The Choice of treatment is often determined by whether circumcision is viewed as an option of last resort to be avoided or as the preferred course. Phimosis, common in males 10 years of age and younger, is normal, and does not require intervention. Non-retractile foreskin usually becomes retractable during the course of puberty. If Phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective.
NON-SURGICAL METHODS
– CREAM
Topical steroid creams such as Betamethasone, Mometasone, Furoate and Cortisone are effective in treating Phimosis and may provide an alternative to circumcision. It is assumed that the steroids work by reducing the body’s inflammatory and immune responses, and also by thinning the skin.
– STRETCHING
Stretching of the foreskin can be accomplished manually, with balloons or with other tools. A skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor.
SURGICAL METHODS
Surgical methods ranges from the complete removal of the foreskin to a more minor operation that relieves the foreskin tightness, this includes;
– CIRCUMCISION
This is sometimes performed for Phimosis, and it is very effective. In a typical procedure, the foreskin is opened and then separated from the glans after inspection. The circumcision device (if used) is placed, and then the foreskin is removed. Topical or locally injected anesthesia is occasionally used to reduce pain and physiologic stress. For adults, general anesthesia is an option, and the procedure may be performed without a specialized circumcision device.
– DORSAL SLIT (SUPERINCISION)
This is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue.
– VENTRAL SLIT (SUBTERINCISION)
This is an incision along the lower length of the foreskin from the tip of the Frenulum to the base of the glans, thereby removing the Frenulum in the process. It is often used when the Frenulum breve occurs alongside the Phimosis.
– PREPUTIOPLASTY
This is an alternative to circumcision in which a limited dorsal slit with transverse closure is made along the constricting band of skin. It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects.