Paraphimosis is a medical emergency that requires immediate professional attention. This condition occurs when the foreskin, once retracted behind the glans (head of the penis), becomes trapped and cannot be returned to its normal position. The resulting constriction is dangerous because it rapidly compromises the blood supply to the glans. Recognizing the signs and seeking prompt treatment is necessary to prevent severe, long-term complications.
Identifying Paraphimosis: Signs and Symptoms
The first and most defining symptom of paraphimosis is the inability to pull the retracted foreskin back over the glans penis. This typically follows an event where the foreskin was pulled back, such as during cleaning, sexual activity, or a medical procedure like catheterization. The trapped foreskin quickly forms a tight, constricting band around the shaft of the penis just behind the glans.
Significant pain and rapid swelling are almost always present. The glans itself will become notably swollen (edematous) due to fluid accumulation. This swelling results from the foreskin acting like a tourniquet, impeding the return of blood and lymphatic fluid.
A change in the color of the glans is another indicator. The head of the penis may first appear intensely red or purplish, and in severe cases, it can turn a dusky blue or black color. This discoloration signals a serious compromise to circulation. The combination of intense pain, swelling, and the inability to reposition the foreskin provides clear evidence of paraphimosis.
Why Paraphimosis is a Medical Emergency
The urgency of paraphimosis stems from the progressive physiological damage it causes through vascular compromise. The tight ring of foreskin restricts venous and lymphatic drainage, allowing blood to flow into the area but preventing it from leaving effectively. This imbalance causes the glans to swell rapidly, leading to edema.
The increased swelling exacerbates the constriction, creating a dangerous cycle where edema makes manual reduction more difficult. As pressure builds, the constriction tightens, eventually impeding arterial blood flow into the glans. This restriction of inflow is known as ischemia, which starves the tissue of oxygen.
If this condition persists for too long, the lack of oxygen leads to tissue death (necrosis) of the glans penis. Untreated paraphimosis can result in severe tissue damage or, in rare cases, the loss of the distal penis. Rapid intervention is necessary to relieve the tourniquet effect and restore proper circulation.
Emergency Treatment and Resolution
When paraphimosis is identified, seeking immediate medical attention is the only appropriate course of action. While waiting for professional care, temporary measures may be suggested to reduce swelling. These steps include manually applying firm compression to the swollen glans or applying a cold compress to the area.
These pre-hospital techniques are only intended to slightly reduce edema and should not delay travel to an emergency department. Attempting to force the foreskin back without first reducing the swelling is painful and can cause further injury. Medical professionals focus on relieving the swelling and repositioning the foreskin.
The initial medical intervention often involves manual reduction, where the physician uses lubrication and firm pressure to push fluid out of the glans. To assist this process, osmotic agents like dextrose solution or concentrated sugar may be applied to the swollen tissue to draw out excess fluid and reduce the edema. Local anesthesia, such as a dorsal penile nerve block, is frequently administered to manage the severe pain before attempting manual reduction.
If manual reduction fails, or if the case is severe, more invasive procedures are required. One technique involves making small punctures into the edematous foreskin with a fine needle to drain the trapped fluid, known as the puncture-aspiration method. If conservative attempts are unsuccessful, a minor surgical procedure called a dorsal slit is performed. This involves making a small incision in the constricting band of foreskin to immediately relieve the tension and restore blood flow. Following resolution, a definitive treatment like an elective circumcision may be recommended to prevent recurrence.