Modern treatment of phimosis

Non-surgical methods now the standard approach

Much of the pressure for circumcision in the Victorian era and up until the 1960s was fear of phimosis - inability or difficulty in retracting the foreskin to expose the glans. In the nineteenth century this condition was wrongly believed to be the cause of a host of nervous and other diseases, leading many doctors to insist that unless the foreskin was fully mobile within a few weeks of birth, circumcision was essential. It was not until the 1940s that this error was corrected by Douglas Gairdner, though it persists in parts of the United States to this day. Research since the 1940s has established that it is perfectly normal for the foreskin not to become retractable until a boy reaches puberty, and that there is no need for any intervention unless he is experiencing discomfort, since most cases resolve spontaneously as he matures.
For cases of persistent phimosis, where there was discomfort, pain or other problems, it is true that there was probably no alternative to circumcision until the 1990s, when it was realised that the application of steroids caused the foreskin tissue to loosen and expand, thus permitting retraction. A host of articles in medical journals since the early 1990s has now established beyond any doubt that application of one or more of several different steroid creams to the foreskin is nearly always effective in resolving problem cases of phimosis. The notion that circumcision is the appropriate response to phimosis is now outdated and unscientific. The only situation where circumcision may still be necessary is in persistent cases of Balanitis xerotica obliterans (BXO or Lichen sclerosus - a very rare skin disease, possibly of fungal origin, but not yet fully understood) that do not respond to conservative treatment.
Most of these articles are available on CIRP, but an additional selection of articles is provided below. These show how assertions of the need for circumcision have decreased as understanding of normal penile development has improved. It is interesting to observe how allegations of the "need" for circumcision fade away as it is increasingly appreciated that, in most cases, the phimotic condition is normal and harmless, and that the foreskins of many healthy boys  do not become fully retractable until puberty or even later. In the first paper below (early 1990s) doctors are still circumcising quite young boys whose foreskins have not become retractable if they do not respond quickly to the steroid treatment. But as more experience is gained (and as false Victorian/Edwardian understanding dissipates) the anxiety recedes.  It comes to be appreciated that that it is quite normal for foreskins not to become retractable until puberty or after, and that in many cases they will do so naturally, even without treatment. What is particularly interesting about the results of many of the papers below is the number of boys in the control (non-treatment) group whose phimosis resolved quite naturally during the course of the study. The lesson here is to be patient and recall the old proverb: Fools rush in where angels fear to tread.
It is doubtful whether any boy needs treatment unless he is still phimotic after puberty and experiencing discomfort, but is is certainly better to undergo a harmless  course of steroid ointment than to suffer the risks and losses of amputating surgery. There is some evidence that extra testosterone can also held achieve foreskin mobility, suggesting that a low testosterone level may be connected with the phimotic condition in the first place.