Do children with tight foreskin really need to undergo circumcision?

Do children with tight foreskin really need to undergo circumcision?

Dr Arbinder Singal, a paediatric urologist tells us why circumcision isn't the way to treat phimosis.

Written by Nirmalya Dutta |Updated : March 19, 2015 7:37 PM IST

According to most people, phimosis or tight foreskin can be treated only by circumcision. But did you know that over 80% of this procedure can be avoided. Dr Arbinder Singal, a paediatric urologist sheds more light on this procedure and tells us how we can deal with it.

What is phimosis? How is it caused?

Dr Singal: Phimosis or tight foreskin is one of the most common surgical problems that paediatricians face. What you need to understand is that all infants have physiological phimosis at birth. After 3-4 years of age, with gradual erections and the creation of dead skin cell deposits called smegma, the inner layer of the foreskin gradually gets separated from the glans and the condition resolves itself by the time the child is 4-5 years of age.

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Is there any difference between a tight foreskin and phimosis? How can parents find out if there child suffers from the condition?

Dr Singal: It s the same thing. There s no need to differentiate between the two, the more important thing is to differentiate between the types of phimosis and understand when it s physiological and when it s pathological. So a tight foreskin till the age of 4-5 is considered completely normal and no treatment is required unless there are problems like dysuria (painful urination), ballooning, and recurring local infections such as balanoposthitis (inflammation of the glans penis or foreskin) or obstructive symptoms in which case a check-up should be done. It s important to remember that genital handling is very common and normal in children and it won t affect the condition or treatment in anyway. In case your child has this condition you should visit a paediatric urologist or a paediatric surgeon.

What are the treatment options? Is circumcision the only option to treat phimosis?

Dr Singal: In children, one long term study that we conducted has shown the application of local steroid cream over the foreskin can lead to resolution of the issue in over 80% cases and thus circumcision can be avoided. The study was published in the Acta Pediatrica in 2011. The most effective and safe steroid for this purpose is Betamethasone Dipropionate 0.05% in ointment base. On the other hand, children who have a scarred foreskin or have failed a steroid treatment should be offered preputioplasty* or circumcision. Ideally, treatment for this condition should be done at diagnosis. Read all you need to know about circumcision surgery!

* Preputioplasty is a surgical procedure in which a limited dorsal slit (as opposed to the complete removal of the foreskin in circumcision) is made to wide a narrow non-retractable foreskin. It s considered non-traumatic and less invasive than circumcision and heals faster. There s also little or no significant alteration to the appearance of the penis.

If one does opt for surgery, what is the recovery period? Will it be painful?

Dr Singal: The recovery period ranges from 3-10 days. During the surgery, the child is given some anaesthesia and there might be some swelling or pain which can be managed with oral medications. In this day and age, most cases of phimosis can be treated easily when the diagnosis is made.

The author is a paediatric urologist with over 17 years of experience. For more information on urological problems in children you can check out the websites www.hypospadiasfoundation.com and www.pediatricurology.in.

Image source: Shutterstock

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