Phimosis vs. Paraphimosis: Symptoms, Causes, and Treatments

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Reviewer: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Phimosis definition and facts

  • Phimosis is the inability to retract the foreskin behind the head (glans) of the penis.
  • Symptoms of may include:
    • Difficulty or pain during urination
    • Painful erection
    • Paraphimosis (A medical emergency where the foreskin can't return to it's normal location once retracted.)
  • This penis disorder usually is divided into physiologic and pathologic phimosis.
    1. Physiologic phimosis is the normal condition in which children are born with a tight foreskin, and separation occurs during late childhood and early adolescence.
    2. Pathologic phimosis happens because of an infection, inflammation, or scarring and usually is found in uncircumcised adult men.

What causes phimosis?

Physiologic phimosis is present at birth and resolves without intervention. Most children will not have a fully retractable foreskin at birth, but do so as they get older with the majority having a fully retractable foreskin by early adolescence.

Pathologic phimosis is caused by scarring, balanitis, and underlying medical risk factors.

What are the signs and symptoms of phimosis?

The inability of the foreskin to retract can lead to difficulty cleaning of the area which can cause balanitis. Other symptoms include:

How can I tell if I have phimosis?

Your doctor can diagnose phimosis based on a thorough history and physical examination. Additional tests are usually not necessary.

What medications, creams, or ointments treat and cure this condition?

Treatment depends on the age of the male, severity, and resulting symptoms.

The first choice of treatment is usually a steroid ointment that is locally applied. This treatment has shown a success rate of over 70%. The ointment softens the foreskin and is applied for 4 to 6 weeks. Once full retraction is possible the ointment is discontinued.

If the steroid treatment is not successful, a circumcision might be beneficial. This depends on the underlying symptoms.

Things You Should Know About Your Penis

Talking about a your penis can be a sensitive topic or uncomfortable for some men (and women) to talk about openly. But sometimes questions about the penis come up, like:

  • Does the penis have a mind of it's own?
  • Does penis size really matter?
  • Can you break the penis?

What is pharaphimosis?

Paraphimosis occurs when the foreskin is retracted behind the glans penis and cannot be returned to its original position. This turns into a urologic emergency as blood flow is decreased to the glands penis.

What are the signs and symptoms of paraphimosis?

Once the skin is trapped, edema occurs and the restriction worsens, often forming a very tight tissue ring. This causes pain and worsening swelling (edema).

What causes paraphimosis?

Paraphimosis is an uncommon condition usually inadvertently caused by retraction of the foreskin by the individual, or in a hospital or nursing home setting by a healthcare professional inserting a Foley catheter, or preparing the patient for a procedure.

How can I tell if I have paraphimosis?

Your doctor will diagnose paraphimosis based on a thorough history and the physical examination. Additional tests are usually not necessary.

What is the treatment and cure for paraphimosis?

Manual reduction is usually the first treatment option. To help with the pain, your doctor other health care professional might apply a local anesthetic cream, give you pain medication by mouth, or apply a local anesthetic block to your penis. Applying ice to the local area can help with the edema during manual reduction.

Local injection of hyaluronidase is effective in decreasing the swelling and allowing reduction.

If none of these techniques are successful or if the doctor feels a faster reduction is necessary, a small surgical slit can be made in the back side (dorsal region) of the constrictive skin. This should usually be followed by a circumcision at a later date to avoid a recurrence.

Can circumcision prevent these penis problems?

Circumcision can prevent paraphimosis and phimosis.

What is the prognosis if I've had either of these penis conditions?

  • The prognosis for phimosis is usually very good. A small amount of bleeding can occur as the skin is retracted but long term negative outcomes are very rare.
  • The prognosis for paraphimosis depends on the speed of diagnosis and reduction.
  • There can be serious complications, however, if there is significant reduction of blood flow for an extended time period. Gangrene of the tip of the penis and even loss of the tip is possible.

REFERENCE:

Reddy S, Jain V, Dubey M, Deshpande P, Singal AK. Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study. Acta Paediatr. 2012 Mar;101(3):e130-3.

Last Editorial Review: 5/10/2017

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Reviewed on 5/10/2017
References
REFERENCE:

Reddy S, Jain V, Dubey M, Deshpande P, Singal AK. Local steroid therapy as the first-line treatment for boys with symptomatic phimosis - a long-term prospective study. Acta Paediatr. 2012 Mar;101(3):e130-3.

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