Paraphimosis is when the foreskin is pulled back behind the tip of the penis and becomes stuck there. The retracted foreskin and the penis become swollen, fluid can build up, and the foreskin is unable to return to its original position. Paraphimosis should not be confused with phimosis, which is when the foreskin cannot be pulled back from the tip of the penis.
Typically, this occurs in younger children and is not usually a serious condition. Paraphimosis, on the other hand, is painful and a medical emergency that needs to be treated quickly. If ignored, it can affect blood flow to the tip of the penis.
In rare cases, this may cause the penis tip to be damaged, or even lost. In children, the foreskin does not retract at all until about 2 years of age. Most boys will have a retractable foreskin by the age of 10, and forcibly pulling the foreskin back before it is ready to do so can cause scarring that can go on to cause paraphimosis. Pressure is applied to the swollen penis for minutes, usually with a saline swab. Ice can also be used.
These treatments can compress the swelling, so it is easier to push the penis while pulling the foreskin back into place. If manual manipulation is unsuccessful, then a puncture technique may be required. This treatment usually needs some form of local anesthesia or sedation. A needle is used to puncture the foreskin in different places.
This allows built-up fluid to be released and for the manual manipulation of the foreskin over the penis to become easier. More severe cases might require a small incision or slit in the foreskin to relieve restriction and to allow the swelling to subside. This procedure requires local anesthesia. In some cases, circumcision may eventually be required.
Cleanliness helps prevent paraphimosis, as well. It is important to clean under a retractable foreskin properly. The foreskin should always be returned to its natural position after cleaning. Usually, they are able to do so by age 7, but some boys need more time. Pathologic phimosis happens in teenage boys and adult men. It can be caused by a naturally tight ring at the tip of the foreskin, poor hygiene, infection, or inflammation.
Sometimes, paraphimosis occurs. This is similar to phimosis, except the foreskin cannot be pulled forward once it has been retracted. To treat phimosis, a doctor might prescribe a steroid cream that softens the foreskin and makes it easier to move back and forth. The cream is typically applied to the tip of the foreskin. After a couple of weeks, gentle stretching exercises may begin. More serious cases of phimosis may require circumcision , a procedure in which part or all of the foreskin is surgically removed.
If only part of the foreskin is removed, recurrence of phimosis is possible. There is no need to clean inside the foreskin in young boys.
Just wash the penis the same as any other part of your son's body and be careful to wash off any soap. When a boy is old enough to bathe himself, he can wash his own penis. Once your son can pull back his foreskin, you can talk to him about pulling back his foreskin and washing. A simple explanation of 'how to' may be helpful:. Tell him to make sure he rinses off any soap before pulling the foreskin back over the head of the penis.
Forcing the foreskin back before the natural separation of the foreskin from the glans has happened causes tearing of the connective tissue. This is painful and can lead to problems:. The white lump smegma is made up of the cells that once attached the foreskin to the head of the penis. As new cells form on the head of the penis and the foreskin's inside fold, old cells form pockets that eventually work their way to the tip of the foreskin, where they can eventually be wiped away.
So if you see a white lump smegma under the foreskin you know that the separation from the head of the penis is occurring naturally. This is another indication that the natural separation of the foreskin from the head of the penis is occurring, but the opening of the foreskin is still narrow. Ballooning can be normal but if it is severe so the flow of wee is restricted you should seek advice from your family doctor.
Encouraging boys to gently try and pull back their foreskin as part of daily hygiene can help. Sometimes a course of steroid cream is needed. Your family doctor can advise you about this. Phimosis refers to a foreskin that cannot be pulled back because its opening is too small to expand over the head of the penis.
This is normal during infancy and childhood. In later childhood, if your child is still unable to retract the foreskin, a course of steroid cream can be prescribed which thins the skin and helps it to stretch over the head of the penis. Your family doctor can discuss this with you. Sometimes the tip of the foreskin becomes reddened. This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive head of the penis and the opening in the penis where wee comes out urinary meatus.
If children are still in nappies, it may be part of nappy rash. When bacteria in the poo react with wee, they produce ammonia, which burns the skin and causes nappy rash. If the foreskin or penis is red, painful and swollen, there may be an infection and you should see your family doctor. Circumcision is the operation to remove the foreskin. There is no medical reason for routine male circumcision. There is an operation called a dorsal split where the foreskin is cut to widen and loosen the foreskin, without removing any foreskin tissue.
This page last reviewed 04 June Do you have any feedback for KidsHealth? If you have any feedback about the KidsHealth website, or have a suggestion for new content, please get in touch with us.
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