Clinical meaning
Phimosis is the inability to retract the foreskin (prepuce) over the glans penis. It can be physiologic or pathologic. Physiologic phimosis is normal in infants and young children - the foreskin is naturally adherent to the glans at birth and gradually becomes retractable over the first several years of life. By age 3, most boys have some degree of retractability, and by puberty, the foreskin should fully retract. Pathologic phimosis occurs when scar tissue or chronic inflammation (such as balanitis xerotica obliterans/lichen sclerosus) causes the foreskin opening to narrow and become non-retractable even in older children or adults. Complications include difficulty with hygiene, recurrent infections (balanitis), pain during erection, and in severe cases, urinary obstruction. Paraphimosis is a related emergency where a retracted foreskin becomes trapped behind the glans and cannot be returned to its normal position, causing vascular compromise.
Exam relevance
Risk factors: - Age (physiologic phimosis normal in young boys) - Recurrent balanitis (foreskin infections) - Forceful foreskin retraction causing scarring - Lichen sclerosus (balanitis xerotica obliterans) - Diabetes mellitus (recurrent infections) - Poor hygiene