A 3 year old boy is brought to your surgery by his parents with the complaint of a “tight” foreskin. They are concerned because his foreskin has never retracted fully, despite daily attempts to pull it back during bath time over the past few months. They are particularly alarmed as his foreskin seems to “balloon” during micturition, and wonder whether he needs circumcising. The prepuce (foreskin) is the retractile covering of the head of the penis (glans). During neonatal development the foreskin is normally non-retractile due to adhesions, which fuse the inner epithelial lining of the foreskin on to the glans. Non-retractile foreskins are therefore common among young boys and form a normal stage in development. At age 3 years, up to 10% of boys will have completely non-retractile foreskins, and a further proportion will have partially retractable foreskins due to persistent adhesions, which are present in almost 75% of 5 year old boys. Over time, the foreskin gradually becomes retractile due to intermittent erections and keratinisation of the inner foreskin. Phimosis is a condition in which the foreskin cannot be retracted over the glans. This may be physiological, because of the reasons mentioned above, or may be due to pathological scarring of the foreskin. This scarring often appears as a contracted white fibrous ring around the …