Phimosis
Encyclopedia
Phimosis from the Greek
phimos ( ("muzzle")), is a condition where, in men, the foreskin
cannot be fully retracted over the glans penis
. The term may also refer to clitoral phimosis in women, whereby the clitoral hood
cannot be retracted, limiting exposure of the glans clitoridis.
In the neonatal
period, it is rare for the foreskin to be naturally retractable; Huntley et al. state that "non-retractability can be considered normal for males up to and including adolescence
." Rickwood, as well as other authors, has suggested that true phimosis is over-diagnosed due to failure to distinguish between normal developmental non-retractability and a pathological condition (a condition deemed a problem). Some authors use the terms "physiologic" and "pathologic" to distinguish between these types of phimosis; others use the term "non-retractile foreskin" to distinguish this developmental condition from (pathologic) phimosis.
Pathological (acquired) phimosis has several causes. Lichen sclerosus et atrophicus (thought to be the same condition as balanitis xerotica obliterans
) is regarded as a common (or even the main) cause of pathological phimosis. Other causes may include scarring caused by forcible retraction of the foreskin
, and balanitis
. Beauge found that patients with phimosis had masturbation
practices that differed from the usual pulling down of the foreskin that mimics sexual intercourse
. Some studies found phimosis to be a risk factor for urinary retention
and carcinoma of the penis
. Common treatments include steroid
creams, preputioplasty
, manual stretching, and circumcision
.
. This attachment forms "early in fetal development and provide[s] a protective cocoon for the delicate developing glans." The foreskin is usually non-retractable in infancy and early childhood.
During the 20th century, studies were released which furthered understanding of the normal development of the foreskin. For example, The fate of the foreskin, a study of circumcision, Further fate of the foreskin, Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys, and Analysis of shape and retractability of the prepuce in 603 Japanese boys.
The American Academy of Pediatrics
and the Canadian Pediatric Society state that no attempt should be made to retract the foreskin of an infant. Age is reportedly a factor in non-retractability: according to Huntley et al. the foreskin is reportedly retractable in approximately 50% of cases at 1 year of age, 90% by 3 years of age, and 99% by age 17. These authors argue that, unless scarring or other abnormality is present, non-retractibility may "be considered normal for males up to and including adolescence." Hill states that full retractability of the foreskin may not be achieved until late childhood or early adulthood.
Some pediatric urologist
s have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis.
(inflammation of the glans penis), perhaps due in turn to inappropriate efforts to retract an infant's foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve
, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, even ballooning does not always indicate urinary obstruction.
Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ('relative phimosis'), and some completely unable to retract their foreskin even in the flaccid state ('full phimosis').
When phimosis develops in an adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
Beaugé noted that unusual masturbation
practices, such as lying face down on a bed and rubbing the penis against the mattress, may cause phimosis. Patients are advised to stop exacerbating masturbation techniques and are encouraged to masturbate by moving the foreskin up and down so as to mimic more closely the action of sexual intercourse
. After giving this advice Beaugé noted not once did he have to recommend circumcision.
One cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans
(BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors.
Phimosis may occur after other types of chronic inflammation (such as balanoposthitis
), repeated catheterization
, or forcible foreskin retraction.
Phimosis may also arise in untreated diabetics due to the presence of glucose in their urine giving rise to infection in the foreskin.
, which more often requires surgery, though the two conditions can occur together.
If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some men with non-retractile foreskins have no difficulties and see no need for correction.
Non surgical methods include:
Surgical methods range from the complete removal of the foreskin to more minor operations to relieve foreskin tightness:
. Sometimes circumcision was performed in infancy to prevent phimosis. "Many boys are circumcised for (pathological or physiological) phimosis before the age of five years, despite (pathological) phimosis being rare in this group".
However, there are dissenting views. Robert S. Van Howe has argued that choosing to skip nonsurgical treatments for phimosis and go straight to circumcision may be influenced by non-medical considerations; he has also suggested that an inaccurate diagnosis of phimosis is sometimes used as a justification for elective circumcision so that it will be covered by a national health system or insurance plan. Moreover, one study has shown that attempting nonsurgical treatment of pathologic phimosis when it occurs in infants and children costs 27.3% less than primary circumcision.
While circumcision prevents phimosis, studies of the incidence of healthy infants circumcised for each prevented case of potential phimosis are inconsistent.
and chokes the glans penis. A totally non-retractable foreskin is rarely painful. There is some evidence that phimosis may be a risk factor for penile cancer.
