What a pediatrician needs to know about phimosis and circumcision: Historical and contemporary views

Foreskin pathology is a topical issue in the practice of not only a pediatrician, but also a pediatric surgeon, urologistandrologist, and dermatovenerologist. The concept of phimosis can be interpreted differently, which contributes to diagnostic errors and leads to unjustified surgical intervention. The term “non-retractable foreskin” is often used by authors in foreign literature. This position is justified by the anatomical and physiological features of the foreskin in children. The ontogenesis of the prepuce demonstrates high individual variability. Consistently across studies, in the mid-20th century scientists showed that the attachment of foreskin in infants is a physiological phenomenon and needs no intervention; the separation of the prepuce is a natural process. However, throughout centuries of history attitudes toward circumcision have been controversial, which has been influenced by cultural and religious reasons. A historical essay on circumcision will make it possible to trace the evolution of ideas about the need for this procedure, as well as to detect trends in therapeutic and preventive measures for the foreskin pathology. Currently, the issue of the advisability of circumcision remains a point of contention among specialists, some of whom emphasize the preventive aspect of the procedure, while others support a more cautious approach due to possible complications. The medical community acknowledges the value of the foreskin as an anatomically significant area with important functions. That is why when deciding on circumcision, the focus shifts from cultural reasons to medical indications. The proper care for the external genitalia in children with physiological phimosis remains a pressing issue, as preventive measures are a fundamental principle of pediatrics.

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