Phimosis: Pathological or Physiological?

Ugeskrift for læger, Volume 167, Issue 17: Pages 1858-1862, 25 April 2005.

Mette Andersen Thorvaldsen & Hans-Henrik Meyhoff

Hillerød Sygehus, Afdeling A, Urologisk Sektion

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This file contains the English language abstract of an article that was published in Danish.

Background: Studies from England indicate that only a minor part of boys referred for phimosis had a real pathological stricture of the foreskin. Most of them probably had a physiological narrowing of the prepuce. The purpose of this study was to evaluate the normal physiological condition regarding retraction of the prepuce in childhood.

Materials and methods: Based on a questionnaire study of 4,000 young men in Frederiksborg County, Denmark, we evaluated the normal physiology of the prepuce in childhood.

Results: Only 38% of those contacted responded to the questionnaire. In newborns and in boys seven years old, the prepuce could not be retracted in 22% and 21%, respectively, compared to 7% at puberty. The boys themselves retracted the foreskin for the first time at a mean age of 10.4 years. Problems with the prepuce were reported by 23% but disappeared spontaneously at a mean age of 13.3 years. Overall, 8% were operated on on the foreskin at a mean age of 11.6 years, but 20% were not satisfied with the results. Furthermore, significantly more young men who had their foreskin operated on had problems reaching ejaculation and orgasm (p < 0005).

Discussion: Our results indicate physiological phimosis to be a frequent condition that often disappears by itself at puberty. Knowledge of normal physiology of the foreskin is important, and treatment or operation should probably await puberty.

Korrespondance: Mette A. Thorvaldsen, Geelsvænget 1, DK-2830 Virum. E-mail: mette-andersen@dadlnet.dk

Literatur

  1. Rickwood AM, Walker J. Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? Ann R Coll Surg Engl 1989;71: 275-7.
  2. Gairdner D. The fate of foreskin. BMJ 1949;2:1433-7.
  3. Nasrallah PF. Circumcision: pros and cons. Prim Care 1985;12:593-605.
  4. Wright JE. Non-therapeutic circumcision. Med J Aust 1967;1:1083-6.
  5. Kayaba H, Tamura H, Kitajima S et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol 1996;156:1813-5.
  6. Larsen GL, Williams SD. Postneonatal circumcision: Population profile. Pediatrics 1990;85:808-12.

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The full text Danish language article may be viewed at: http://www.dadlnet.dk/ufl/2005/1705/VP-html/VP44785.htm.

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