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This guideline covers Phimosis in both adults and children.
Phimosis is the inability to retract the foreskin
True pathological phimosis is rare in those under 18 year old and must be distinguished from physiological adherence of the foreskin to the glans, which is normal.
The proportion of partially or fully retractable foreskin by age is at:
A non-retractile foreskin and/or ballooning of the foreskin during micturition in a child under two, do not routinely need to be referred for circumcision.
Pathological phimosis is more common in the adult population. This is due to scarring of the foreskin secondary to a wide list of conditions. The differential diagnosis includes recurrent balanitis, sexually transmitted diseases (STDs) and skin diseases such as eczema, psoriasis, lichen sclerosus, Zoons balanitis, carcinoma in situ, and frank squamous carcinoma.
Phimosis is a risk factor for penile carcinoma.
Cultural circumcision is not NHS funded within Devon – see circumcision commissioning policy
Parents and patients should be made aware of the risks and benefits of circumcision.
Phimosis (true or physiological) usually presents with one or more of the following:
Phimosis
Both patient and parental expectations should be explored and the options explained.
Only a minority of children will have pathology and be subsequently listed for circumcision:
Indications for referral for circumcision (circumcision commissioning policy):
Circumcision is routinely commissioned in Devon for:
e-Referral Service Selection
e-Referral Service Selection
This guideline has been signed off on behalf of NHS Devon.
Publication date: June 2020
Updated: February 2024