A mother reports that her 2-year-old son's foreskin balloons during micturition but returns to normal afterwards. On examination the prepuce retracts partially to reveal healthy glans tissue, with no white sclerotic ring or scarring. What is the correct advice?

• A Circumcision should be done now to prevent balanitis
• B The foreskin should be retracted forcefully daily until fully retractile
• C Topical corticosteroid cream must be started immediately
• D This is physiological phimosis requiring only reassurance and hygiene advice ✓

Explanation

Physiological phimosis is present at birth and the foreskin becomes fully retractile progressively; about 90 percent of boys have a retractile prepuce by 3 to 5 years. Preputial ballooning during micturition is common and benign when there is no scarring or BXO. Forceful retraction causes microtears, cicatricial scarring, and true pathological phimosis. Circumcision and steroids are reserved for pathological phimosis or recurrent balanitis, neither of which is present here.

Reference: Bailey and Love Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.