Phimosis and Undescended Testicle: Important Checks During a Child’s Growth

Phimosis and Undescended Testicle: Important Checks During a Child’s Growth

During a child’s growth, parents may have questions about genital development, such as a non-retractable foreskin, phimosis or the position of the testicle. Here is when a specialist assessment may be useful.

During a child’s growth, some aspects of genital development may raise concerns for parents: a foreskin that does not retract completely, recurrent local inflammation, or a testicle that does not always seem to be present in the scrotum.

In many cases, these situations can simply be observed over time, without unnecessary alarm. In others, however, a paediatric surgery consultation can be useful to distinguish what is physiological from what may require treatment.

As a paediatric surgeon, my goal is to help families understand when monitoring is enough and when, instead, it is appropriate to intervene.

Phimosis is the difficulty or inability to retract the foreskin, the skin that covers the glans. In young children, some difficulty retracting the foreskin can be physiological and part of normal development. In the absence of symptoms, infections or scarring, early treatment is not always necessary.

The situation is different in the case of pathological or cicatricial phimosis, which may appear over time and can be associated with inflammation, local infections or changes in the skin of the foreskin. One sign that should not be underestimated is the presence of a whitish, tight scar-like ring at the tip of the foreskin, which may be linked to a skin condition called lichen sclerosus.

I recommend a specialist consultation when there are recurrent local infections, urinary tract infections, pain or discomfort, difficulty urinating, swelling of the foreskin during urination, a whitish scar-like ring or phimosis that persists as the child approaches puberty.

It is important to avoid forcing the foreskin open: forced retraction can cause pain, small tears and scarring, potentially worsening the narrowing.

Not all children with difficulty retracting the foreskin need surgery. In younger children, if there are no infections, pain or signs of scarring, observation over time may be appropriate. When phimosis is symptomatic, cicatricial or persistent, treatment can be considered.

The possible options depend on the individual case and may include topical treatment, circumcision, foreskin-preserving procedure or, when the problem mainly involves a short frenulum, frenulotomy.

An undescended testicle, or cryptorchidism, is a condition in which one or both testicles are not stably present in the scrotum. The main sign is precisely the absence of one or both testicles from the scrotum, often noticed during daily hygiene or during a paediatric check-up.

During development, the testicles form in the abdomen and normally descend progressively into the scrotum. When this descent is not completed, the testicle may stop along its path, for example in the groin area. In general, this condition does not cause pain: this is why it is important to pay attention to the position of the testicle even when there are no symptoms.

I recommend a specialist evaluation whenever there is any doubt about the position of the testicle: for example, if the scrotum appears empty or less developed on one side, if one testicle is not always present in the scrotum, if the paediatrician suspects an undescended testicle or if the testicle seems to “move up” frequently.

During the consultation, I assess whether the testicle is palpable, where it is located and whether it can be brought down into the scrotum. This also helps distinguish a truly undescended testicle from a retractile testicle, which may temporarily move upward but can be brought back into the scrotum during the examination.

The timing of the evaluation is important: in the first months of life, in some children, the testicle may complete its descent spontaneously. After 6 months of age, however, this becomes much less likely. For this reason, if the testicle is not stably present in the scrotum, it is important not to postpone the assessment.

When indicated, the surgical treatment is called orchidopexy and aims to bring the testicle into the scrotum and secure it in the correct position. The decision regarding timing and technique depends on the child’s age, the position of the testicle and the specialist evaluation.

Phimosis and undescended testicle are different conditions, but they have one thing in common: parents often do not know whether they should wait, worry or seek medical advice promptly.

This is exactly what the consultation is for: to distinguish physiological situations from those that require closer attention, explain to the family what to observe and define the most appropriate care pathway.

In some cases, monitoring is enough. In others, intervening at the right time can help prevent possible complications and support the child’s growth more appropriately.

If you have concerns about your child’s foreskin, notice recurrent local infections or feel that a testicle is not always present in the scrotum, a paediatric surgery consultation can help clarify the situation.

During the visit, I assess the child, collect the clinical history and explain to the family whether it is enough to monitor the condition over time or whether treatment is indicated.

My goal is to support parents and children with care, clarity and expertise, choosing the most appropriate pathway based on each individual case.