The most acute complication is paraphimosis
. In this condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. The proximal penis is flaccid.
Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
phimos ( ("muzzle")), is a condition where, in men, the foreskin
Foreskin
In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus when the penis is not erect...
cannot be fully retracted over the glans penis
Glans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
. The term may also refer to clitoral phimosis in women, whereby the clitoral hood
Clitoral hood
In female human anatomy, the clitoral hood, , is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin in male genitals.-Variation:This is a protective hood of skin that covers the clitoral glans...
cannot be retracted, limiting exposure of the glans clitoridis.
In the neonatal
Infant
A newborn or baby is the very young offspring of a human or other mammal. A newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth...
period, it is rare for the foreskin to be naturally retractable; Huntley et al. state that "non-retractability can be considered normal for males up to and including adolescence
Adolescence
Adolescence is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood , but largely characterized as beginning and ending with the teenage stage...
." Rickwood, as well as other authors, has suggested that true phimosis is over-diagnosed due to failure to distinguish between normal developmental non-retractability and a pathological condition (a condition deemed a problem). Some authors use the terms "physiologic" and "pathologic" to distinguish between these types of phimosis; others use the term "non-retractile foreskin" to distinguish this developmental condition from (pathologic) phimosis.
Pathological (acquired) phimosis has several causes. Lichen sclerosus et atrophicus (thought to be the same condition as balanitis xerotica obliterans
Balanitis xerotica obliterans
Balanitis xerotica obliterans is a dermatological condition affecting the male genitalia. It was first described by Stuhmer in 1928, though earlier reports describe what may have been the same condition....
) is regarded as a common (or even the main) cause of pathological phimosis. Other causes may include scarring caused by forcible retraction of the foreskin
Forcible retraction of the foreskin
Forcible retraction of the foreskin, sometimes called premature retraction, in infants or young children can damage the glans and mucous inner tissue of the foreskin. Doctors or parents who may be unfamiliar with the foreskin can often forcibly retract it, unaware that it can be damaging.At birth,...
, and balanitis
Balanitis
Balanitis is inflammation of the glans penis . When the foreskin is also affected, it is termed balanoposthitis....
. Beauge found that patients with phimosis had masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...
practices that differed from the usual pulling down of the foreskin that mimics sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
. Some studies found phimosis to be a risk factor for urinary retention
Urinary retention
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
and carcinoma of the penis
Carcinoma of the penis
Penile cancer is a malignant growth found on the skin or in the tissues of the penis. A Squamous cell carcinoma usually originating in the glans or foreskin is by far the most common type, occurring in 9 out of 10 cases. Penis cancer tends to develop in men over the age of sixty. Penile cancer is...
. Common treatments include steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
creams, preputioplasty
Preputioplasty
Preputioplasty or prepuce plasty, also known as "limited dorsal slit with transverse closure", is a plastic surgical operation on the prepuce or foreskin of the penis, to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a...
, manual stretching, and circumcision
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
.
Normal development
At birth, the inner layer of the foreskin is sealed to the glans penisGlans penis
The glans penis is the sensitive bulbous structure at the distal end of the penis. The glans penis is anatomically homologous to the clitoral glans of the female...
. This attachment forms "early in fetal development and provide[s] a protective cocoon for the delicate developing glans." The foreskin is usually non-retractable in infancy and early childhood.
During the 20th century, studies were released which furthered understanding of the normal development of the foreskin. For example, The fate of the foreskin, a study of circumcision, Further fate of the foreskin, Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys, and Analysis of shape and retractability of the prepuce in 603 Japanese boys.
The American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
and the Canadian Pediatric Society state that no attempt should be made to retract the foreskin of an infant. Age is reportedly a factor in non-retractability: according to Huntley et al. the foreskin is reportedly retractable in approximately 50% of cases at 1 year of age, 90% by 3 years of age, and 99% by age 17. These authors argue that, unless scarring or other abnormality is present, non-retractibility may "be considered normal for males up to and including adolescence." Hill states that full retractability of the foreskin may not be achieved until late childhood or early adulthood.
Some pediatric urologist
Pediatric urology
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age...
s have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis.
