Further to “the further fate of the foreskin”: Update on the natural history of the foreskin

Abstract

The fortunate foreskin of an infant boy will usually be left well alone by everyone but its owner. Problems such as phimosis are not common, and can usually be treated medically without resort to circumcision.

Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment

“…Hence, pathologic phimosis, to which treatment would be indicated, should be as symptomatic phimosis. 8 All of the boys who entered the present study had symptoms of a certain degree of obstruction or recurrent infections.…”

“…However, forceful retraction of the foreskin may produce recurrent adhesions between the glans to cause secondary phimosis. 8 …”

“…As Wright has emphasized, scarred fibrotic foreskin would suggest lichen sclerosus et atrophicus. 8 Lindhagen has studied topical steroid ointment in infantile phimosis and has proved histopathologically that lichen sclerosus et atrophicus does not respond to topical steroid ointment treatment. 6 Phimosis presenting with an abnormality in the appearance of the foreskin that would lead one to suspect lichen sclerosus et atrophicus may not respond to conservative treatment with ointments containing either steroids or estrogens.…”

Circumcision for phimosis and other medical indications in Western Australian boys

“…Gairdner incorrectly believed that 92% of boys would have a retractile prepuce by age 5 years. Unfortunately, Gairdner's data was wrong 5 . Gairdner achieved his artificially high rate of retractability by first “running a probe around the preputial space” to break the normal physiological fusion between the foreskin and glans penis, 4 a procedure few would recommend today because of pain, trauma, risk of infection, and iatrogenic creation of adhesions.…”