Brazil — A recent analysis by the Brazilian Society of Urology (SBU) has highlighted a significant surge in surgical admissions for conditions associated with phimosis among adolescents treated through Brazil’s public healthcare system. According to the organisation, hospitalisations for foreskin-related procedures in young people aged 10 to 19 increased by more than 80% over the past decade, prompting urologists to question whether late diagnosis and care gaps may be driving the rise.
Phimosis refers to the inability to retract the foreskin covering the head of the penis. The condition is common in early childhood — often termed “physiological phimosis” — and typically resolves naturally within the first few years of life. However, when the tissue fails to retract by school age, difficulties in hygiene and recurrent infections may develop. If left unresolved, adolescents can suffer discomfort, pain during erections and emotional distress due to embarrassment.
Clinicians in Brazil note that topical steroid creams can be effective when the condition persists beyond the age of seven. However, if conservative management fails, surgery is recommended, with paediatric procedures generally associated with faster recovery and fewer complications. Urologist Daniel Suslik Zylbersztejn, from Einstein Israelita Hospital, stresses that delaying intervention until adolescence often results in more pain, slower healing and a higher risk of complications.
The SBU’s review, based on hospital information systems operated by Brazil’s Unified Health System (SUS), reported a jump from 10,677 adolescent admissions for phimosis, paraphimosis and related foreskin disorders in 2015 to 19,387 in 2024. Specialists attribute this escalation to several factors: gaps in early screening, reduced continuity of care after children leave paediatric services, and disruptions caused by the Covid-19 pandemic, which postponed elective surgeries and limited routine medical appointments.
Beyond discomfort, untreated phimosis has been linked to urinary infections, sexually transmitted infections and, in severe cases, penile cancer. Zylbersztejn adds that hormonal changes during puberty, including increased testosterone and more frequent erections, can aggravate symptoms and delay recovery. Many teenagers, he notes, seek treatment due to pain associated with masturbation or early sexual activity.
Despite the challenges, surgeons emphasise that the procedure can be safely performed at any age, with bleeding and bruising being the most common complications and infection remaining uncommon when proper post-operative care is followed.
The Brazilian trend reflects developments abroad. In the United States, research published in Pediatrics described a decline in neonatal circumcision, a practice typically recommended in the first days of life by American paediatricians. National rates reportedly fell from 54% in 2012 to 49% in 2022, although the reduction was concentrated among white and higher-income families, while rates among Black and Hispanic communities remained stable. The authors suggested that shifting attitudes towards medical recommendations and changes in health insurance coverage contributed to the decline.
Zylbersztejn emphasises that the Brazilian context differs substantially, as routine neonatal circumcision is not recommended nationally. In Brazil, the procedure is restricted to clinically indicated cases or religious reasons. Nonetheless, the urologist stresses that in both countries the fundamental priority remains the same: ensuring accessible, reliable information for families and guaranteeing early diagnosis and appropriate follow-up, particularly for children and adolescents affected by foreskin disorders.