Paraphimosis
Paraphimosis occurs when the fold of skin that covers the head (glans) of an uncircumcised penis (i.e., the foreskin) has been retracted and narrows below the glans, constricting the lymphatic drainage and causing the glans to swell. If not corrected, blood flow in the penis becomes impeded by the increasingly constricting band of foreskin, which causes further swelling of the glans. Because lack of oxygen from the reduced blood flow can cause tissue death (necrosis), paraphimosis is considered a medical emergency and requires immediate treatment.
What is paraphimosis?
Paraphimosis (say: "para-fim-oh-sus") is a serious
condition that can happen only in men and boys who
haven't been circumcised. Paraphimosis means the
foreskin is stuck behind the head of the penis and can't
be pulled back down into a normal position.
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What Causes Paraphimosis?
Uncircumcised men sometimes pull the foreskin back
during sex, when they go to the bathroom or when they
clean their penises. Doctors and nurses might pull the
foreskin back when they examine the penis or put in a
catheter.
Causes
Causes include the following:
-
Bacterial infection (e.g., balanoposthitis)
-
Catheterization (i.e., if the foreskin is not
returned to its original position after a urethral
catheter is inserted, the glans may become swollen,
which can initiate paraphimosis)
-
Poor hygiene
-
Swelling-producing injury
-
Vigorous sexual intercourse
Sometimes you, a doctor or a nurse might forget to pull
the foreskin back down. If the foreskin is left behind
the head of the penis too long, your penis might swell
so much that the foreskin is trapped behind it.
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What can I do to Avoid Getting Paraphimosis?
-
After having sex, going to the bathroom or cleaning
yourself, be sure to pull the foreskin back down to
its natural position.
-
Never leave the foreskin behind the head of your
penis for any longer than you need to.
-
If a catheter is put into your bladder, check
afterward to be sure that the foreskin is covering
the head of your penis.
What Happens if I Get Paraphimosis?
Paraphimosis usually causes pain in your penis, but not
always. You might get an infection in your penis. You
might not be able to go to the bathroom at all. If you
can't pull your foreskin over the head of your penis,
you need to call your doctor right away.
The first thing your doctor will do is treat the
swelling. This can be done by pressing your penis with a
hand or by wrapping your penis in a tight bandage. After
the swelling has gone away, your doctor should be able
to pull the foreskin back down. If the foreskin remains
stuck, your doctor might need to make a small cut in the
trapped foreskin to loosen it.
Signs & Symptoms
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Symptoms include the following:
-
Band of retracted foreskin tissue beneath the glans
-
Black tissue on the glans (indicates necrosis)
-
Inability to urinate (urinary retention)
-
Penile pain
-
Redness (erythema)
-
Swollen glans (the shaft of the penis is not
swollen)
-
Tenderness
When the foreskin is retracted it usually slips back
over the glans, or head of the penis, if the penis is
not erect. Sometimes the foreskin remains retracted,
restricting the flow of blood out from the glans. This
causes swelling, and the ring of tissue that keeps the
foreskin from slipping back over the glans tightens even
more. If the foreskin is left in a retracted position
long enough, the painful swelling known as paraphimosis
can result.
Complications
Tissue death caused by loss of blood supply (gangrene)
and spontaneous detachment of diseased tissue (autoamputation)
of the glans are possible complications of paraphimosis.
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Care
Sometimes the foreskin can be worked back into place
manually. However, the doctor may need to make a slit in
the foreskin to relieve the pressure. Removal of the
foreskin (circumcision) is often recommended.
WHAT YOU SHOULD DO
·
If the doctor slits the foreskin, keep the dressing
clean and dry and leave it in place until you return to
the doctor.
·
Apply ice packs to the penis to reduce swelling.
·
You may take over-the-counter pain medicines such as
aspirin, acetaminophen, or ibuprofen. You doctor may
prescribe additional medication.
·
Do not try to pull back the foreskin until after your
follow-up visit.
·
Avoid sexual intercourse for 7 to 10 days.
·
In uncircumcised babies, the foreskin is normally tight.
It usually doesn't start to loosen enough to be pulled
back until the baby is at least 18 months old. Until
then, leave the foreskin alone. Later, you may gently
pull back the foreskin during bathing.
Call Your Doctor If...
·
The pain gets worse.
·
The foreskin stays swollen for 24 hours, or the swelling
gets worse.
· You have increasing redness, swelling, or drainage from the area. These are signs of infection.
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Seek Care Immediately If...
·
You are unable to urinate.
·
You develop severe pain.
·
You have bleeding from the area that will not stop with
gentle pressure.
·
You have a high temperature.
In the
Uncircumcised males are at risk. Piercing the penis
increases the risk if the penile ring interferes with
foreskin retraction or replacement over the glans, and
if infection results from the piercing.
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You can probably bring your foreskin back yourself. The
procedure is very like getting a tight ring off your
finger. The essence of getting the glans back through
the foreskin is not stretching the foreskin, but
compressing the glans. Gently squeezing it and pushing
it with your thumbs will press the blood back down the
penis and make it smaller. It can then be pushed back
through the narrowest part of your foreskin. A drop or
two of something slippery like cooking oil or sexual
lubricant on the glans may help.
If the patient is a child, the person reducing the
paraphimosis by this method needs to know that the
process will hurt, but only momentarily.
One good way to reduce the swelling is by covering the
penis in ordinary (granulated) sugar. This draws the
fluid out of the penis by osmosis (the old high school
water-through-a-membrane trick).
If this fails, it is important to see a doctor. S/he can
draw off the fluid with a hypodermic needle or, as a
last resort, cut through the tight band.
Recently another method has been recommended, the "
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The doctor may then recommend circumcision or try to
order it, maybe telling you tales of necrosis, gangrene
and autoamputation ("You penis will fall off!") to scare
you into it. Circumcision will remove any chance of this
happening again. But if the doctor has put a slit in
your foreskin, that is probably enough and it won't
happen again. Otherwise, it's up to you whether you
think you can trust yourself to act in time next time -
as you did this time. You're hardly likely not to notice
that your foreskin is retracted. It also depends how
much you value your foreskin.
The commonest cause of paraphimosis is iatrogenic
(doctor-caused), when a catheter (drainage tube) is put
in your penis and your foreskin is not brought forward
again - probably because the doctor or nurse is
unfamiliar with the normal foreskin. The catheter
pushing out from inside and the foreskin constricting
from outside combine to produce the paraphimosis. The
catheter needs to be removed before the paraphimosis is
reduced. No catheter, no paraphimosis, and no need for
circumcision. The catheter can be put back, the foreskin
pulled forwards and paraphimosis will not occur again.
Treatmnet
Treatment for
Paraphimosis
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