Physiological phimosis, do we manage it in primary care according to current recommendations? 

Introduction: phimosis is one of the most frequent presenting complaints in pediatric Primary Care. Most of the cases are physiologic and it is advised to manage them conservatively, focusing on hygiene and care of the foreskin. The aim of this study is to analyze the management of this condition in Primary Care and compare the results with current guidelines.

Material and methods: we have carried out a survey that has been distributed among the pediatricians in our area and a bibliographic search on foreskin care protocols or “guidelines” for the management of phimosis on the main scientific websites.

Results: the majority of pediatricians adopt an expectant management before toilet training (83.6%). One of two years after toilet training, 78.7% of professionals start topical treatment and they refer the patient to surgery if it is ineffective, even if the child is asymptomatic. Current international guidelines advocate conservative management of physiological phimosis. In specific cases that require intervention, topical treatment is favored before considering surgery.

Conclusions: in our setting, the management of phimosis in Primary Care is in line with the recommendations in most cases. It remains unclear when asymptomatic phimosis will not resolve and will require referral to surgery. Information to parents and communication between teams is essential for suitable management in each case.