Last reviewed: 25 May 2021
Last updated: 05 Jul 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • newborn and toddler age
  • abnormal location of urethra
  • incomplete prepuce
  • penile curvature and/or torsion
  • recent genital examination or procedure
  • history of short or small penis
  • penile pain and swelling
  • foreskin adherent to glans
  • penile adhesions and smegma
  • penile cicatrix
  • penile glans oedema
  • prominent pre-pubic fat pad
  • presence of hernia or hydrocele

Other diagnostic factors

  • forced retraction of foreskin
  • dyspareunia
  • recent penile trauma
  • history of balanitis or balanoposthitis
  • urinary obstruction or retention
  • necrosis of penile skin
  • discoloration of glans
  • penile length discrepancy
  • history of UTI
  • history of pelvic or genitourinary surgery
  • erectile dysfunction

Risk factors

  • uncircumcised penis (paraphimosis)
  • indwelling urinary catheter (paraphimosis)
  • parental unawareness (phimosis)
  • balanitis xerotica obliterans (phimosis)
  • penile trauma (phimosis)
  • recurrent balanitis and balanoposthitis (phimosis)
  • low birth weight (hypospadias)
  • premature delivery (hypospadias)
  • maternal gestational diabetes, obesity, or hypertension (hypospadias)
  • family history (hypospadias, congenital penile curvature and/or torsion)
  • obesity (buried penis)
  • circumcision (trapped penis)
  • penile and lower abdominal scarring (buried penis)
  • hernia or hydrocoele (buried penis)

Diagnostic investigations

Treatment algorithm


Nicol Corbin Bush

Co-Director, PARC Urology

Vice-President, Operation Happenis




NCB declares that she has no competing interests.

Dr Nicol Corbin Bush would like to gratefully acknowledge Dr Nicholas Cost, Dr Linda Baker, and Dr Michael Holzer, previous contributors to this topic. NC, LB, and MH declare that they have no competing interests.

Peer reviewersVIEW ALL


Department of Urology

The Jack Lapides Professor of Urology

University of Michigan Medical School

Ann Arbor



DB declares that he has no competing interests.

Lecturer in Uro-oncology and Consultant Urological Surgeon

Department of Urology

Addenbrooke's Hospital




VG declares that he has no competing interests.


Pediatric Urology

and Professor

Urology and Pediatrics

UCSF Children's Hospital

San Francisco



LB declares that he has no competing interests.

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