Phimosis and Paraphimosis

What is phimosis and paraphimosis?

Phimosis is a constriction of the opening of the foreskin so that it cannot be drawn back over the tip of the penis. This condition is a normal occurrence in the newborn boy, but over time the skin that adheres to the tip of the penis can be retracted as the foreskin loosens. By age 3, 90 percent of uncircumcised males should be able to completely retract their foreskin from the tip of the penis. By age 17, 97 to 99 percent of males will be able to completely retract their foreskin. Phimosis can also occur if the foreskin is forced back before it is ready. This can cause a fibrous scar to form, which may prevent future retraction of the foreskin.

Paraphimosis occurs when the foreskin is retracted behind the corona (or crown) of the penis and cannot be returned to the unretracted position. This can cause entrapment of the penis, impairing the drainage of blood, and may be serious.

What are the symptoms of phimosis and paraphimosis?

The following are the most common symptoms of phimosis and paraphimosis. However, each child may experience symptoms differently. Symptoms may include:

Phimosis:

• bulging of the foreskin during urination
  
  
• inability to completely retract the foreskin by age 3 (in some children this process may take longer)

Paraphimosis:

• swelling of the tip of the penis as the foreskin is retracted or pulled back
• pain
• inability to pull the foreskin back over the tip of the penis
• discoloration, either dark red or bluish color, of the tip of the penis

The symptoms of phimosis and paraphimosis may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How is phimosis or paraphimosis diagnosed?

A careful physical examination by your child's physician normally provides satisfactory information to make a diagnosis.

Treatment for phimosis and paraphimosis:

Specific treatment for phimosis or paraphimosis will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• the extent of the condition
• the type of condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include the following:

• Treatment for repeated phimosis may involve application of a steroid cream to the foreskin up to three times a day for about a month to loosen the adhesive ring. If the child has ballooning of the foreskin during urination after the age of 10, a circumcision (surgical removal of all or part of the foreskin) may be recommended.
  
  
• Treatment for paraphimosis may involve lubricating the foreskin and tip of the penis and then gently squeezing the tip of the penis while pulling the foreskin forward. If this is ineffective, a small incision to relieve the tension may be performed. An emergency circumcision (surgical removal of all or part of the foreskin) may be recommended.

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