Phimosis and Paraphimosis
Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency.
Phimosis is normal in children and typically resolves by age 5. Treatment is not required in the absence of complications such as balanitis, UTIs, urinary outlet obstruction, unresponsive dermatologic disease, or suspicion of carcinoma.
Betamethasone cream 0.05% bid to tid applied to the tip of the foreskin and the area touching the glans for 3 mo is often effective. Stretching the foreskin gently with 2 fingers or over an erect penis for 2 to 3 wk with care not to cause paraphimosis is also successful. If conservative measures are ineffective, circumcision is the preferred surgical option.
In adults, phimosis may result from balanoposthitis or prolonged irritation. Risk of UTI, penile cancer, HIV, and sexually transmitted diseases is increased. The usual treatment is circumcision.
Paraphimosis can occur when the foreskin is left retracted (behind the glans penis). Retraction may occur during catheterization or physical examination. If the retracted foreskin is somewhat tight, it functions as a tourniquet, causing the glans to swell, both blocking the foreskin from returning to its normal position and worsening the constriction.
Paraphimosis should be regarded as an emergency, because constriction leads quickly to vascular compromise and necrosis of the glans penis. Firm circumferential compression of the glans with the hand may relieve edema sufficiently to allow the foreskin to be restored to its normal position. If this technique is ineffective, a dorsal slit done using a local anesthetic relieves the condition temporarily. Circumcision is then done when edema has resolved.