Pediatric Phimosis and Paraphimosis

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.

Phimosis is caused by a tightening of the opening of the foreskin. This condition 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 and can keep the foreskin from retracting in the future.

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

Symptoms can occur a bit differently in each child. The most common symptoms of phimosis include:

• Bulging of the foreskin during urination
• Not able to fully retract the foreskin

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 that is dark red or blue in color

The symptoms of phimosis and paraphimosis can be like other health conditions. Make sure your child sees his healthcare provider for a diagnosis.

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

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. Treatment for repeated phimosis may include:

• Putting a steroid cream on the foreskin up to three times a day for one month 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 during urination after trying the steroid cream first

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. Be sure to communicate and ask questions.

Possible complications can include:

• Pain
• Infection
• Trouble urinating
• Death of tissue (necrosis) in the tip of the penis

Call the healthcare provider if your child has:

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