Cause
Pathological phimosis (as opposed to the natural non-retractability of the foreskin in childhood) is rare and the causes are varied. Some cases may arise from balanitisBalanitis
Balanitis is inflammation of the glans penis . When the foreskin is also affected, it is termed balanoposthitis....
(inflammation of the glans penis), perhaps due in turn to inappropriate efforts to retract an infant's foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve
Frenulum breve
Frenulum breve, or a short frenulum, is a condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce...
, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, even ballooning does not always indicate urinary obstruction.
Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ('relative phimosis'), and some completely unable to retract their foreskin even in the flaccid state ('full phimosis').
When phimosis develops in an adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
Beaugé noted that unusual masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...
practices, such as lying face down on a bed and rubbing the penis against the mattress, may cause phimosis. Patients are advised to stop exacerbating masturbation techniques and are encouraged to masturbate by moving the foreskin up and down so as to mimic more closely the action of sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
. After giving this advice Beaugé noted not once did he have to recommend circumcision.
One cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans
Balanitis xerotica obliterans
Balanitis xerotica obliterans is a dermatological condition affecting the male genitalia. It was first described by Stuhmer in 1928, though earlier reports describe what may have been the same condition....
(BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors.
Phimosis may occur after other types of chronic inflammation (such as balanoposthitis
Balanoposthitis
-Background:Balenoposthitis is defined as the inflammation of the foreskin and glans in uncircumcised males. Balanoposthitis occurs over a wide age range and may have any of multiple bacterial or fungal origins or be caused by contact dermatitis...
), repeated catheterization
Urinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
, or forcible foreskin retraction.
Phimosis may also arise in untreated diabetics due to the presence of glucose in their urine giving rise to infection in the foreskin.
Management
Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. In older children and men, phimosis should be distinguished from frenulum breveFrenulum breve
Frenulum breve, or a short frenulum, is a condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce...
, which more often requires surgery, though the two conditions can occur together.
If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some men with non-retractile foreskins have no difficulties and see no need for correction.
Non surgical methods include:
- Application of topical steroidSteroidA steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
cream, such as betamethasoneBetamethasoneBetamethasone is a potent glucocorticoid steroid with anti-inflammatory and immunosuppressive properties. Unlike other drugs with these effects, betamethasone does not cause water retention. It is applied as a topical cream, ointment, foam, lotion or gel to treat itching...
, for 4–6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective. It has replaced circumcision as the preferred treatment method for some physicians in the British National Health ServiceNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
. - Stretching of the foreskin can be accomplished manually, with balloons or with other tools. Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The tissue expansionTissue expansionTissue expansion is a technique used by plastic and restorative surgeons to cause the body to grow additional skin, bone or other tissues.-Skin expansion:...
promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction. Beaugé treated several hundred adolescents by advising them to change their masturbation habits to closing their hand over their penis and moving it back and forth. Retraction of the foreskin was generally achieved after four weeks and he stated that he never had to refer one for surgery.
Surgical methods range from the complete removal of the foreskin to more minor operations to relieve foreskin tightness:
- CircumcisionCircumcisionMale circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
is sometimes performed for pathological phimosis, and is effective. - Dorsal slitDorsal slitA dorsal slit is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue....
(superincision) is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. - Ventral slit (subterincision) is an incision along the lower length of the foreskin from the tip of the frenulum to the base of the glans, removing the frenulum in the process. Often used when frenulum breveFrenulum breveFrenulum breve, or a short frenulum, is a condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce...
occurs alongside the phimosis. - PreputioplastyPreputioplastyPreputioplasty or prepuce plasty, also known as "limited dorsal slit with transverse closure", is a plastic surgical operation on the prepuce or foreskin of the penis, to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a...
, in which a limited dorsal slit with transverse closure is made along the constricting band of skin can be an effective alternative to circumcision. It has the advantage of only limited pain and a short time of healing relative to circumcision, and avoids cosmetic effects.
Surgery
Physicians often saw the natural unretractability of the foreskin in infancy as pathological and recommended circumcisionCircumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
. Sometimes circumcision was performed in infancy to prevent phimosis. "Many boys are circumcised for (pathological or physiological) phimosis before the age of five years, despite (pathological) phimosis being rare in this group".
