapacité de rétracter le prépuce. Il importe de différencier le phimosis physiologique du phimosis pathologique, puisque le premier se traite aisément tandis que le second exige une intervention chirurgicale. Un prépuce non rétractile suscite beaucoup d’anxiété chez les patients comme chez les parents. La plupart des patients qui sont envoyés aux cliniques d’urologie pédiatrique pour phimosis ont des prépuces phimotiques physiologiquement normaux. Le fait d’envoyer des cas de phimosis physiologiques aux cliniques d’urologie peut inquiéter patients et parents sur l’éventualité d’une chirurgie, tout en allongeant indûment la liste d’attente des évaluations en spécialité. Les pénis non circoncis ne requièrent aucun traitement particulier. La plupart des prépuces finissent par devenir rétractiles si on les lave normalement avec de l’eau et du savon, et si on les rétracte délicatement pendant la miction ou le bain.

CONCLUSION: Le médecin de famille est souvent consulté pour des phimosis physiologiques. Il doit alors rassurer patients et parents sur la normalité de cette condition et leur rappeler les mesures d’hygiène adéquates du prépuce. En présence d’un phimosis pathologique, il doit demander une consultation, puisque cette condition requiert un traitement chirurgical.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Tight preputial orifice on retraction of foreskin
A) Skin at preputial outlet is healthy with no scarring, and the inner preputial mucosa is starting to evert through the outlet. With physiologic phimosis, the preputial outlet is always closed and one cannot see the glans unless the foreskin is retracted, as the examiner has done in the photograph. 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. There is no inner mucosal eversion through the outlet. Reproduced with permission from the Canadian Journal of Urology.
Figure 1
Figure 1. Tight preputial orifice on retraction of foreskin
A) Skin at preputial outlet is healthy with no scarring, and the inner preputial mucosa is starting to evert through the outlet. With physiologic phimosis, the preputial outlet is always closed and one cannot see the glans unless the foreskin is retracted, as the examiner has done in the photograph. 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. There is no inner mucosal eversion through the outlet. Reproduced with permission from the Canadian Journal of Urology.
See this image and copyright information in PMC

Comment in

  • Common misdiagnosis.
    Steben M. Steben M. Can Fam Physician. 2007 Jul;53(7):1148; author reply 1149. Can Fam Physician. 2007. PMID: 17872807 Free PMC article. No abstract available.

References

    1. Oster J. Further fate of the foreskin. Arch Dis Child. 1968;43(228):200–4. - PMC - PubMed
    1. Gairdner D. The fate of the foreskin, a study of circumcision. BMJ. 1949;2(4642):1433–7. - PMC - PubMed
    1. Cold CJ, Taylor JR. The prepuce. Br J Urol. 1999;83(Suppl 1):34–44. - PubMed
    1. Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Transm Infect. 1998;74(5):364–7. - PMC - PubMed
    1. Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000;56(2):307–10. - PubMed

Substances