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Two conditions commonly occur with the foreskin of the penis of an uncircumcised or improperly circumcised boy or man.
Phimosis: One condition happens when the foreskin cannot be retracted (pulled back) behind the head (glans) of the penis. This is called phimosis. It is usually a condition found in children.
Paraphimosis: The other condition, paraphimosis, is somewhat the opposite—the foreskin, after being pulled back, becomes trapped and then swollen behind the head (glans) of the penis.
The swelling is caused by the blockage of blood flow, which can lead to death of the glans.
This condition is considered a true medical emergency. Circumcision at birth or revision of a prior circumcision can prevent this condition.
Foreskin Problems Causes
Causes for phimosis include infection, poor hygiene, and previous foreskin injury.
Any condition or activity that results in prolonged foreskin retraction can lead to development of paraphimosis.
An improperly circumcised penis
Frequent insertion of bladder catheters
Vigorous sexual activity, including masturbation
Foreskin Problems Symptoms
With phimosis, your child may have any or all of the following signs and symptoms:
Difficulty with urination
Pain upon urination
Blood in his urine
Pain in his penis
With paraphimosis, you or your child can have these symptoms:
Penile pain (particularly in the glans)
Penile discoloration (this occurs after blood flow is cut off)
When to Seek Medical Care
Phimosis usually does not require emergency medical treatment. But if your child has any urinary symptoms, for example, difficulty urinating or burning upon urination, then you should contact your doctor.
Phimosis is not considered a true emergency, but if your child exhibits urinary symptoms, treatment should occur within 12-24 hours. In certain circumstances, phimosis can lead to paraphimosis, which does require immediate medical attention.
With paraphimosis, if you cannot return the foreskin to its original position and the glans or foreskin becomes progressively more painful, swollen, or discolored, seek immediate medical attention.
Paraphimosis is a medical emergency. If not treated immediately, it can result in death of the glans and foreskin. If the ice and direct pressure technique does not relieve the problem rapidly, go immediately to the nearest hospital's Emergency Department or to your doctor's office.
Exams and Tests
In considering phimosis, the doctor will do 2 tests:
A full genital examination
A urine analysis to look for evidence of infection (if indicated)
Paraphimosis can mimic other medical conditions:
A constricting foreign body (usually a piece of hair wrapped around the penis)
Insect bites
Contact dermatitis
Infection
Foreskin Problems Treatment
Self-Care at Home
At this time, there is no recommended home therapy for phimosis.
For paraphimosis, apply ice to the penis to reduce swelling. One method is to place ice in a rubber glove and then place the penis inside the glove. After cold application, apply pressure to the glans while simultaneously pulling forward on the foreskin.
Medical Treatment
With phimosis, a doctor can use certain tools to attempt to open or to expand the stuck foreskin. Usually, a doctor will do this only if there are problems urinating.
With paraphimosis, the doctor will repeat the ice with direct pressure technique.
If that does not free the foreskin, the doctor will contact a urologist for surgical treatment.
Local anesthetic will be introduced into your penis with a fine needle.
An incision then will be made through the area of constriction, allowing the foreskin to return to its original position.
Next Steps
Follow-up
For either condition, you must follow up with a visit to a urologist.
To prevent phimosis from returning, you should plan for the child to be circumcised.
Prevention
Phimosis only affects uncircumcised males. Circumcision is the definitive preventive measure against this disorder. For those who choose to remain uncircumcised, good hygiene can reduce the risk of developing phimosis.
Paraphimosis has no effective preventive measures beyond good hygiene.
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