fimosis (of Greek phimos φῑμός) is a condition of the cutaneous Annexes of Penis that alters the mechanics of this organ. The fimosis must Estenosis of the prepucial orifice that prevents the complete retraction of prepucio to leave Glande shortage, actively during the flaccidity of the penis, or passively during the erection.

Or still more simple, the fimosis is the narrowness of prepucio, is worth to say, glande cannot be discovered. The normal thing is that glande can be discovered to be able to clean up it in flácido state and to have pleasant sexual relations.

Prepucio is developed as a small layer of epitelio that surrounds glande, as of the twelfth week of gestation. For the moment of the birth, it hides glande completely and is adhered strongly to his epitelio. In the course of the first four to five years of age, the gradual separation of prepucio takes place, by means of the intermittent erections and the accumulation of cells of moulting, which do not have to be confused like Esmegma .

If prepucio until behind glande cannot be dissuaded completely, then there would be fimosis. All the prepucios automatically do not dissuade when experimenting an erection of the penis. If it can be done manually, fimosis is not had.

The fimosis is quite frequent, mainly in children, before Adolescence . Esteem that only less than 2% of the adolescents of 17 years suffer fimosis. In 95% of new born the prepucial retraction is difficult. To the 6 months only 20% of the prepucios are retractable, to the year 50% are retractable and to the 3 years 90% are retractable.

Usually it has several degrees, from a painful narrowness during the erection that lets discover glande, to a punctiform estenosis that makes difficult until Urination . A classification has become of the fimosis in 3 categories:

Punctiform Fimosis: that one in which the prepucial orifice is of a minimum diameter, as soon as appreciable, with the surrounding skin of normal aspect and thickness.

Nonretractable cicatricial or annular Fimosis: that one in which the skin that surrounds the prepucial orifice indurada or is thickened, habitually by previous balanopostitis.

Annular Fimosis: those cases that cannot be included neither in previous groups, being prepucio narrowed in major or measured minor and by some circumstance exist complications or failure for the retraction.

It is thought that the cause of the fimosis is congenital, but also can have to retractions forced of prepucio of the babies during his hygiene by the parents, that creates fibrous ring in prepucio and balanoprepuciales adhesions.

In the adults the fimosis causes usually are varied, the chronic or recidivante balanopostitis, in mainly diabetic, obliterante xerótica balanitis and traumatisms (direct, violent sexual acts, urologic manipulations).

Fimosis and parafimosis

Parafimosis is necessary to differentiate the fimosis from urologic urgency produced by Inflammation or Edema of prepucio, that prevents the covering of glande after its forced retraction and that produces a constriction or strangling of glande by a ring of prepucio that has been dissuaded, at the risk of Necrosis of glande, that can inflict its casualty. He is relatively frequent in adults with urinary drilling and children after his first peneanas manipulations.

The worse acute complication is Parafimosis . In this acute situation, glande is swollen and adolorido, and prepucio is immobilized by the inflammation, in a position partially dissuaded. The proximal part of the penis follows flácida. The parafimosis is considered a emergencia.

Complications of the fimosis

• painful Sex : due to the lack of sliding of prepucio on glande and the penis.

• Balanitis : is Infection of the penis, due to the accumulation of Esmegma in the balanoprepucial space.
• Infections of urine : if the infection of esmegma promotes by Uretra .
• Problems in urination: that oscillates from Disuria, until acute retentions of repetition urine and that require urinary drilling.
• balanoprepuciales Adhesions: is the union of prepucio with glande, that complica plus the fimosis and that can be present in the absence of fimosis.
• Cancer of penis : is the rarest complication, with a smaller incidence of 1/100,000 men to the year, that can have to the fimosis persistence after the puberty.
• Parafimosis : occurs when glande happens of form forced through a narrow fimótico ring, next edematiza, it becomes inflamed, and it cannot return to the normal position. The inflammatory changes progress in the part retained under pressure (glande) and will not stop until their reduction surgical manual or. It must be avoided with a manipulation adapted before the fimosis existence.

Treatment of the fimosis

The fimosis generally deals with medical Circuncisión, realized by Urologist in conditions of asepsis and with necessary the surgical supplies.

Usually it is realized as of the three years of age, because before, the majority of the prepuciales estrecheces is reversible. After the three years, the own boy in his daily hygiene and later with Masturbation, allows the solution of the majority of the supposed fimosis.

Before resorting to the circuncisión, Treatment with topical Corticoids indicated by the pediatrician as of the three years during about two or three months and with the aid of smooth retractions can solve the fimosis.

2% or less than the adult men than suffer fimosis, could be reduced still more, since the treatment lacks risks in the majority of the cases, because not always the circuncisión is necessary.

Fimosis in history

• Maria Antonieta was 14 years old and Luis XVI, the future king of France was 15 years old when they contracted marriage in 1770 . Luis suffered a genital anomaly, evidently was fimosis, was corrected with a small surgery after the 7 years of the wedding. Maria Antonieta could give finally to light her first son the following year.
• President of the United States of America, James Garfield, was assassinated in 1881 by Charles Guiteau . After died the assassin, the report of its autopsy indicated that it suffered of fimosis. This took to the conclusion that the behavior of Charles Guiteau had to the madness produced by this genital anomaly.

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