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Steroids

1K views 1 reply 2 participants last post by  hakunangovi 
#1 ·
What's the general consensus here on steroid cream to treat phimosis? I have an intact 8 year old with a very tight foreskin which does not retract at all. I know that alone is well within normal range and wouldn't tempt me to use a cream but he has been experiencing mild to moderate intermittent burning (no other symptoms) while urinating for a little over a year now. The burning will last from a day to occasionally a week, then disappear. He tested neg for a uti with the first urine test, but positive for strep b at a later date. Tried a one week course of amoxicillin, but the burning returned one week later. Nurse physician, who claims to be intact friendly, would like to try the cream as she suspects urine is being trapped and causing this mild irritations and infections. Thoughts? I'm happy to be spared the "He must be circ'd!!" spiel, but not entirely convinced about the steroid.
 
#2 ·
From what I can gather, the steroid application along with gentle stretching will give rise to easier retraction, but that with younger children the foreskin sphincter tends to tighten again upon cessation of the stretching and steroid application. Two things must take place for a foreskin to be able to retract: The sphincter must loosen enough to allow the foreskin tip to expand over the glans and the natural connection between inner foreskin and glans must dissolve.

I am more inclined to think that he is experiencing occasional bouts of separation trauma where the synechia (that attaches the inner foreskin to the surface of the glans) are breaking down in little patches leaving a raw spot that will sting when contact with urine occurs. Usually this process takes place over a shorter period of time, but the surface area of the glans is fairly large. I have a nephew who was about 16 when the last attachment broke free. Often doctors call this scenario "adhesions", but it is normal and is natures way of keeping contaminants out. I have heard that manipulation of the foreskin by pulling it FORWARD can hasten this part of the process.
 
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