Clinical Recognition A tight phimosis can result in ballooning of the foreskin during voiding, which in turn traps urine and can lead to inflammation In a child over years old, the foreskin should be able to be retracted to the point where the urethral meatus can be visualized Paraphimosis is evident as a broad, edematous band of skin proximal to the glans This skin is often erythematous and very tender to touch Management Phimosis does not have to be treated emergently Betamethasone cream, 0.05%, applied twice daily for weeks, is the first-line treatment Hydrocortisone cream is an alternative The patient/family must be instructed to pull the foreskin back as far as it will go, then to apply a small amount directly to the tightened area The goal in paraphimosis is to bring the foreskin back into normal location This requires reduction of the edema in the skin The application of ice and steady manual compression on the inflamed ring of foreskin usually reduces the edema and permits manual reduction of the paraphimosis Topical anesthetic cream or a dorsal penile nerve block will reduce the discomfort experienced by the child during compression of the edematous foreskin Once a portion of the edema has been reduced, pressure on the glans (like turning a sock inside out) usually permits reduction of the foreskin back to its normal position If manual reduction fails, a surgical division of the foreskin to permit reduction is indicated; however it is uncommon to need to perform this The family should be counseled not to pull the foreskin back over the glans for at least a week Vaseline can be applied to the raw edges of the foreskin, especially in the setting of small abrasions, to prevent infection The family can be counseled about circumcision, although this is not required