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Submit Cancel. Open in new tab. Captions English Add a one-line explanation of what this file represents. Summary [ edit ] Description Uncircumcised Penis foreskin retraction. I, the copyright holder of this work, hereby publish it under the following license:. You cannot overwrite this file. Structured data Items portrayed in this file depicts. Wikimedia username : Knowhow Creative Commons Attribution-ShareAlike 3.
Category : Videos of human foreskin. Namespaces File Discussion TimedText. The mechanism of effect of betamethasone dipropionate cream on the phimotic ring is thought to be local anti-inflammatory action. Betamethasone cream may improve the elasticity of the foreskin and, together with the moisturizing effect of the cream, allow for easier retractability for hygiene measures, thought to help prevent recurrence of acquired phimosis.
Whether moisturizing creams without an anti-inflammatory agent would have a similar efficacy is unknown. The acute condition paraphimosis develops when the prepuce is retracted and then trapped proximal to the corona, with subsequent edema, pain, and venous congestion.
A tight band is created around the penile shaft and the prepuce cannot be returned to its normal position. Immediate intervention is needed, beginning with manual reduction with gentle pressure. Four fingers from each hand are placed on each side of the trapped prepuce, and upward tension is applied while the two thumbs push the glans downward through the preputial opening. Paraphimosis may progress to the point where urgent urologic consultation is needed, and surgical intervention may be indicated.
Reduction under general anesthesia is almost always possible without need for a dorsal slit, and circumcision should be considered only for the unusual case of recurrent episodes. Urinary tract infection and acute balanoposthitis. Difficulty obtaining a urine specimen in the uncircumcised male makes it challenging to diagnose a urinary tract infection with certainty.
Uncircumcised boys have a higher incidence of urinary tract infection compared with circumcised boys younger than 5 years. Balanitis and balanoposthitis are infrequent problems in children and rarely lead to bacterial ascent in the urethra to initiate a true urinary tract infection.
Only in the most severe cases of infection accompanied by urinary retention is acute surgical intervention a dorsal slit required. An unrelated condition, balanitis xerotica obliterans BXO , also known as lichen sclerosus et atrophicus , is a chronic atrophic mucocutaneous disorder with no known cause.
Fortunately, it is rare in children. In its most severe form, involvement of the prepuce obliterates the preputial sac with dense adhesions, and the urethra may be affected. Penile lymphedema is a rare problem, affecting the prepuce and sometimes involving the shaft to varying degrees. Inflammatory erythema can make it difficult to distinguish lymphedema from balanoposthitis in the initial acute phase.
Surgical intervention a dorsal slit in the acute phase may be needed in patients with urinary difficulty. More definitive therapy with circumcision is best postponed for at least six months. Parental concerns about care of their uncircumcised son can often be addressed with education and reassurance a Guide for Parents appears below.
With older circumcised boys, review penile hygiene during health supervision visits. With pubertal males, also include education on testicular self-examination. Topical steroid therapy is a cost-effective, safe, and frequently efficacious treatment for phimosis.
Referral for urologic consultation is indicated for true phimosis that is unresponsive to topical steroid therapy, difficulty urinating, or balanoposthitis not responsive to an antibiotic. When betamethasone dipropionate 0. One 15 g tube is usually sufficient. You can provide parents with the following instructions.
Apply the betamethasone dipropionate cream once after your son urinates in the morning and once after he urinates in the evening, following these guidelines:.
The parent guide on care of the uncircumcised penis may be photocopied and distributed to families in your practice without permission of the publisher. Many parents who have chosen not to have their son circumcised have questions about how to care for the penis. They also want to know what is "normal" for a penis that has foreskin—the skin that covers the head of the penis.
When a boy is born, the foreskin is not usually retractable. This means that it can't be pulled back over the head of the penis called the glans. A normal process occurs that gradually separates the foreskin from the glans. The penis sheds skin cells, which may look like whitish pearls, lumps, or bumps under the foreskin.
These cells, called smegma, are part of the separation process. Erections aid in this process, causing the foreskin to retract or loosen up a little at a time. The foreskin separates from the glans bit by bit until it can be retracted pulled back without difficulty. This occurs in most boys by the time they are 5 years old, but the age varies for each child; in some boys, the foreskin may stay partially stuck to the head of the penis until puberty.
The foreskin should never be forcibly retracted, as this can cause pain and bleeding and may result in scarring and trouble with natural retraction. The foreskin of an infant's penis needs no special care. The most important thing to remember is not to force the foreskin to retract.
Wash the penis regularly when you give your son a bath. Avoid most soaps or cleansing agents because they can irritate the penis; water is usually sufficient for cleansing. Frequent diaper changes to keep urine and feces away from the skin decrease skin irritation, helping to prevent diaper rash, which can occur on just the penis or scrotum or on any part of the diaper area.
Diaper creams containing zinc oxide are useful if a rash does develop, as they create a protective barrier. Once the foreskin separates easily from the glans, gently retract and clean underneath the foreskin with a washcloth and water at least once a week.
After cleansing, always pull the foreskin forward to its normal position. Retract the foreskin again after the bath so you can dry the head of the penis with a towel; then again pull it back to the normal position to cover the head.
Teach your son to retract the foreskin and clean on a regular basis as he takes more responsibility for his own bathing, usually during the preschool years. As he gets older and bathes alone, verbally remind him about proper penile hygiene; the foreskin should be cleaned with each bath or shower. Most wrongful diagnoses of alleged "pathologic phimosis" in childhood are based on outdated beliefs about when the foreskin should become retractile.
For current correct information on the development of retractability, see Normal. This guide may be photocopied and distributed without permission to give to the parents of your patients.
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