Penis Disorders: Phimosis and Paraphimosis

By the time most uncircumcised boys are 10 years old, they can pull the foreskin back from the head of their penis. For some, it may not retract completely until they are about 17 years old. When this happens, it’s called phimosis.

Boys born with phimosis, and it can last through puberty. With time, the skin retracts off the head of the penis naturally. You need treatment only if it happens after your foreskin has become fully retractable. Or if, as a child, the head of the penis has redness, pain, or swelling.

When the foreskin gets stuck behind the head of the penis, in paraphimosis, circulation can get cut off. Men or boys of any age need to take this seriously and see a doctor or go to the hospital immediately.

Causes

Scar tissue. Infections can scar the foreskin, which might make the skin less stretchy. The tough tissue can make it hard to pull it back.

Pull and stretch. Don’t forcefully move your foreskin. Go easy on it. Even pulling or stretching it can cause tiny tears and inflammation that eventually lead to phimosis.

Aging. The same changes that happen on your face with age -- wrinkles and looseness -- happen to your foreskin. You are more likely to get it if you get fewer erections.

Medical conditions. If you have diabetes, you’re more likely to have balanitis, an infection of the tip of penis. Talk to your doctor about your complete medical history so they can treat you properly.

Why Paraphimosis Happens

Mishandled foreskin. Make sure to put your foreskin back after you, or your caregiver, washes it or inserts a catheter.

Piercings. Pain and swelling from penis piercings can make it difficult to put the foreskin in place after pulling it back.

During sex. You might pull your foreskin back to have sex. If it stays there too long, it might swell so much that the foreskin gets trapped behind the head.

Other penis conditions. Other ailments of the penis can lead to foreskin problems. For example, phimosis can lead to paraphimosis.

Symptoms

In both conditions, your foreskin will be stuck in one place, either over the tip of the penis or behind. With phimosis, you might also have the following signs:

• In the bathroom. Your foreskin will expand when you pee, like a balloon. It can be painful. You might see blood in the stream or in the toilet. The stream might seem weaker than normal.
• When you have sex. You might have pain with an erection.
• Infections. You may get urinary tract infections. Symptoms include blood in your urine, pain or burning when you pee, the urge to go even when your bladder is empty, and pain or pressure in your lower abdomen or back.
• Foreskin pain. You notice that your foreskin hurts. It might have discharge, too.
• White ring. The opening of your foreskin has a white ring that looks like scar tissue.

You may have painful swelling in the head of your penis or in the whole organ.

Diagnosis

Your doctor can usually figure out if you have one of these conditions by listening to you describe your symptoms and with an exam. They have probably seen cases like yours many times, so there’s no need to be embarrassed or shy.

Treatment

Phimosis. You can get treatment in an outpatient setting by a urologist. How they treat you depends on the severity of your condition. They will also consider the cause of the problem and ask what kind of solutions you prefer.

They may recommend:

• A steroid cream that you apply to your foreskin several times a day for several weeks. This can loosen the skin.
• A partial or full circumcision.

Paraphimosis. It’s often treated in the emergency room. The ways the doctors will provide relief include:

• A solution is applied to your penis to reduce the swelling. Then a doctor manually works the foreskin loose from its position.
• The doctor uses a needle to make several holes in the foreskin to allow fluids to escape. This reduces the swelling.
• You get fluids to help you release unneeded water to reduce swelling.
• Your doctor makes a small slit in your foreskin in order to loosen it.
• You get a circumcision.

Risks

If you have phimosis, you are more likely to get penile cancer. If left untreated, it can lead to increased swelling, and in extreme cases, gangrene, and eventually the loss of your penis.

Prevention

In most cases, these penis disorders are easy to prevent. The head and the foreskin need to be washed and dried regularly. Be gentle with the skin if you pull it back, and don’t forget to put it back in place when you finish.

If you have either of these conditions, consider getting circumcised to stop it from happening again.

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