Paraphimosis is when the foreskin is pulled back behind the tip of the penis and becomes stuck there. The retracted foreskin and the penis become swollen, fluid can build up, and the foreskin is unable to return to its original position.
Paraphimosis should not be confused with phimosis, which is when the foreskin cannot be pulled back from the tip of the penis. Typically, this occurs in younger children and is not usually a serious condition.
Paraphimosis, on the other hand, is painful and a medical emergency that needs to be treated quickly. If ignored, it can affect blood flow to the tip of the penis. In rare cases, this may cause the penis tip to be damaged, or even lost.
Paraphimosis can be caused by any of the following conditions or activities:
- A foreskin that is left retracted long enough for swelling to occur. This can happen during a medical examination, after cleaning, or after urination.
- A tight foreskin that is retracted, causing the penis to swell. This results in the foreskin not being able to move back to its natural position.
- Vigorous sexual activity, penile piercing, and use of a constricting penile ring to enhance erection by compression.
Paraphimosis can also result from the following medical conditions or procedures:
- Infection, due to various factors, including poor personal hygiene.
- Scarring, caused by repeated infection of the foreskin, or by forced retraction of the foreskin in young boys.
- A circumcision that has not be done correctly.
- Swelling of the penis and foreskin, due to insect or spider bite.
Paraphimosis in older men is often due to one of the following:
- Diabetes, causing chronic inflammation of the penis and foreskin. This makes paraphimosis more likely.
- Catheterization that is done without the foreskin being returned to its natural position.
In children, the foreskin does not retract at all until about 2 years of age. Most boys will have a retractable foreskin by the age of 10, and forcibly pulling the foreskin back before it is ready to do so can cause scarring that can go on to cause paraphimosis.
Paraphimosis is characterized by the following:
- inability to pull the retracted foreskin back over the head of the penis
- swelling of the end of the penis
- discomfort and pain
Other symptoms may include:
- redness, tenderness
- inability to urinate
- dark blue or black tissue on the end of the penis
Pressure is applied to the swollen penis for 5-30 minutes, usually with a saline swab. Ice can also be used. These treatments can compress the swelling, so it is easier to push the penis while pulling the foreskin back into place.
If manual manipulation is unsuccessful, then a puncture technique may be required. This treatment usually needs some form of local anesthesia or sedation. A needle is used to puncture the foreskin in different places. This allows built-up fluid to be released and for the manual manipulation of the foreskin over the penis to become easier.
More severe cases might require a small incision or slit in the foreskin to relieve restriction and to allow the swelling to subside. This procedure requires local anesthesia. In some cases, circumcision may eventually be required.
After the foreskin has been retracted, it should be replaced over the head of the penis.
Cleanliness helps prevent paraphimosis, as well. It is important to clean under a retractable foreskin properly. The foreskin should always be returned to its natural position after cleaning.
Circumcision, when done correctly, prevents paraphimosis from occurring.
A physical examination is enough for a doctor to confirm a diagnosis of paraphimosis.
It is usually easy to see and will be characterized by a tight band of foreskin trapped behind the head of the penis.
Sometimes, however, this constricting foreskin band can be completely hidden by surrounding swollen tissue.
As part of a diagnosis, a person will usually be asked some question to establish background information, including any symptoms, problems, or activities relating to the penis or foreskin.
Additional tests are usually not required to confirm a diagnosis. During an examination, a swab may be taken to pinpoint the type of infection that caused the paraphimosis.
If there has been a circumcision, or removal of the foreskin, this will rule out a paraphimosis diagnosis.
Complications of paraphimosis are secondary conditions and other disorders that are caused by it. Often the difference between the symptoms and the complications of paraphimosis are not always clear.
In severe cases, or if the paraphimosis is untreated, the following complications can occur:
- damage to the penis tip
- impaired or loss of blood flow
- loss of the penis tip
Risk factors for having paraphimosis include a person’s age. The condition can occur at any age but is most common in adolescence.
It also occurs in older men, typically those who have diabetes, those who need catheterization, or those who have a history of bacterial infection.
The outcome is likely to be excellent if the condition is diagnosed and treated quickly. A small amount of bleeding can occur, as the skin is retracted, but long-term negative outcomes are rare.
Recurrence of paraphimosis can be fairly common. Circumcision can prevent a reoccurrence once the swelling has subsided.
If paraphimosis is left untreated, serious damage can occur, including loss of blood flow and potential loss of the tip of the penis.