“Phimosis is the inability of the foreskin (prepuce) to retract over the glans and it can be physiologic or pathologic. Nonretractile foreskin is very common in young boys, and is seen in up to 10% of uncircumcised 3-year-old boys. This physiologic phimosis is part of normal development and over time the foreskin will become retractile due to intermittent erections and keratinization of the inner foreskin. Pathologic phimosis is due to distal scarring and on examination typically appears as a white, contracted fibrotic ring around the preputial outlet. Pathologic phimosis, painful erections with a tight foreskin, recurrent bouts of balanitis, and recurrent urinary tract infections in conjunction with phimosis are indications for urologic consultation and consideration of circumcision. This child’s examination is consistent with physiologic phimosis. A short course of a topical corticosteroid (2–8 weeks of 0.05% betamethasone twice daily) applied to the preputial outlet may result in accelerated resolution of physiologic phimosis. However, given this child’s age and the absence of complications, reassurance and continued good foreskin hygiene are recommended. The foreskin should not be forcibly retracted, as this may lead to microtears and resultant scarring. In the absence of infection, neither antibacterial nor antifungal ointment is indicated.
Ref: McGregor TB, Pike JG, Leonard MP: Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Can Fam Physician 2007;53(3):445-448. 2) Drake T, Rustom J, Davies M: Phimosis in childhood. BMJ 2013;346:f3678.” ABFM