Barking & Havering Health Authority

Guideline for the management of phimosis and balanitis and indications for circumcision

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Phimosis

Is it true phimosis or a simple non-retractile foreskin?

• Phimosis is a tight preputial ring often made of scar tissue preventing retraction of the foreskin. It may be primary, or secondary to recurrent infection
  
• Phimosis may produce urinary obstruction with ballooning of the foreskin
  
• In adults phimosis can lead to chronic inflammation and carcinoma
  
• This is different to a simple non-retractile foreskin, a normal finding in many boys
  
• Occasionally the two can be hard to differentiate and phimosis may only be diagnosed in retrospect when there is no improvement

Management

• Boys aged under 7 with an asymptomatic non-retractile foreskin require no treatment and may be followed up annually
  
• Parents may be reassured that the condition nearly always resolves over time
  
• Parents should be discouraged from trying to retract the boy’s foreskin
  
• Referral may be considered if there are symptoms or parental concerns
  
• An obvious true phimosis requires a referral

Balanitis/ Balanoposthitis (Infection of the glans/glans and foreskin)

• Infection may be bacterial or fungal (the latter is more common in diabetics)
  
• Infections are sometimes recurrent

Management

• Each episode should be treated with local hygiene and antibiotics
  
• Oral antibiotics may be required if there is systemic illness
  
• Proven fungal infection should be treated appropriately
  
• In recurrent infection advice should be given about genital hygiene and the use of soaps and bubble baths which can exacerbate this condition
  
• Referral may be considered if there is no improvement or if there is an associated phimosis

Indications for Circumcision

We recommend that any referrals are made to a consultant urologist or specialist paediatric surgeon