Phimosis and Paraphimosis in Children: Causes and Symptoms

What are Phimosis and Paraphimosis?

Phimosis and paraphimosis are conditions in which the foreskin on the penis of uncircumcised males cannot be ​retracted​ (pulled down) from ​the glans (tip or head of the penis​).  

Phimosis can be categorized into 2 types (physiological and pathological).

• Physiological phimosis​: Babies are born with a tight foreskin that naturally separates from the tip over time. The foreskin should start detaching from the tip by itself when your child is 2-6 years old. In some cases, it does not easily retract until your child is around age 10.
• Pathological phimosis​: Scarring, inflammation or infection prevent the foreskin from retracting. If pulled back forcefully, the tip of the foreskin may tear, causing it to bleed and develop scar tissue.

Paraphimosis​ occurs when a retracted foreskin cannot move back over the head of the penis. It remains retracted behind the ​corona​ (crown) of the penis. This causes the penis to become entrapped (trapped). This can limit normal blood flow and may lead to other more serious conditions. Paraphimosis is extremely painful and requires urgent medical attention.

What Causes Phimosis and Paraphimosis in Children?

All infant males are born with a tight foreskin. There are natural adhesions (connections or attachments) between the inner foreskin and the glans. Over time, these adhesions naturally dissolve so the foreskin is looser and can be retracted easily. By age 6 years, most males can retract their foreskin fully.

Pathological phimosis occurs when the foreskin is forced back before it is ready. This creates a fibrous scar (scar made up of thick bands of tissue) that limits future retracting of the foreskin.

Like pathological phimosis, paraphimosis is caused when foreskin is forcefully retracted behind the crown of the penis before it is loose.

What Are the Symptoms of Phimosis and Paraphimosis?

Symptoms of phimosis and paraphimosis are different in every child with either of the conditions. Possible symptoms include:

Physiological phimosis:

• Inability to completely retract foreskin at age 3 (though some children naturally take longer)

Pathological phimosis:

• Bulging or ballooning of the foreskin during urination
• Balanitis (an infection that causes pus, redness, and inflammation on the head of the penis​) or balanoposthitis (infection that causes pus, redness or inflammation of the foreskin)
• Urinary tract infection
• Pushing or straining to urinate
• Painful erections

Paraphimosis:

• Extreme swelling of the foreskin just under the tip of the penis
• Change in color of tip of the penis to blue or dark red
• Decreased urinary stream
• Severe penile pain

If your child is experiencing any of these symptoms, contact your healthcare provider immediately.