Paraphimosis is a condition in which the fold of skin (foreskin) covering the glans penis in an uncircumcised penis stays retracted behind the glans, thereby leading to constriction of the lymphatic drainage causing inflammation of the glans penis. Paraphimosis is a medical emergency and if it is not treated then the blood flow to the penis is obstructed by continued constricted foreskin responsible for concomitant swelling of the glans. The lack of oxygen from diminished blood flow can lead to necrosis and auto-amputation of the glans, which mandates immediate medical attention.
What are The Symptoms of Paraphimosis?
Inflammation of the retracted foreskin tissue is the major symptom of Paraphimosis Paraphimosis is characterized by inflammation of the glans penis and a band of retracted foreskin tissue beneath the glans is often noticed with penile pain and tenderness. The localized area is swollen and red (erythematous); however, there is no swelling of the penile shaft or base of the penis. The inflammation of the glans penis might also lead to urinary retention or inability to urinate. The lack of blood flow to the glans penis due to constriction may lead to color change of the glans causing blue black penile glans tissue.
Various complications might ensue if paraphimosis is not treated immediately. These might include damage to the penile tip, impairment or loss of blood flow, hence reduced oxygen leading to necrosis and gangrene of the penile tip. This may lead to auto amputation of the tip of the penis. This can have an everlasting emotional, psychological and physical impact on the patient suffering/suffered from paraphimosis.
Risk Factors For Paraphimosis
Paraphimosis is an uncommon condition and is seen in about 1% of males in the United States. Although rare, it is mostly seen in young adults, usually over the age of 16 years. It is also seen in elderly patients who undergo frequent catheterizations and individuals with a history of poor hygiene or bacterial infections.
Males who are uncircumcised or partially circumcised are at a greater risk of developing paraphimosis. Individuals with penile piercings, penile rings and infections are also at a greater risk as these penile rings/piercings might interfere with foreskin retraction/replacement, thus leading to infection or paraphimosis.
The frequent causes of paraphimosis include bacterial infections (such as balanoposthitis), catheterization (if the foreskin is inadvertently left retracted post urethral catheterization, then it might lead to the swelling of the glans), poor personal hygiene, vigorous sexual intercourse and any injury that might cause swelling of the area.
Scarring due to repeated infections of the foreskin or forced retraction of the foreskin in young boys can also lead to paraphimosis. Partial circumcision and tight foreskin are also known causes of paraphimosis. Diabetes leading to chronic inflammation of the foreskin and penis can also cause paraphimosis.
Diagnosis, Treatment and Prevention of Paraphimosis
The diagnosis of paraphimosis is done during a physical examination. The treatment of paraphimosis depends on the severity of the condition. Initially, manual manipulation is employed to replace the foreskin to its anatomical position using pressure for 5-30 minutes to reduce the swelling or an ice pack can be used to help with the swelling.
If manual manipulation is not successful then puncture technique can be employed for replacement of foreskin to its anatomical position. This requires use of needle to drain the excess fluid (edematous fluid) from the glans to reduce the swelling. A local anesthesia may be required as the procedure can be quite painful.
If the inflammation is too severe and puncture technique is also unsuccessful then a small incision under a local anesthesia might be given in the foreskin to alleviate constriction and resolution of swelling.
Prompt treatment ensures full recovery of the patient. However, time is of real essence as delay in seeking treatment can lead to severity of the condition. On some occasions, circumcision can also be employed for treating paraphimosis.
Circumcision, good personal hygiene and replacement of foreskin to its anatomical position after catheterization or check up can prevent this condition.