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Phimosis and Paraphimosis

by Patrick J. Shenot, MD

Phimosis and paraphimosis can develop only in uncircumcised males.

Phimosis

In phimosis, the foreskin is tight and cannot be retracted over the glans penis (the cone-shaped end of the penis). This condition is normal in newborns and young boys and usually resolves without treatment by about age 5. In older men, phimosis may result from prolonged irritation or recurring inflammation of the glans penis and foreskin (balanoposthitis). The tightened foreskin can interfere with urination and sexual activity and may increase the risk of urinary tract infections. The usual treatment is circumcision. However, in children, sometimes the application of a corticosteroid cream 2 or 3 times daily and periodic gentle stretching of the foreskin are effective and spare the child a circumcision. The cream may be used for up to 3 months.

Paraphimosis

In paraphimosis, the retracted foreskin cannot be pulled forward to cover the glans penis. The condition most commonly develops when the foreskin is left retracted after a medical procedure (such as catheterization) or after cleaning the penis of a child. The glans penis swells, increasing pressure on the retracted foreskin, which then becomes trapped. The increasing pressure eventually prevents blood from reaching the penis, which could result in the destruction of penile tissue if the foreskin is not pulled forward. Immediate treatment involves squeezing the glans penis to shrink it so that the foreskin can be pulled forward. If this technique does not work, the penis is anesthetized and the foreskin is slit to relieve the constriction. Later, circumcision is done.