Phimosis is a narrowing of the skin covering the glans penis. As a result, spotting or exposing the head becomes difficult or even impossible. The consequences of this condition can be difficulty urinating, pain or an unpleasant sensation during sexual intercourse. Also, phimosis can be the cause of recurrent infections due to difficulty in maintaining good hygiene. Phimosis can be congenital (primary) or acquired (secondary). The physiological form of the condition is common in children between 2 and 4 years of age. Boys are born with physiological phimosis as a consequence of normal embryonic development and foreskin adhesions. It is completely normal and natural for the foreskin to cover the head of the penis at birth, even if it is fused to it. As children grow, the skin becomes more elastic and in most cases pulls back on its own to whiten the glans. At the end of the first year, retraction of the foreskin is possible in only about 50% of boys. Usually, this process is physiologically completed in all children between the ages of 5-7 years. Here it is the place to note that the forcible “whitening” of the baby’s head causes more trauma – it predisposes to microtraumas and adhesions in the future and above all causes pain, which makes whitening in infancy completely unnecessary. Pathological phimosis is a problem for patients in adulthood. Most often, its development is associated with a skin problem called balanitis xerotica obliterans. Behind its development, it is assumed that there is an autoimmune pathology, which is the cause of a chronic skin disease. It is responsible for developing adhesions that make it difficult or impossible to retract the foreskin and expose the glans penis. A number of disease states predispose to the development of pathological (secondary) phimosis. This includes frequent and recurrent balanoposthitis. This is a collective term for inflammation of the head of the penis – balanitis and inflammation of the foreskin – postitis. These two diseases almost never occur independently, which is why the collective name – balanoposthitis is used. The reason for the development of secondary phimosis are also traumas and incorrect healing of the foreskin, as well as forced whitening in childhood, which predisposes to the development of adhesions. Diabetes is the most common cause of phimosis these days. The release of glucose through the urine is a favorable environment for the development of bacterial flora and the development of balanitis and balanoposthitis, which are responsible for the formation of phimosis. Lichen sclerosus et atrophicus is a rare skin disease associated with the formation of a whitish rigid ring on the foreskin. Symptoms of phimosis can include redness, swelling, and soreness when an active infection is present. There are also dysuric complaints when urinating. Pain and discomfort during intercourse are possible,as friction during sex can cause the foreskin to tear. The diagnosis is made extremely easily when patients seek help from a urologist. Although rare, it is necessary to differentiate phimosis from certain conditions, such as congenital megapreputium and especially from paraphimosis, which is an emergency and requires immediate intervention. Treatment can be medical and surgical. In milder cases, in which the phimosis ring is elastic and still allows partial whitening, the use of special corticosteroid creams can be tried. However, they can rarely achieve a good and long-lasting result and are used only for minor defects. Permanent treatment consists of circumcision. The procedure is a surgical treatment of the condition and takes a few minutes. It consists in cutting the foreskin circularly, with which the ring is also removed. The procedure can be done with scissors, diathermocoagulation or laser. Prevention of the development of phimosis in babies involves careful and gradual “whitening” of the penis. Rougher intervention is a prerequisite for the occurrence of microtraumas, which at a later stage during healing can lead to adhesions and the formation of phimosis in adulthood. Prevention of phimosis in adults includes control of diabetes and good hygiene to prevent the development of balanoposthitis. References Urology, Prof. P. Panchev National library of medicine – Phimosis