Management of phimosis in adolescents during puberty primarily involves conservative approaches initially, as physiological phimosis is common and often resolves spontaneously with time and puberty.
Good hygiene is essential; adolescents should be advised to wash the genital area daily with lukewarm water without forcibly retracting the foreskin if it is still non-retractable, to avoid trauma and secondary infection NICE CKS.
Topical corticosteroids, such as 1% hydrocortisone cream, applied once daily for up to 14 days, are recommended to reduce inflammation and facilitate foreskin retraction in cases of symptomatic or persistent phimosis NICE CKS. This approach is supported by clinical experience and the British Association of Paediatric Urologists (BAPU) statement on foreskin management NICE CKS.
If phimosis is associated with recurrent balanitis or suspected lichen sclerosus, referral to a paediatric urologist or surgeon is advised for further assessment and consideration of circumcision, especially if topical corticosteroids fail to resolve the condition NICE CKS.
Surgical intervention, such as circumcision, is reserved for persistent, symptomatic phimosis unresponsive to medical treatment or when there are complications like severe balanitis or scarring (pathological phimosis) NICE CKS.
Recent literature emphasizes that physiological phimosis in adolescents is a normal developmental stage and that conservative management with topical steroids and hygiene is effective in most cases, reducing unnecessary surgical procedures Dobanovacki et al. 2012.