Phimosis is a medical condition that causes a difficulty in retracting the foreskin due to a tight ring of foreskin around the tip of the penis. There are two types of phimosis: physiologic and pathologic.
Physiologic phimosis is normal in uncircumcised infants or children. They are born with a tight prepuce (foreskin) and separation occurs naturally prior to the age of 10.
- This type of phimosis is not a problem unless it causes urinary obstruction, pain, or haematuria.
- Proper care of the uncircumcised penis will result in natural, progressive retraction over time. This involves only gentle retraction with cleansing underneath the foreskin. After retraction and cleaning, the foreskin should be pulled back over the head of the penis to its normal position.
This type of phimosis occurs because of inflammation, infection, or scarring.
- Poor hygiene increases the risk of developing pathological phimosis
- It is most common in uncircumcised males but can occur in circumcised males with sclerotic excess skin.
- Female phimosis is uncommon and poorly recognized but may be caused by lichen sclerosis.
Physiologic phimosis may present with related to smegma production and painless ballooning of the foreskin during urination.
Pathologic phimosis does not resolve naturally and may cause other complications including:
- Irritation, bleeding, or discharge
- Painful erections
- Recurrent urinary tract infections
- Ballooning of the foreskin resulting in painful or difficult urination
- Urinary retention
- Recurrent infections of the foreskin
Treatments may vary depending on the severity of phimosis. Treatments may include:
- Manual retraction
- Corticosteroid application
- Long-term antibiotics
- Carbon dioxide laser therapy
- Radial preputioplasty
Paraphimosis is the result of a tight prepuce being retracted and becoming caught behind a swollen glans. This may occur because of scarring, vigorous sexual activity, chronic infection, penile piercing, or improper replacement of the prepuce after catheterization.
Paraphimosis is a medical emergency. Check to be sure there is no foreign body encircling the penis, such as a rubber band.
Paraphimosis may present with the following symptoms:
- Irritability in infants
- Pain on erection
- Oedema around the constricting band, which is usually the prepuce
- Black or blue colored glans due to necrosis
Treatment options will vary based on the severity of the paraphimosis.
- Reduce swelling with ice and gentle compression of the glans followed by reduction of the prepuce over the glans
- Manual compression and osmotic reduction using a swab of 50% dextrose
- For more severe cases, other alternatives may be considered including dorsal incisions or punctures in the oedematous foreskin
Consult with a qualified medical professional for appropriate diagnosis and treatment, contact Dr. Grace Hyun.
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