Summary Although there continues to be considerable debate over the merits of circumcision, it is clear that preservation of the pediatric foreskin, even in the presence of phimosis, is a viable option. Steroid topical cream is a painless, less-complicated, and more economical alternative to circumcision for treating phimosis. Success rates are quite high, especially when patient selection is appropriate and parents are adequately instructed on application. In those children in whom topical steroid therapy has failed, there remains a variety of foreskin-preserving surgical options for treating phimosis. Compared to circumcision, these less-invasive techniques are associated with lower morbidities and cost. Furthermore, depending on the tissue-preserving technique used, satisfactory cosmesis is also achieved. Thus, those males who were not circumcised at birth now have medical and surgical options, which will decrease the likelihood of requiring circumcision at an older age. As health care providers in the United States see more and more uncircumcised male children, it is important for these children and their parents to understand the natural history of physiologic phimosis. Additionally, it is the responsibility of health care providers to present the management options available for the treatment of the persistent nonretractile foreskin and/or pathologic phimosis. These options are particularly important for those individuals whose religious, cultural, or personal preference is to retain the foreskin.