Paraphimosis is a medical condition affecting uncircumcised males where the foreskin becomes trapped behind the glans of the penis. It is recognized as a penile emergency.
Understanding Paraphimosis
Paraphimosis occurs when the retracted foreskin forms a constricting band around the penis, just behind the glans. This constriction impedes the flow of blood and lymphatic fluid, leading to swelling (edema) of the glans and the trapped foreskin. Symptoms include swelling, pain, and a change in the color of the glans, which may appear dark red, purple, or even bluish due to reduced blood flow. Left untreated, this impaired circulation can lead to tissue damage, necrosis, or even gangrene of the glans.
Immediate Steps for Relief
When paraphimosis occurs, gentle, immediate steps can sometimes aid in reduction. Applying a cold compress, such as an ice pack, to the swollen area for 5 to 10 minutes can help reduce swelling. Following this, gentle, sustained compression of the glans and the swollen foreskin for several minutes can help to manually disperse the edema, pushing fluid away from the glans. Lubricants can be applied to the glans and foreskin to facilitate easier movement during reduction attempts.
After applying compression and lubrication, attempt to manually reduce the foreskin by placing both thumbs on the glans while using the fingers to gently pull the foreskin forward over the glans. It is important to apply slow, steady pressure. If pain worsens, there is no progress in reduction, the glans shows increasing discoloration, or severe swelling persists, home attempts should be stopped immediately. At this point, urgent emergency medical attention is necessary to prevent further complications.
Professional Medical Care
When manual reduction at home is unsuccessful or the condition is severe, healthcare professionals treat paraphimosis. Initial medical treatment often involves further attempts at manual reduction, which may be facilitated by local anesthesia, such as a dorsal penile nerve block with lidocaine, to manage pain and allow for patient cooperation. Medical providers might also apply osmotic agents like granulated sugar or 20% mannitol-soaked gauze to the swollen foreskin, which helps draw out fluid and reduce edema over approximately 30-45 minutes.
Another technique involves multiple needle punctures into the edematous foreskin with a fine needle (e.g., 18-gauge hypodermic needle), followed by gentle manual compression to express trapped fluid. This can reduce swelling and enable manual reduction. If these conservative methods fail, surgical intervention may be required. A dorsal slit procedure involves a small incision in the constricting band of the foreskin, which immediately relieves the pressure. In more severe or recurrent cases, a formal circumcision, the complete removal of the foreskin, may be performed to definitively resolve the issue.
Preventing Recurrence
Preventing paraphimosis from recurring involves attention to foreskin care. After any retraction, such as during cleaning, urination, or sexual activity, it is important to always return the foreskin to its natural, unretracted position covering the glans. Proper hygiene, including regular and gentle cleaning of the penis and foreskin with warm water, also helps prevent foreskin issues. For individuals who experience repeated episodes of paraphimosis, a healthcare provider may discuss circumcision as a permanent preventive measure. A dorsal slit procedure is also an option for preventing recurrence if circumcision is not suitable.