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Phimosis and Paraphimosis


Patrick J. Shenot

, MD, Thomas Jefferson University Hospital

Last full review/revision May 2021| Content last modified May 2021
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Topic Resources

Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency.


Betamethasone cream 0.05% two to three times a day applied to the tip of the foreskin and the area touching the glans for 3 months is often effective. Stretching the foreskin gently with 2 fingers or over an erect penis for 2 to 3 weeks 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 Balanitis, Posthitis, and Balanoposthitis Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both. Inflammation of the head of the penis has both infectious... read more 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.

Pearls & Pitfalls

  • Always remember to reduce the foreskin after urethral catheterization.

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.

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A 45-year-old man comes to the office for routine evaluation. Medical history includes hypertension treated with spironolactone, hypothyroidism treated with levothyroxine, seasonal allergies treated with cetirizine, and occasional erectile dysfunction treated with sildenafil, as needed. Physical examination shows no abnormalities except for gynecomastia. Which of the following drugs is most likely responsible for this finding? 
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