Phimosis : Management in adults

The management of phimosis in adults encompasses both medical and surgical strategies, tailored to the severity of the condition and patient-specific considerations. Medical management primarily involves the application of very potent steroid creams, such as Dermovate (Clobetasol 0.05%), to the tight part of the foreskin. Patients are advised to undertake regular stretching exercises alongside the application of the cream to facilitate the loosening of the foreskin. This approach is often effective for more than 50% of patients, although there is a possibility of recurrence.

Surgical options, including preputioplasty or circumcision, are considered when medical management is unsuccessful. These procedures are usually performed under local anaesthesia. Circumcision, however, is designated as a Low Priority Procedure and is typically only funded after the failure of medical treatment, not for religious reasons. Indications for surgical referral include paraphimosis, pathological phimosis due to scarring, recurrent balanitis, or suspected penile malignancy. This comprehensive approach aims to address the symptoms of phimosis while minimizing potential complications and considering patient preferences.