Conservative Treatment of Phimosis

Medically Reviewed by Dr Sravya, MBBS, MS 

What is Phimosis?

Phimosis is a condition in males for difficulty retracting the penile prepuce(foreskin). Options available for Phimosis treatment are conservative and surgical.

Physiological and pathological are the two forms of phimosis. The physiologic form is very common in children between the age of 2-4 years and is self-limiting. The pathologic form is usually due to balanitis xerotica obliterans (white inflammatory )patches that can affect both males and females also known as lichen sclerosus.

Laboratory tests and radiography are not generally needed in the assessment of phimosis, and studies have demonstrated no proof of obstruction from physiological phimosis. 

Table of Contents

Grades of the Severity of Phimosis

Symptoms

This condition may start with only mild symptoms. However, symptoms may also get worse if left untreated.

People affected by phimosis may experience the following symptoms:

Conservation Treatment in the Mangement of Phimosis

The process of management of phimosis is an interprofessional process. The condition is usually first seen by the primary caregiver or nurse practitioner, in most cases a consultation from a urologist is also recommended.

Topical steroid application is a simple, safe, and effective method as first-line treatment in boys with severe Phimosis symptoms. Many randomized placebo-controlled studies have shown that several corticosteroids had 68 to 96% efficacy.

Several clinical trials related to Phimosis treatment have signified that therapy results were most successful when the topical steroid was applied along with exercising gentle stretching of the foreskin. While stretching pull the foreskin back slightly and stop pulling the foreskin when it starts hurting. 

conservation treatment for phimosis 2

Some commonly used topical steroids are:

1. Clobetasol propionate

Regular application of clobetasol propionate cream is a safe and effective Phimosis treatment and circumcision or associated risks can be avoided.

It should be prescribed before instead of directly going for circumcision. Clobetasol propionate gives anti-inflammatory, immunosuppressive, and antimitotic effects by affecting the growth, differentiation, and function of different cells & tissues and inhibiting the production of cytokine.

2. Mometasone furoate

Mometasone furoate is a synthetic corticosteroid that is effective in the treatment of the phimosis due to its anti-inflammatory activity.

The topical application of 0.1% Mometasone furoate is an effective, and safe Phimosis treatment. There is no side effect and no recurrence of the condition after Phimosis treatment with these topical corticosteroids.

3. Betamethasone/hyaluronidase

Phimosis treatment with topical 0.2% betamethasone/hyaluronidase cream for a specific period of weeks has good efficacy and is safe, especially if the urethral meatus is exposed and no previous balanoposthitis( inflammation of both the glans penis and prepuce) is there.

Topical treatment using 0.05% betamethasone ointment has shown a successrate of 94.2%, no matter what type and degree of foreskin retraction .

Some ointments and creams available for the treatment of Phimosis:

1. Elocon-

Eloconis is an ointment that contains a steroid named Mometasone furoate(0.1%). It is an anti-inflammatory drug very effective in the treatment of Phimosis and other conditions like psoriasis, eczema, lichen planus, etc.

It is also available in the cream and lotion forms. This ointment gives relief from swelling, redness, and itching within two weeks of continuous use. Elocon should be used for children above the age of two years.

2. Hydrocortisone-

Hydrocortisone can be used to treat swelling, itching, and irritation cause ddue to Phimosis. Hydrocortisone skin treatment is mild and available in pharmacies as cream, ointment, and lotion.

Adults and children aged 10 years and above can use hydrocortisone 1%. You should not use hydrocortisone for children below the age of 10 years unless without the recommendation of a doctor.

Most patients need to use hydrocortisone treatments for a short time. Stop using it immediately once the skin is better.

3. Bentovate-N-

It is the most common ointment in the treatment of phimosis. The Betnovate-N ointment contains a steroid named betamethasone valerate. It also comes with an antibacterial agent called neomycin sulfate.

It should be used twice a day for 4-5 weeks regularly for better effect. It will give relief from redness, itching, and swelling. Not to be used in children below age 1.

4. Temovate-

It is another effective ointment used to treat Phimosis containing clobetasol propionate(0.05%). Use Temovate twice a day for only two weeks as prolonged use can cause side effects.

A Temovate cream with 0.05 percent clobetasol propionate is usually prescribed for use at the time of stretching of the foreskin.

5. Canesten-

Clotrimazole is a medicine that is used to treat fungal infections is present in Canesten, thus, it is prescribed for phimosis when caused by fungal infection.

6. Aristospan-

Aristospan contains Triamcinolone and is available as a topical cream, ointment, lotion, and spray for certain skin conditions caused by Phimosis such as lupus, psoriasis, lichen planus, and others.

There are some side effects related to the use of Aristospan like nausea, bloating, appetite changes, stomach or side pain, headache, insomnia, and acne. To use the ointment, cream, or lotion just apply it sparingly in a thin layer and rub gently over the infected area. 

7. Novoglan-

Novoglan-01 study has shown foreskin tissue expander balloon device is an effective treatment. It is one of the best conservative treatments for adult phimosis.

It enables quality of life improvement by reducing pain, discomfort, and anxiety during sexual intercourse.

Conclusion

Topical steroid application is a simple, safe, and effective method of first-line treatment.

Gentle retraction or stretching exercise of the foreskin while taking a bath and the use of topical ointment helps to maintain hygiene and fast recovery from Phimosis.

Treatment should be followed regularly for a specified period for better effect and
must not be stopped before the suggested time.

Frequently Asked Questions

Yes, males can acquire fungal infections, particularly in the genital area. Although it is less frequent in men than in women, men must recognize the signs and seek proper treatment. 

No, fungal infections are not classified as sexually transmitted infections. However, sexual activity can sometimes upset the natural balance, increasing the risk of infection.

While vaginal yeast infections are more frequent in women, they can occur in men as well, mainly through sexual transfer.

For minor yeast infections, over-the-counter antifungal treatments can be beneficial. However, if symptoms persist or worsen, it is essential to seek medical attention.

Stress can impair the immune system, making it more difficult to battle illnesses such as yeast infections.