Phimosis

Phimosis is inability to retract the prepuce, or foreskin, over the glans without pain. In a child younger than 3 years, this is usually physiological: the foreskin is still separating from the glans and the opening may remain naturally narrow. Nonretractability alone does not establish disease. Pathological phimosis develops when the preputial opening becomes abnormally tight because of fibrosis and scarring. The typical visual clue is a firm, pale or white circumferential ring at the opening. Persistent inflammation, recurrent balanitis, or lichen sclerosus can damage the tissue and replace flexible skin with a less elastic scar. Retraction then creates small tears, and repeated tearing can produce still more scarring—the narrowing becomes a cycle rather than a stage of normal development. The experienced nurse looks at tissue quality and urinary function, not age or retractability in isolation. A young child who voids normally and has a supple, noninflamed opening is different from a child whose foreskin was previously retractable and is now painful, scarred, or progressively narrower.