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Paraphimosis

 

Definition

Paraphimosis is the inability of an uncircumcised male to pull the foreskin back over the head of the penis.

Causes

Paraphimosis and phimosis are related conditions caused by swelling and irritation (inflammation) and narrowing of the foreskin. Causes of inflammation include:

  • Infection, which may be due to poor personal hygiene
  • Direct trauma to the area that results in swelling

Uncircumcised males, and those who may not have been correctly or completely circumcised, are at risk.

Paraphimosis occurs most often in children and the elderly.

Symptoms

The foreskin is pulled back (retracted) behind the rounded tip of the penis (glans) and stays there. The retracted foreskin and glans become swollen. This makes it difficult to return the foreskin to its extended position.

Symptoms include:

  • Inability to pull the retracted foreskin over the head of the penis
  • Painful swelling at the end of the penis
  • Pain in the penis
Signs and tests

A physical examination confirms the diagnosis. The health care provider will usually find a "doughnut" around the shaft near the head of the penis (glans).

Support Groups

Expectations (prognosis)

The outcome is likely to be excellent if the condition is diagnosed and treated quickly.

Calling your health care provider

Go to your local emergency room if this occurs.

Complications

If paraphimosis is left untreated, it can disrupt blood flow to the tip of the penis. In extreme cases, this may lead to:

  • Damage to the penis tip
  • Gangrene
  • Loss of the penis tip
Treatments

Pressing on (compression of) the head of the penis while pushing the foreskin forward may reduce the swelling due to paraphimosis. If this fails, prompt surgical circumcision will be needed.

Prevention

Circumcision, when done correctly, prevents this condition.

References

Jordan GH, Schlossberg SM. Surgery of the penis and urethra. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 33.

Elder JS. Abnormalities of the genitalia in boys and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 126.

Elder JS. Anomalies of the penis and urethra. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 544.


Review Date: 9/7/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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