I have phimosis and paraphimosis

Paraphimosis

Paraphimosis (Spanish collar): Pinching of the retracted foreskin behind the glans in the so-called glans rim. The glans swells, turns blue and is very painful due to the congestion of blood and inflowing tissue water. Causes are the foreskin being pushed back in phimosis or the improper placement of an indwelling catheter if the foreskin has not been pulled back.

Paraphimosis is a urological emergency; if therapy is delayed, the glans penis may die. For treatment, the doctor carefully pushes the foreskin back manually after numbing the penile nerves. If this does not succeed, the foreskin must be incised.

Leading complaints

  • Very painful swelling of the glans
  • Bluish discoloration
  • Visible ring under the glans.

When to the doctor

Immediately (to the clinic at night and on weekends), if

  • the foreskin is painfully pinched under the coronal furrow of the glans and can no longer be pulled back. On the way there, the glans should be carefully cooled.

The illness

Disease emergence

Paraphimosis occurs when the foreskin, which is too tight, is forcibly pulled back and trapped in the glans furrow, which results in impaired blood flow. The glans and the pinched foreskin swell strongly, and edema (water retention in the tissue) forms, which is extremely painful and makes it increasingly impossible for the foreskin to pull back. If left untreated, the paraphimosis threatens to cut off the blood supply, which leads to the death of the glans.

causes

  • Forced retraction of the foreskin in phimosis
  • Forgotten repositioning of the foreskin after inserting a urinary catheter
  • Masturbation, sexual intercourse (e.g. due to a relative narrowing of the foreskin when the limb swells during erection).

Diagnostic assurance

The doctor recognizes the paraphimosis by the ring in the glans furrow, which is caused by the pinched foreskin. There is also swelling, redness, and pain.

treatment

Solving a paraphimosis is very painful, so the doctor first numbs the nerve at the base of the penis by injecting a local anesthetic. Sometimes those affected are also sedated with a sedative or even given a short anesthetic.

The doctor will then "squeeze" the edema of the foreskin for a few minutes, then move the glans back and the foreskin forward. In most cases, this enables the foreskin to be repositioned.

In severe cases, manual squeezing is not enough and the doctor has to make an incision in the foreskin, this is called a dorsal incision. Depending on the findings, he may also recommend circumcision to avoid a new paraphimosis.

forecast

If you intervene quickly, no damage is left behind. If the phimosis is not treated or treated late, there is a risk of inflammation and tissue death.

Your pharmacy recommends

  • If you have paraphimosis, see your doctor immediately. Shame or embarrassment can cost the glans.
  • Never forcefully pull back a foreskin that is too tight! Before puberty in particular, it is sufficient to wash the outside of the penis. Adhesion of the foreskin sheets is physiological and usually dissolves by puberty (see phimosis).
  • If the (loose) foreskin is pushed back over the glans while washing, care must be taken to ensure that it returns to its normal position afterwards.

Further information

Authors

Dr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 09:29


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.