Phimosis in Children — Chandigarh Dr. Karun Singla

At birth, the foreskin is naturally attached to the head of the penis. It separates gradually over years, at a different pace in every child.

• Birth to 2 years — the foreskin is normally attached and does not retract
• 2 to 6 years — separation usually begins
• By around 10 years — most boys can retract the foreskin
• Some boys — full separation happens only in the early teens, and this is still within normal

A foreskin that does not retract at five, or at eight, is not by itself a problem.

"Never force your son's foreskin back."

Forced retraction tears the tissue. It hurts, it can bleed, and the tearing heals with scar tissue — which is how a normal, naturally tight foreskin becomes a genuinely scarred one that later needs surgery.

Well-meaning attempts to "clean underneath" cause a meaningful share of the childhood phimosis that ends up in a urology clinic. If it does not retract easily and painlessly on its own, leave it alone.

Nothing needs to be done under the foreskin while it remains attached.

• Wash the outside of the penis gently with warm water during a bath
• Do not pull the foreskin back to clean underneath
• Plain water is enough; if you use soap, use a mild unperfumed one
• Avoid talc, deodorants and antiseptic washes

Once the foreskin retracts easily on its own — usually as an older child — he can gently wash underneath and return it to its normal position afterwards.

You may notice small white lumps under the foreskin. These are smegma pearls, shed skin cells trapped as the foreskin separates. They are harmless, need no treatment, and work their way out on their own.

Most boys need no assessment. Book a consultation if your son has:

• Difficulty passing urine — straining, a weak stream, or marked ballooning of the foreskin
• Repeated infections — redness, soreness, swelling or discharge occurring more than once or twice
• Pain on passing urine
• A pale, thickened, scarred ring at the tip of the foreskin
• Bleeding or splitting
• A foreskin that does not retract at all by the mid-teens

Paraphimosis is an emergency. If the foreskin has been pulled back, will not go forward, and the head of the penis is swelling and painful, go to hospital immediately.

Nothing. For physiological phimosis without symptoms, the right treatment is reassurance and time. This is the outcome for most boys seen in clinic.

Topical steroid cream. Where the foreskin is tight enough to cause symptoms, a short course of steroid cream applied to the tip, with very gentle stretching, resolves the great majority of cases. Typically four to eight weeks. No surgery.

Preputioplasty. A small procedure that widens the tight ring while keeping the foreskin. An option for some boys whose parents wish to avoid circumcision.

Circumcision. Reserved for boys with established scarring, lichen sclerosus (BXO), recurrent infections that have not responded to other treatment, or urinary obstruction.

Surgery is the last option, not the first. You will be told plainly which category your son falls into.