Education And Debate


BMJ 1996; 312 doi: (Published 18 May 1996) Cite this as: BMJ 1996;312:1291
  1. Chris Dawson,
  2. Hugh Whitfield


    Phimosis is the most common reason for circumcision, although recurrent balanitis is also an indication. Circumcision may also be performed for religious or social reasons.


    At birth, adhesions are present between the glans penis and the foreskin, but separation begins to occur immediately and continues thereafter. The prepuce normally becomes retractile after the age of 2 years, but many adolescent boys retain some adhesions. Preputial adhesions are a common reason for referral to a urologist, but adhesions are normal and should be treated only if they persist into adolescence and cause problems with masturbation or sexual intercourse. A non-retractile foreskin is free of symptoms and self limiting, and circumcision is not needed. Parents often say that the prepuce “balloons” when the child urinates, but this is a sign of a non-retractile foreskin rather than phimosis. Careful examination will show that the urethral meatus is visible through the narrowed preputial opening, and with time this opening widens to allow the foreskin to retract normally. True phimosis is rare but may cause appreciable problems in either childhood or adolescence. Treatment is usually circumcision.

    Possible indications for circumcision for phimosis

    • Recurrent infection under the foreskin

    • Appreciable restriction to urine flow

    Undescended testis

    The incidence of undescended testis after the first year of life is under 1%. It is not clear why testes fail to descend into the scrotum, but recent evidence suggests that descent occurs in two distinct phases and that androgens may have an important role, possibly acting via the genitofemoral nerve. In 80% of cases the undescended testis will be palpable in the inguinal canal.

    Investigation and management of undescended testis.

    If the testis is palpable in the inguinal canal then orchidopexy should be carried out. The correct timing of orchidopexy has been debated. Spontaneous descent of undescended testis is rare after the age of 1 year, and …

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