What are phimosis and paraphimosis?

Phimosis and paraphimosis are issues that affect the foreskin of the penis. Phimosis is when the foreskin can’t retract (pull down) from the tip of the penis. Paraphimosis occurs when the foreskin is retracted but can’t be replaced over the glans penis. They are common conditions in boys, but serious complications can happen if left untreated.

What causes phimosis and paraphimosis?

The shaft and glans (head) are the two main parts of the penis. The foreskin is a continuous layer of skin that covers the shaft and glans. The foreskin is firmly attached to the glans in uncircumcised boys. Over time, the foreskin will naturally begin to separate, usually around 3 years of age. This separation allows the foreskin to be pulled back to expose the glans.

However, if the foreskin is forced back, injury to the foreskin and then scarring can happen, which can result in phimosis. Phimosis describes a tightening of the foreskin opening, where the foreskin cannot be pulled down.

Paraphimosis describes a condition when the foreskin is retracted and is stuck behind the glans. When this occurs, the foreskin cannot move over the tip of the penis. This may cause circulation issues in the penis, which can cause a serious condition.

Phimosis and paraphimosis symptoms

Symptoms may present differently in each child. Boys should be evaluated by their pediatrician to see if an evaluation by a pediatric urologist is needed.

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Common phimosis symptoms include:

  • Bulging of the foreskin while urinating
  • Foreskin unable to fully retract by age 3
  • Frequent infections of the foreskin (balanitis)

Common paraphimosis symptoms include:

  • Unable to pull the foreskin to cover the tip of the penis
  • Pain or numbness
  • Swelling of the tip of the penis when foreskin is pulled back
  • The penis tip appears dark red or blue in color

Phimosis and paraphimosis treatment

Treatments for phimosis and paraphimosis depend upon a child’s age, symptoms and current health, including the severity of the condition.

Phimosis treatment may include:

  • Topical steroid cream for the foreskin
  • Circumcision (surgery to remove all or part of the foreskin)

Paraphimosis is a medical emergency requiring treatment quickly to prevent glans necrosis. Treatment may include:

  • Managing swelling (edema) and manually placing the penis in the correct position
  • Making an incision in the foreskin with or without circumcision
  • Circumcision (surgery to remove all or part of the foreskin)

A child with these conditions should be seen by a pediatric urologist for treatment –– parents nor children should attempt to push or pull the foreskin forcefully if phimosis or paraphimosis is present.

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