Pediatric Phimosis: When to Consider Surgery?

The child's glans is not protruding..?

For a 4-year-old child whose glans penis cannot be exposed due to phimosis, is circumcision necessary? He has no issues urinating.
Another child, aged 3, exhibits behaviors similar to adult masturbation; is this normal?

Xiao Mama, 30~39 year old female. Ask Date: 2005/05/01

Dr. Cai Zhengxian reply Pediatrics

Dear Mom,
Circumcision surgery in children requires general anesthesia, so it must be approached with special care and caution.
There are two situations that necessitate surgery: 1.
A tight foreskin that obstructs urine flow, causing the foreskin to balloon during urination, resulting in a weak stream.
2.
A tight foreskin that prevents the glans from being exposed and leads to recurrent balanitis, which can affect the child's physiological health.
In such cases, the child should undergo circumcision to prevent health issues, as it is considered a necessary procedure.
More than half of children under six years old still have a tight foreskin, and the glans is often not exposed.
By puberty, as the penis develops, the opening of the foreskin gradually enlarges, and most boys after puberty can naturally expose the glans.
I recommend further observation.
Sincerely,
Dr.
Tsai Cheng-Hsien
Tainan City Hospital

Reply Date: 2005/05/01

More Info

Pediatric phimosis is a condition where the foreskin cannot be retracted over the glans (the head of the penis). It is relatively common in young boys, and many cases resolve naturally as the child grows older. However, the question of whether to consider surgery, specifically circumcision, can be a source of concern for many parents.

In your case, with a 4-year-old who has not yet been able to retract the foreskin but does not experience any urinary issues, it is important to understand that many boys will not have full retraction of the foreskin until they are older, often around the ages of 5 to 7. If the child is urinating without difficulty and there are no signs of infection, inflammation, or other complications, surgery may not be necessary at this time.
Surgery, such as circumcision, is typically considered in the following situations:
1. Recurrent Infections: If the child experiences frequent urinary tract infections or balanitis (inflammation of the glans), it may warrant surgical intervention.

2. Pain or Discomfort: If the child complains of pain during urination or has difficulty with hygiene due to the inability to retract the foreskin, surgery might be recommended.

3. Phimosis with Other Symptoms: If there are additional symptoms such as bleeding, swelling, or other complications, it is advisable to consult a pediatric urologist for further evaluation.

Regarding the behavior of your 3-year-old child exhibiting actions similar to adult masturbation, it is essential to recognize that children often explore their bodies as part of normal development. This behavior is generally considered normal and is not usually a cause for concern unless it becomes excessive or interferes with daily activities. If the behavior is persistent or concerning, discussing it with a pediatrician can provide reassurance and guidance.

In summary, for your 4-year-old, if there are no urinary issues or signs of complications, it may be best to monitor the situation and allow for natural development. If any concerning symptoms arise, seeking advice from a healthcare professional is recommended. For the 3-year-old, normal exploration of the body is typical at this age, and unless it becomes problematic, it is usually not a cause for concern. Always feel free to consult with a pediatrician for personalized advice and to address any specific worries you may have regarding your children's health.

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