Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency.
Phimosis
Phimosis is normal in children and typically resolves by age 5. Treatment is not required in the absence of complications such as balanitis, urinary tract infections (UTIs), urinary outlet obstruction, unresponsive dermatologic disease, or suspicion of carcinoma.
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
© Springer Science+Business Media
DR P. MARAZZI/SCIENCE PHOTO LIBRARY
© Springer Science+Business Media
In adults, phimosis may result from balanoposthitis or prolonged irritation. Risk of UTI, penile cancer, HIV, and sexually transmitted infections is increased. The usual treatment is circumcision.
Paraphimosis
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.
Pearls & Pitfalls
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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.