However, there are dissenting views. Robert S. Van Howe has argued that choosing to skip nonsurgical treatments for phimosis and go straight to circumcision may be influenced by non-medical considerations; he has also suggested that an inaccurate diagnosis of phimosis is sometimes used as a justification for elective circumcision so that it will be covered by a national health system or insurance plan. Moreover, one study has shown that attempting nonsurgical treatment of pathologic phimosis when it occurs in infants and children costs 27.3% less than primary circumcision.
While circumcision prevents phimosis, studies of the incidence of healthy infants circumcised for each prevented case of potential phimosis are inconsistent.
Prognosis
Chronic complications of acquired (pathological) phimosis can include discomfort or pain during urination or sexual intercourse. The urinary stream can be impeded, resulting in dribbling and wetness after urination. Harmful urinary obstruction is possible but uncommon. Pain may occur when a partially retractable foreskin retracts during sexual intercourseSexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
and chokes the glans penis. A totally non-retractable foreskin is rarely painful. There is some evidence that phimosis may be a risk factor for penile cancer.
The most acute complication is paraphimosis
Paraphimosis
Paraphimosis is an uncommon medical condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced...
. In this condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. The proximal penis is flaccid.
Epidemiology
A number of medical reports of phimosis incidence have been published over the years. They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised. A commonly cited incidence statistic for pathological phimosis is 1% of uncircumcised males., When phimosis is simply equated with nonretractility of the foreskin after age 3 years, considerably higher incidence rates have been reported.Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.
History
- According to some accounts, phimosis prevented Louis XVI of FranceLouis XVI of FranceLouis XVI was a Bourbon monarch who ruled as King of France and Navarre until 1791, and then as King of the French from 1791 to 1792, before being executed in 1793....
from impregnating his wife for the first seven years of their marriage. She was 14 and he was 15 when they married in 1770. However, the presence and nature of his genital anomaly is not considered certain, and some scholars (such as Vincent CroninVincent CroninVincent Archibald Patrick Cronin, FRSL was a British historical, cultural, and biographical writer, best-known for his biographies of Louis XIV, Louis XVI and Marie Antoinette, Catherine the Great, and Napoleon, as well as for his books on the Renaissance.Cronin was born in Tredegar, Monmouthshire...
and Simone Bertiere) assert that surgical repair would have been mentioned in the records of his medical treatments if it had indeed occurred. - U.S. president James Garfield was assassinated by Charles GuiteauCharles J. GuiteauCharles Julius Guiteau was an American lawyer who assassinated U.S. President James A. Garfield. He was executed by hanging.- Background :...
in 1881. Guiteau's autopsy report indicated that he had phimosis. At the time, this led to the simplistic speculation that Guiteau's murderous behavior was due to phimosis-induced insanity. - Canadian prime minister Richard Bedford Bennett had phimosis.
See also
- ParaphimosisParaphimosisParaphimosis is an uncommon medical condition where the foreskin becomes trapped behind the glans penis, and cannot be reduced...
- PreputioplastyPreputioplastyPreputioplasty or prepuce plasty, also known as "limited dorsal slit with transverse closure", is a plastic surgical operation on the prepuce or foreskin of the penis, to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a...
- Medical analysis of circumcisionMedical analysis of circumcisionNumerous medical studies have examined the effects of male circumcision with mixed opinions regarding the benefits and risks of the procedure. Opponents of circumcision say it is medically unnecessary, is unethical when performed on newborns, is painful even when performed with anesthetic,...
- Frenulum breveFrenulum breveFrenulum breve, or a short frenulum, is a condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce...
- David ReimerDavid ReimerDavid Reimer was a Canadian man who was born as a healthy male, but was sexually reassigned and raised as female after his penis was accidentally destroyed during circumcision. Psychologist John Money oversaw the case and reported the reassignment as successful, and as evidence that gender...
- SmegmaSmegmaSmegma is a combination of exfoliated epithelial cells, transudated skin oils, and moisture. It occurs in both female and male mammalian genitalia.-Human smegma:Both females and males produce smegma...
External links
- Our son is not circumcised. When will his foreskin retract? by American Academy of PediatricsAmerican Academy of PediatricsThe American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
- Normal development of the foreskin: Birth through age 18 by CIRP
- Conservative Treatment of Phimosis: Alternatives to Radical Circumcision by CIRP
- Male Initiation and the Phimosis Taboos
- Encyclopedia of Phimosis Statistics
- NORM-UK: Information about conservative treatment of phimosis
- Phimosis treatment information
- The Manitoban article on phimosis and frenulum breve
