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'''Phimosis''' is a medical condition in which the [[foreskin]] of the [[penis]] of an uncircumcised male cannot be fully retracted. The word derives from the Greek ''phimos'' (''φῑμός'', "muzzle"). The term is confusing because it is used to denote both a physiologic stage of development (i.e., not a disease), and a pathologic condition (i.e., a condition that causes problems for a person). Elasticity and ambiguity of definition are especially common when referring to infants. Conflicting [[incidence]] reports and widely varying post-neonatal [[circumcision]] rates reflect looseness in the [[diagnosis|diagnostic]] criteria<ref name="emedicine">{{cite web|url=http://www.emedicine.com/emerg/topic423.htm|title=Phimosis and Paraphimosis|accessdate=2006-03-21}}</ref><ref>{{cite web|url=http://www.mja.com.au/public/issues/178_04_170203/dew10610_fm.html|accessdate=2006-03-20|title=Treating phimosis|author=Paddy A Dewan}}</ref>. Phimosis has become a topic of contention in circumcision debates<ref name="mja1">{{cite web|url=http://www.mja.com.au/public/issues/178_11_020603/matters_arising_020603-3.html|title=Circumcision for phimosis and other medical indications in Western Australian boys|accessdate=2006-03-21}}</ref> (see also [[Medical analysis of circumcision]]).
Phimosis in most but not all infants is physiologic rather than pathologic, whereas phimosis in older children and adults is more often pathologic than physiologic. Some have suggested that physiologic infantile phimosis be referred to as ''developmental nonretractility of the foreskin'' to more clearly distinguish this normal stage of development from pathologic forms of phimosis
==Infantile or congenital phimosis==
It has been widely recognized by the medical profession for most of the last century that normal male infants have foreskins which are incompletely separated from the [[epithelium]] of the glans penis
#Some physicians, especially in the first half of the twentieth century, recommended that the foreskin be repeatedly retracted, if necessary with some force, to free it from the glans. It was thought that ensuring separation early could prevent later (pathologic) phimosis and urinary problems in older boys, since it permitted washing of the glans and foreskin. Poor hygiene was thought to predispose to pathologic phimosis. This approach is now rarely recommended by physicians.
#Some physicians, particularly in the middle of the twentieth century, used avoidance of phimosis as justification for routine neonatal circumcision
#In the last three decades, as the circumcision rate in North America has declined, the most common "official" recommendations and guidelines from medical societies, as well as infant care books written by "experts," have emphasized that it is normal not to be able to retract an infant's foreskin fully and that it need not be done. The [[American Academy of Pediatrics]] recommends gentle soap and water cleaning, but specifically recommends against forcible retraction.
#Phimosis is sometimes used as a justification for circumcision<ref
Not all infantile phimosis is simply physiologic. Though uncommon, phimosis can occasionally lead to urinary obstruction or pain. Causes of pathologic phimosis in infancy are varied. Some cases may arise from [[balanitis]] (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to separate and retract an infant 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 physiologic phimosis from pathologic 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<ref>{{cite
There are several management approaches to infant phimosis
When phimosis persists into later childhood or adolescence, it is less likely to resolve with maturation, and incurs a higher risk of causing problems. However, even in adolescents and adults, some non-retractile foreskins can fairly be termed "physiologic," in the sense of being a developmental variation that does not necessarily cause trouble.
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==References==
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# [http://www.medem.com/medlb/article_detaillb_for_printer.cfm?article_ID=ZZZ13FOPIUC&sub_cat=1 American Academy of Pediatrics. Circumcision: frequently asked questions.] AAP recommendations on care of uncircumcised foreskin.
# [http://www.emedicine.com/emerg/topic423.htm Cantu Jr. S. Phimosis and paraphimosis.] Excellent Emedicine overview.
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