A discussion of three types of genital lesions:
A 5-year-old boy presented with "ballooning" of the foreskin whenever he voided. He had a previous urinary tract infection and 2 episodes of balanoposthitis. On examination, the preputial opening was minute and the foreskin non-retractable.
Phimosis, the inability to pull back the foreskin, may result from narrowing or scarring of the preputial opening. Phimosis is physiological at birth and slowly resolves during infancy; by age 3 years, 90% of boys have a retractable foreskin. Phimosis might persist or develop consequent to forceful retraction of the foreskin, episodes of balanoposthitis, or other causes of foreskin inflammation. Ballooning of the foreskin when the child voids suggests relative obstruction at the preputial opening.
Treatment consists of careful attention to genital hygiene, gentle retraction of the foreskin, and the topical application of a hydrocortisone(Drug information on hydrocortisone) (eg, 0.05% betamethasone(Drug information on betamethasone)) cream twice a day to the foreskin edge and preputial opening. Attempts at forceful retraction and stretching may lead to pain, tearing of the foreskin meatus, bleeding, and scarring; such practice should be discouraged.
Circumcision should be considered if topical treatment with hydrocortisone cream is not successful; if the child experiences recurrent episodes of balanoposthitis; or if there is preputial scarring, balanitis xerotica obliterans, or urethral obstruction.
■ Webster TM, Leonard MP. Topical steroid therapy for phimosis. Can J Urol. 2002;9:1492-1495. ■ Zampieri N, Corroppolo M, Camoglio S, et al. Phimosis: stretching methods with or without application of topical steroids? J Pediatr. 2005;147:705-706.