Phimosis and Penile Adhesions

Phimosis and penile adhesions are physiologic (normal) in the first years of life, and they may persist until sexual maturity. Similarly, smegma (yellowish sebaceous accumulation under the foreskin) is a normal finding as well. Smegma is merely accumulated sloughed skin cells and sebum, which promotes spontaneous lysis of adhesions.

Options of treatment for pathologic or persistent symptomatic phimosis include topical corticosteroid treatment vs. circumcision. The former involves the application of steroid cream with gentle foreskin retraction with a ~80-85% success rate. This would then allow routine hygiene and foreskin care, avoiding circumcision.

Despite its well-known medical benefits, circumcision is not routinely recommended to all male newborns. Complications of newborn circumcisions are low (0.2%), including bleeding, infection and penile injury. A disadvantage of performing circumcision after the neonatal period is the need to undergo the procedure under general anesthesia.

We take into consideration parents’ cultural, ethnic and religious backgrounds along with the medical information when counseling about phimosis and circumcision to allow them to make the most appropriate decision for their child.