What is phimosis and paraphimosis in children?

Phimosis and paraphimosis are problems with the foreskin of the penis. Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the penis. This is a common problem in young boys. Paraphimosis is when the foreskin is retracted but can’t move back up. This can prevent normal blood flow in the penis and may cause serious problems.

What causes phimosis and paraphimosis in a child?

Phimosis is caused by a tightening of the opening of the foreskin. This is normal in a newborn baby. Over time the foreskin loosens and can be pulled down more easily. By age 17, most boys will be able to fully retract their foreskin. Phimosis can also occur if the foreskin is forced back before it is ready. This can cause a fibrous scar to form. This can stop the foreskin from retracting in the future.

Paraphimosis is caused when the foreskin is retracted behind the crown (corona) of the penis. The foreskin is too tight to be moved back to the tip of the penis.

What are the symptoms of phimosis and paraphimosis in a child?

Symptoms can be a bit different in each child.

The most common symptoms of phimosis include:

• Bulging of the foreskin when urinating

• Not able to fully retract the foreskin by age 3. In some boys this may take longer.

The most common symptoms of paraphimosis include:

• Swelling of the tip of the penis when the foreskin is pulled back

• Pain

• Not able to pull the foreskin back over the tip of the penis

• Tip of the penis is dark red or blue in color

• Pain when urinating

• Decreased urinary stream

The symptoms of phimosis and paraphimosis can seem like other health conditions. Have your child see their healthcare provider for a diagnosis. A paraphimosis is an emergency medical condition. Seek medical care right away if you think your child has paraphimosis.

How are phimosis and paraphimosis diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. The physical exam will include examining the penis and foreskin.

How are phimosis and paraphimosis treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

Treatment for repeated phimosis may include:

• Putting a steroid cream on the foreskin up to 3 times a day for 1 month. This is to loosen the skin.

• Having surgery to remove all or part of the foreskin (circumcision) for a child age 10 or older who still has bulging of the foreskin when urinating

Treatment for paraphimosis may include:

• Lubricating the foreskin and tip of the penis, then gently squeezing the tip of the penis while pulling the foreskin forward

• Making a small cut (incision) in the foreskin

• Having surgery to remove all or part of the foreskin (circumcision)

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of phimosis and paraphimosis in a child?

Possible complications can include:

• Pain

• Infection

• Trouble urinating

• Death of tissue (necrosis) in the tip of the penis

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about phimosis and paraphimosis in children

• Phimosis and paraphimosis are problems with the foreskin of the penis.

• Phimosis is when a foreskin can’t be pulled down (retracted) from the tip of the penis. This is a common problem in young boys.

• Paraphimosis is when the foreskin is retracted but can’t move back up. This can prevent normal blood flow in the penis and may cause serious problems.

• Treatment for either problem may include steroid cream, lubrication, or surgery to remove the foreskin.

• Possible complications can include trouble urinating and death of tissue (necrosis) in the tip of the penis.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.