Paraphimosis

Paraphimosis is a condition affecting the penis, in which the foreskin is retracted behind the glans and, because of narrowness and subsequent swelling, it cannot be brought back to its usual position. In other words, it can be described as the inability of the foreskin to cover the glans penis once pulled back. It is a rare problem that generally occurs in men who are not circumcised or who are partially circumcised.

It is considered as one of the medical emergencies because blood gets trapped which may lead to gangrene and other complications that may even result in the removal of the penis. It is noticed that patients in hospitals are more prone to paraphimosis because the foreskin is retracted for various purposes (by medical professionals) such as an examination, cystoscopy, catheterization and cleaning catheters, and may be left in the same retracted position (due to carelessness) for several hours or days resulting in paraphimosis. Thus, paraphimosis is usually induced by someone and commonly not by oneself. There are cases reported of paraphimosis after erections.

Paraphimosis constricts the blood flow from glans penis to prepuce causing swelling and severe pain. Apart from swelling and pain, children may complain of difficulty in urination. Paraphimosis can be mild, moderate or severe. The prognosis is very good with mild paraphimosis. It can be manually reduced by compressing the glans penis firmly to reduce its size and then pushing the glans back while moving the prepuce forward. This is possible only when the condition is mild and treatment is sought at the earliest.

Moderate paraphimosis can also be reduced manually but may need other conservative measures as well. Circumcision is usually indicated once the inflammation and swelling subsides. In severe cases of paraphimosis, a procedure called dorsal slit is performed where a small incision is made in the foreskin to release the strangulation and allowing the blood to flow freely. There is also another method called the dundee technique where a fine needle is inserted to aspirate the fluid or blood from the edematous area and thereby releasing pressure. However, circumcision is performed surgically after immediate care.

Circumcision is the excision of the foreskin, or prepuce of the glans penis. It is performed in children for hyegienic purpose and in adults as a part of treatment for paraphimosis. Bleeding is one of the complication after surgery and should be watched carefully. Adults express a lot of pain after circumcision and hence pain killers are used liberally. If the paraphimosis is left without treatment for longer periods, the blood flow to the distal part of the penis is obstructed, resulting in necrosis. The only treatment of choice for this condition is partial amputation of the penis (surgical removal of the distal part of the penis).