Paraphimosis

Paraphimosis is a condition affecting uncircumcised males that occurs when the foreskin can no longer be pulled forward over the tip of the penis. This causes the foreskin to swell and become stuck behind the tip of the penis. Paraphimosis can interrupt the flow of blood to the tip of the organ and cause serious complications if left untreated. The condition most frequently occurs when a doctor or other healthcare provider mishandles the foreskin during an examination or a procedure. Although any uncircumcised male can experience paraphimosis, the condition is most common among boys and older men. In addition to intractability of the foreskin, the symptoms of the disorder include pain, swelling, tenderness, and trouble urinating. Paraphimosis is the opposite of phimosis, which is a condition that occurs when the foreskin cannot be pulled back from the tip of the penis. While phimosis is generally harmless, paraphimosis is an emergency condition that should be treated immediately.

Background

The foreskin is the flap of skin on an uncircumcised penis that covers the tip of the penis, or glans. Functionally, the foreskin protects the glans from abrasion and other potential irritants. Because its inner surface is similar to the inside of the mouth, the foreskin helps to keep the glans lubricated as well. The nerves inside the foreskin also allow for added stimulation during sexual intercourse. In terms of size, the foreskin typically accounts for one-third to one-half of the penile skin. While in some men, the foreskin covers the entire glans, in others it only partially covers it. In some cases, the foreskin may be so small that it is virtually non-existent or fully retract beneath the glans during puberty.

While the foreskin has some protective purposes, it can also lead to certain problems. Because it keeps the glans lubricated, the glans must be properly cleaned to prevent bacterial buildup. Failure to do so can result in the accumulation of a type of discharge called smegma, as well as urinary tract infections. The mucus surfaces of the foreskin can also be prone to a type of inflammation called balanposthitis. A skin disease called balanitis xerotica obliterans can affect the foreskin as well. Of course, the foreskin can also be affected by phimosis and paraphimosis, conditions that interfere with its ability to retract or descend normally. These are all reasons for circumcision, or the surgical removal of the foreskin. Usually performed at birth, circumcision is a simple procedure involving the removal of the foreskin and frenulum, which is a piece of tissue that connects the foreskin to the glans. Most physicians agree that the benefits of newborn male circumcision—which include improved hygiene and the avoidance of conditions like phimosis and paraphimosis—outweigh any potential risks. Circumcision can also lower the risk of some sexually transmitted diseases and penile cancer as well as the risk of cervical cancer in female sex partners. For males who are not circumcised, paraphimosis remains a potentially dangerous problem requiring immediate medical attention.

Overview

Paraphimosis is a condition that occurs when the foreskin can no longer be pulled forward over the glans. Essentially, the foreskin gets stuck behind the glans and cannot be pulled back down into its normal position. This may lead the foreskin to become swollen to the point that it slows or even completely blocks the flow of blood to the tip of the penis. If left untreated, paraphimosis can lead to serious injury.

There are several possible causes of paraphimosis. It most commonly occurs when a doctor or other healthcare provider fails to manually retract the foreskin after a medical examination or procedure. It can also occur from pulling back on his foreskin too forcefully, having a foreskin that is tighter than normal, or having a foreskin that has been retracted for an extended period. Physical trauma or infection can lead to paraphimosis as well. In some instances, patients with diabetes may experience a chronic swelling of the penis and foreskin that can cause paraphimosis.

The primary symptom of paraphimosis is simply being unable to pull the foreskin back into its normal position once it is retracted. Paraphimosis may also cause swelling of the glans, discomfort, pain, redness, tenderness, or difficulty urinating. If it is not treated quickly, paraphimosis can lead to serious complications, including severe infection, damage to the glans, or even tissue death leading to complete loss of the glans.

The preferred treatment for paraphimosis generally depends on the severity of the condition. In most cases, treatment involves reducing the swelling in the area. This may mean applying ice, bandaging the penis, draining pus or blood, or injecting hyaluronidase, which is an enzyme that reduces swelling. Once the swelling has been sufficiently reduced, the doctor will manually return the foreskin to its normal position. Due to the pain involved, this may require an anesthetic, a nerve block, or an oral narcotic. In especially severe cases, a complete circumcision may be the only viable treatment option. Regardless of severity, it is usually possible to make a full recovery from paraphimosis as long as the condition is treated quickly. After treatment, patients are advised to refrain from sexual activity for up to ten days and keep the glans clean in the future.

Of course, the best way to prevent paraphimosis is through circumcision. Short of that, the condition can also be prevented by practicing good hygiene by cleaning and drying the glans regularly. It is equally important to always remember to pull the foreskin back into its normal position after it has been retracted for urination, sexual intercourse, or cleaning. Patients who have undergone a medical examination or procedure in the area should also be sure to pull the foreskin back to its normal position afterwards. It may also be advisable to avoid getting penile piercings or using penile rings, as these may increase the likelihood of paraphimosis. Most importantly, it is a good idea to ensure that the foreskin never remains retracted behind the glans for an extended period of time.

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