Phimosis and Paraphimosis

Phimosis is a condition when the foreskin cannot be fully retracted over the glans penis.

Paraphimosis occurs when it is possible to retract the foreskin, but it does not return to the original point, compressing the base of the glans and causing obstruction of venous and lymphatic flow. In this paper we explain phimosis and paraphimosis in a language accessible to all.

Phimosis and paraphimosis
Phimosis and paraphimosis

What is foreskin?

The foreskin is retractable one layer of skin, a kind of skin that covers and protects the glans, commonly known as head of the penis. The foreskin in adults covers the glans when the penis is flaccid, but retracts when it is erect.

The foreskin begins to be formed in the first weeks of fetal development. From birth through the first years of human life, the foreskin is adhered to the glans, a physiological process called phimosis. With the growth the inner region is gradually loosening the glans, to be fully retractable when the penis is erect. One should not force the detachment of the foreskin in children, because it occurs naturally over the years. In 90% of boys, physiological phimosis disappears during the first 3 years of life.

From now on, whenever we talk about phimosis we refer to pathological phimosis, or phimosis which is not physiological.

What is phimosis?

Phimosis occurs when you cannot retract the foreskin and fully expose the glans. Even with an erect penis, the glans is not exposed, as seen in the photos below.

A phimosis can arise in two ways:

1) Phimosis from birth, when the individual reaches adolescence without ever having the foreskin retracted, i.e. one which has not disappeared early in life and therefore cannot be considered as physiological.

Some men are born with the ring of the foreskin (opening) very tight, which prevents the retraction of the skin even after the detachment of the foreskin in the first years of life. Another cause of phimosis from birth occurs in men, whose parents tried to force the retraction of the foreskin as a child, causing damage and creating scars that perpetuated the phimosis.

2) Acquired phimosis, which is the case of the adult who had phimosis, but because of infection or trauma scars created in the penis causing adherence of the foreskin, preventing its retraction. This type of phimosis occurs usually by poor hygiene of the penis, favoring the accumulation of secretions and proliferation of bacteria inside the foreskin.

Symptoms of phimosis

The main signal is a foreskin that will not retract. There are varying degrees of phimosis, since those with partial retraction and compression of the glans, to complete obstructions, when it is not even possible to see the urethral opening (hole in the tip of the penis where the urine comes out), as pictured on a far left photo.

Phimosis can cause painful erections, hematuria, weak urinary stream and recurrent urinary infections.

Treatment of phimosis

Every case of phimosis should be evaluated by a urologist. Reducing manual foreskin is usually sufficient to correct the phimosis but should preferably be done by a professional for no complications. The local application of ice may help in the process. If there are signs of swelling, some doctors suggest steroid-based ointments to reduce inflammation and facilitate further reduction.

Circumcision is a simple surgical procedure that corrects and prevents its recurrence. It is the most commonly used, but at first, soon after the resolution of the inflammatory process.

What is paraphimosis?

Paraphimosis occurs when the foreskin can be retracted, but cannot return to its original point, causing constriction of the glans and blood flow obstruction. Unlike phimosis, paraphimosis is a medical emergency which, if not treated in time, can cause gangrene of the penis.

Among the risk factors for paraphimosis are:
  • Phimosis
  • Infections of the penis, as balanoposthitis
  • Traumas
  • Deployment of body piercing

Eventually, paraphimosis may occur after sexual intercourse, especially when the man does not clean the penis and the foreskin does not return to the correct location after it going limp. There are cases in which the patient sleeps immediately after intercourse and wakes up with a penis in paraphimosis.

Paraphimosis can also occur in children with physiological phimosis when parents try to reduce the phimosis, causing a permanent retraction of the foreskin of the penis and compression.

Symptoms of paraphimosis

As in phimosis, the diagnosis of paraphimosis is made by physical examination, which detects a swelling on the glans penis and a kind of gentler constrictor cord around the base of it. If the service is not fast, the glans can start getting purple, denoting penile tissue ischemia. The paraphimosis is a very painful process.

Treatment of paraphimosis

As have been already mentioned, paraphimosis is an emergency and should be reduced as soon as possible. The reduction may be performed manually, usually under some degree of anesthesia, if there are no signs of necrosis of the penis. If there are already signs of ischemia or manual reduction is not effective, the patient should be sent for surgery.
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