Phimosis and paraphimosis (narrowing of the foreskin): what are its causes and symptoms?

The foreskin, technically called the prepuce, is a physiological part of the external sexual organ - the penis. A narrowed foreskin (phimosis) makes it impossible to pull it over the glans.

In paraphimosis, on the other hand, it is impossible to pull the foreskin back over the glans to its original position.

Causes, symptoms, treatment, difference between phimosis and paraphimosis, about narrowed foreskin in children and many other interesting information can be found in the article.

The foreskin and its importance

A newborn male child physiologically has the glans penis covered by the foreskin. The foreskin is tightly adherent to the glans, so that the urethra remains free. Gradually, as the newborn grows, the glans grows and the foreskin gradually peels off and relaxes.

The foreskin has primarily a protective function for the glans. It protects the glans penis from mechanical irritation and damage. It also serves to protect the opening of the penis from infection. However, the importance of the foreskin is currently debated in the lay and professional community.

What is phimosis?

Phimosis is a condition in which the foreskin of the penis is narrowed so much that it cannot be pulled over the glans towards the body (or only partially). Phimosis is manifested by the inability to pull it over the surface of the glans or the act is very painful.

The consequences of untreated phimosis are pain during erection (erection of the penis), discomfort and pain during intercourse, poor intimate hygiene, odour and increased susceptibility to infection.

Phimosis is a common cause of infection of the urethra and urinary tract. Restriction of urine flow and complications associated with defecation are also possible. Discomfort and pain during intercourse is a common complication.

The narrowing is pathological in adults and children from 3 years of age.

In newborns, the foreskin gradually relaxes physiologically by 3 years of age.

In adults, phimosis occurs mainly as a result of inflammatory and healing (fibrous) processes. It also occurs in the case of disproportion, i.e. an excessively large glans, a tight foreskin and a shorter penile bridle.

If a man forcibly pulls the constricted foreskin over the glans, there is a danger that the foreskin will become trapped under the lower edge of the glans. This creates an acute urological condition known professionally as paraphimosis, which is the inability to pull the foreskin back into its original position.

Phimosis can be divided into physiological (up to 3 years), congenital and acquired.

Acquired phimosis can also be caused by forcible overstretching of the foreskin in infancy and the subsequent formation of micro-cracks that form scars and thus impair the elasticity of the foreskin.

What is paraphimosis?

Paraphimosis is an acute condition in which the constricted foreskin cannot be pulled over the glans dorsi into its original position.

It occurs when the narrower foreskin is pulled over the glans, then gets stuck under the glans and cannot be pulled back. Paraphimosis occurs mainly during sexual intercourse or masturbation.

In children, it occurs mainly after forcible pulling of the constricted foreskin over the stomach.

It is a risky condition because the glans is compressed, lymphatic and blood circulation is disturbed and swelling increases. Paraphimosis requires urgent professional medical intervention.

Conservative means can be used to return the foreskin to its physiological position. If therapy fails, minor surgery is also an option.

The main risk of paraphimosis is that the foreskin strangles the glans penis. There is a risk of stopping blood flow and oxygen supply to the glans tissues.

The glans in paraphimosis is painful to the touch, swollen and reddened.

Causes of phimosis:

• Absence of gradual retraction of the foreskin
• Forced retraction of the foreskin at a young age
• Frequent local infections and inflammation
• Consequence of inflammation and healing process
• Congenital defect (primary phimosis)
• Diabetes mellitus and dermatitis

Symptoms, manifestations and risks of phimosis:

• Narrowed tight foreskin
• Foreskin cannot be pulled under the stomach
• The foreskin pulls very painfully over the stomach
• Painful erection
• Painful and uncomfortable intercourse
• Weak urine flow and problems with excretion
• Frequent local infections and inflammation
• Inadequate intimate hygiene
• Local odour

Symptoms, manifestations and risks of paraphimosis:

• Foreskin cannot be retracted to its original position
• Increasing swelling of the glans
• Painful acral area
• Reddened to purple stomach
• Restricted vascularity

The diagnostic process consists of an examination by a urologist by inspection (by sight) and palpation (by touch). The doctor will assess the condition of the foreskin narrowing and determine the type of treatment, taking into account the age, clinical symptoms and health status of the patient.

Depending on the condition, the doctor may choose laboratory tests and examinations, for example, if urinary tract complications are suspected.

In most cases, the condition of phimosis is addressed and regularly checked at a young age. In the case of an urgent condition of paraphimosis, the diagnosis and treatment are established acutely. The diagnosis determines the type of treatment, either conservative or surgical.

The course, along with symptoms and risks, is described above in the article...

Phimosis in young children

At birth, the inner leaf of the foreskin is glued to the surface of the glans itself and gradually detaches during development. In most young boys, the foreskin becomes loose by the age of 3 years.

In 50% of cases the foreskin can be reattached during the first year and in 80% of cases by the second year of the boy's life.

A white coating composed of exfoliated epithelium and the product of local sebaceous glands is present in the foreskin. It is technically called smegma.

The main role of this white material is to separate the foreskin from the surface of the glans.
However, once the foreskin is loose, smegma is a sign of poor hygiene.

It is not recommended to forcefully pull the foreskin to avoid pain, tearing, inflammation and possible scarring. Only non-violent pulling during showering and intimate hygiene is recommended.

If the foreskin gradually loosens itself, it is advisable to pull it only as far as it will go on its own.

On the other hand, forcible stretching can result in paraphimosis, an acute condition in which the stretched foreskin becomes stuck under the lower edge of the glans. Forcible stretching also risks micro-tears, which can lead to adhesions and acquired phimosis.

Hygiene in young boys consists of washing the genitals with clean water or baby soap.

There is no need to use special soaps or bath foams, which can be irritating and disrupt the child's local protective microflora. If the child has bathed in foam, it is advisable to shower him with clean water after the bath.

Phimosis in young children and advice for parents:

• Prohibition of forcible pulling of the foreskin
• Only pull the foreskin if it is loose.
• Preventive visits to the urologist
• Regular intimate hygiene
• Intimate hygiene with clean water
• Not using irritating bath products