Phimosis and Paraphimosis

• Phimosis is the inability to retract the foreskin behind the head (glans) of the penis.
• This penis disorder usually is divided into physiologic and pathologic phimosis.
  1. Physiologic phimosis is the normal condition in which children are born with a tight foreskin, and separation occurs during late childhood and early adolescence.
  2. Pathologic phimosis happens because of an infection, inflammation, or scarring and usually is found in uncircumcised adult men.

Physiologic phimosis is present at birth and resolves without intervention. Most children will not have a fully retractable foreskin at birth, but do so as they get older with the majority having a fully retractable foreskin by early adolescence.

Pathologic phimosis is caused by scarring, balanitis, and underlying medical risk factors.

The inability of the foreskin to retract can lead to difficulty cleaning of the area which can cause balanitis. Other symptoms include:

• Difficulty urinating
• Painful urination
• Painful erection
• Paraphimosis

Your doctor can diagnose phimosis based on a thorough history and physical examination. Additional tests are usually not necessary.

Treatment depends on the age of the male, severity, and resulting symptoms.

The first choice of treatment is usually a steroid ointment that is locally applied. This treatment has shown a success rate of over 70%. The ointment softens the foreskin and is applied for 4 to 6 weeks. Once full retraction is possible the ointment is discontinued.

If the steroid treatment is not successful, a circumcision might be beneficial. This depends on the underlying symptoms.

Paraphimosis occurs when the foreskin is retracted behind the glans penis and cannot be returned to its original position. This turns into a urologic emergency as blood flow is decreased to the glans penis.

Once the skin is trapped, edema occurs and the restriction worsens, often forming a very tight tissue ring. This causes pain and worsening swelling (edema).

Paraphimosis is an uncommon condition usually inadvertently caused by retraction of the foreskin by the individual, or in a hospital or nursing home setting by a healthcare professional inserting a Foley catheter, or preparing the patient for a procedure.

Your doctor will diagnose paraphimosis based on a thorough history and the physical examination. Additional tests are usually not necessary.

Manual reduction is usually the first treatment option. To help with the pain, your doctor other health care professional might apply a local anesthetic cream, give you pain medication by mouth, or apply a local anesthetic block to your penis. Applying ice to the local area can help with the edema during manual reduction.

Local injection of hyaluronidase is effective in decreasing the swelling and allowing reduction.

If none of these techniques are successful or if the doctor feels a faster reduction is necessary, a small surgical slit can be made in the back side (dorsal region) of the constrictive skin. This should usually be followed by a circumcision at a later date to avoid a recurrence.

Circumcision can prevent paraphimosis and phimosis.

• The prognosis for phimosis is usually very good. A small amount of bleeding can occur as the skin is retracted but long term negative outcomes are very rare.
• The prognosis for paraphimosis depends on the speed of diagnosis and reduction.
• There can be serious complications, however, if there is significant reduction of blood flow for an extended time period. Gangrene of the tip of the penis and even loss of the tip is possible.