CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

Foreskin care in childhood

“…Pathologic phimosis occurs in less than 2% of boys and presents as a sclerotic white ring at the foreskin tip on clinical examination. 1 Lichen sclerosus, a form of pathologic phimosis related to chronic skin inflammation, is rarely seen in the first few years of life and results in substantial, progressive scarring that can involve the urethra. 2…”

“…Adhesions between the inner and outer foreskin release over time from repeated reflex erections and smegma collection. 1 Physiologic phimosis exists in about 50% of 7-year-old boys and decreases to less than 10% by age 13. 3…”

“…This involves gentle retraction during voiding to prevent urine pooling, and cleaning during bathing with soap and water. 1 Avoiding paraphimosis (foreskin pushed above the glans penis, resulting in edema) is critical; if paraphimosis occurs, it requires urgent medical attention.…”

“…Physiologic phimosis with recurrent urinary tract infections, balanoposthitis (inflammation of the entire foreskin and glans penis) or persistence of phimosis beyond age 10 years should prompt medical therapy and possible urologic referral. 1 Treatment involves a topical steroid cream (0.1% betamethasone) applied to the distal foreskin with gentle retraction for up to 8 weeks (70%-80% success rate, with similar efficacy from less potent steroids) . 1,5 Pathologic phimosis may be treated medically initially and closely monitored by a urologist.…”

“…The efficacy of medical treatment is lower for pathologic phimosis than for physiologic phimosis, and patients who do not respond to medical treatment require circumcision. 1 Lichen sclerosus may be treated with a short course of steroids but often requires circumcision. 2 PRACTICE | FIVE THINGS TO KNOW ABOUT ...…”