Phimosis is the inability to retract the foreskin. At birth, physiological phimosis is present as adhesions between the foreskin and the glans that prevent its retraction.
With spontaneous erections and natural manipulation, more than 90% of the foreskin becomes retractable by 3 to 4 years old. Forced retraction is not required for this to occur and can also start the vicious cycle of tears and scarring that can lead to pathological phimosis*.
When this occurs, the foreskin ring itself narrows, sometimes resulting in recurrent infection (balanitis) or swelling of the foreskin during urination. In some cases, applying a corticosteroid cream may effectively thin the preputial ring, resulting in resolution of the phimosis*.
Circumcision May be considered in older boys, from the age of 5 years, in whom steroid treatment has been unsuccessful*.
Operative Pediatric Surgery 7º Ed - Imran Mushtaq - ISBN: 978-1-4441-6501-2
Basic Techniques in Pediatric Surgery. An Operative Manual - R. Stewart & M. E. Flett - ISBN: 978-3-642-20640-5
SCIENTIFIC EVIDENCE * AG Coran. Pediatric Surgery 7º Ed. * P Mattei. Fundamentals of Pediatric Surgery. * JM Hutson, M O’Brien, SW Beasley, WJ Teague, SK King. Jones’ Clinical Paediatric Surgery 7º Ed.