Phimosis and Paraphimosis

When the foreskin won't retract

Doctor and male patient.
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Phimosis, or preputial stenosis, refers to any condition where the foreskin of the penis cannot be retracted. Most infants are born with a foreskin that cannot be retracted and the prepuce may be tight until after puberty.

A fully retractable foreskin occurs in 50% of 10-year-olds, 90% of 16-year-olds and 98 to 99% of 18-year-olds.

Causes

Phimosis can be caused by the failure of foreskin to loosen during growth, infections such as balanitis, deformities caused by trauma, and diseases of the genitals.

Symptoms

Phimosis is usually a painless condition. Infection may result from an inability to carry out effective cleaning of the area, in which case swelling, redness, and discharge may all be present, making the area tender and painful. A very tight foreskin can cause problems during intercourse and urination.

Treatment

Medical opinion differs on the condition and on the treatment of phimosis. It has been suggested that any radical or surgical treatments for phimosis should not be done until after puberty. This is partly due to a perception of the overuse of circumcision as a mainstream treatment for phimosis. It has also been reported that significant numbers of doctors are unable to recognize developmentally normal tight prepuce from pathological phimosis. It is believed that many unnecessary circumcisions are performed because of current medical practice and misdiagnosis of phimosis.

Balanitis xeroticia obliterans has been cited as one of the only causes of phimosis that should lead to a surgical circumcision.

If treatment is required there are three main types:

  • Tropical creams, steroidal and non-steroidal, applied to the prepuce.
  • Gradual stretching of the opening of the prepuce to widen it.
  • Surgical reshaping of the prepuce to make it wider.

All these treatments tend to avoid the side effects associated with surgical circumcision, trauma, pain, side effects of the removal of the foreskin such as friction and interference of the erogenous and sexual functions.

Paraphimosis

Paraphimosis is a condition in which the foreskin becomes trapped behind the head of the penis and is unable to be pulled back into position over the head of the penis. It can cause pain, swelling of the head of the penis and the foreskin. It may also restrict blood flow, causing the head of the penis to become dark purple in color. If this should occur emergency treatment is required.

Treatment

If the foreskin cannot be pulled back into place treatment should be sought. If the blood flow to the penis is restricted then emergency treatment is required and if the foreskin cannot be pulled back a surgical cut to the trapped foreskin may be required. Failure to seek treatment can result in permanent damage to the penis.

Hygiene and the Foreskin

The American Academy of Pediatrics recommends that the immature foreskin of intact boys is not forced back for a cleaning.

The only person who should clean and retract the foreskin is the boy himself. Bubble bath products and other chemical irritants can cause the foreskin to tighten and it is recommended they should be avoided by intact males.

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Article Sources

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  • Foreskin Hygiene Guidelines. American Academy of Pediatrics