Paraphimosis - Causes, Symptoms, Diagnosis, Management, Prevention, and Complications

What Is the Meaning of Paraphimosis?

The penis is one of the most crucial organs of the male reproductive system. It consists of several parts, including the head known as the glans, the skin covering the glans, known as the foreskin, and a tip. During puberty, the penis develops completely and reaches a maximum size. Sometimes, the foreskin covering the penis is removed for various reasons, and such people are known to be circumcised. At the same time, some boys retain the foreskin and are known to be uncircumcised.

Normally, the boys can pull back their foreskin to cover the tip of the penis by around ten years of age. However, the problem arises when the person is unable to pull the foreskin back to the normal position. As a result, the foreskin gets stuck behind the head of the penis and becomes swollen. The blood supply to the tip of the penis is lost, resulting in a condition known as paraphimosis. It is one of the most serious conditions and requires emergency medical care and attention.

Is Paraphimosis the Same as Phimosis?

Paraphimosis and phimosis are the conditions that affect the penis mainly. Phimosis is not a medical emergency and occurs in uncircumcised or partially circumcised people. They are unable to bring the foreskin back to the natural position. However, phimosis subsides after some time and does not require any treatment. Paraphimosis presents with a similar problem, but it requires treatment at the earliest. It is because the blood supply gets cut off to the part of the penis and results in gangrene (life-threatening bacterial infection).

What Are the Causes of Paraphimosis?

Paraphimosis can happen in both young and old people. There are several causes of paraphimosis that have been described below:

1. Retraction of the Foreskin - The foreskin is usually retracted during medical examination, urination, or cleaning. Sometimes, the patient retracts the foreskin to clean after intercourse. The problem arises when the skin is left retracted for a long time, and swelling occurs.

2. Infection - Uncircumcised boys need to retract the foreskin and clean the area to keep it healthy. However, if the site is not cleaned, the bacteria accumulate and increase the risk of infections. The risk of paraphimosis increases with a bacterial infection.

3. Tight Foreskin - Sometimes, the foreskin becomes so tight that it is impossible to retract it. In such a case, the patient pulls the skin forcefully, which causes swelling and paraphimosis.

4. Trauma - The penis or the organ between the abdomen and the legs, that is, the pelvis, might get injured due to accidents, car crashes, sexual activity, penile piercing, or the use of constricting ring. As a result, the arteries supplying blood to the penis and the foreskin get ruptured, resulting in paraphimosis.

5. Spider Bites - The spider makes a poison that affects the nervous system and the muscles. Paraphimosis is one of the most severe complications of spider bites.

6. Diabetes - Diabetes is a condition that reduces the immune response of the body and makes it vulnerable to infections. If the person is suffering from diabetes for a prolonged period, inflammation of the penis and foreskin is commonly seen. As a result, the foreskin gets damaged, resulting in paraphimosis.

7. Catheterization - A catheter is a tube that is inserted into the body through the urethra to facilitate the drainage of urine. Suppose the foreskin was not retracted to the normal position during catheterization, the risk of paraphimosis increases.

What Are the Signs and Symptoms of Paraphimosis?

Paraphimosis is a condition in which the foreskin of the penis can not be pulled forward to cover the head. The signs and symptoms of paraphimosis are listed below:

• The patient is unable to pull the foreskin back to the normal place.

• Swelling of the tip of the penis.

• The patient feels uncomfortable due to the pain and swelling.

• The skin becomes blue or purple.

• Tenderness and redness.

• Inability to pass urine.

What Methods Are Used to Diagnose Paraphimosis?

The diagnosis of paraphimosis is based on medical history and physical examination. Laboratory and imaging tests are not required as the condition is visible on physical examination. The diagnostic methods have been described below:

1. Medical History - The medical history provides a better understanding of the general health of the patient. The following questions are asked in the medical history:

   1. Does the patient clean the penis regularly?

   2. Is the foreskin retracted by the patient or any caregiver?

   3. Did the patient undergo circumcision?

   4. Has the patient undergone catheterization for any reason?

2. Physical Examination - The doctor checks the physical signs of paraphimosis. The following signs are usually evaluated:

   1. The foreskin will be stuck behind the head of the penis.

   2. The band of the foreskin might not be visible due to swelling.

   3. The area is usually purple due to reduced blood supply.

   4. If the catheter has been placed, it is important to evaluate the reason for the placement of a catheter.

   5. The doctor will also check if the catheter has been positioned correctly and if the foreskin was retracted or not.

3. Swab Test - It is rarely done to check the type of infection present in the penis. The doctor inserts sterile cotton into the urethra to obtain a sample of the cells of the penis. The cells are then examined under the microscope to check the presence of infection.

How to Manage Paraphimosis?

Uncomplicated and mild paraphimosis can be treated with non-surgical methods, while surgery is required in complicated paraphimosis. The treatment options have been described below:

• Manual Reduction - The swelling can be compressed manually, that is, without surgical intervention, in the following ways:

  • The doctor compresses the foreskin slowly to allow the reduction of swelling.

  • Another method used to compress the swelling is placing a gauze pad and a compression bandage around the penis for 10 to 15 minutes.

  • Ice packs can be applied to the penis to relieve swelling and inflammation.

  • A eutectic mixture of local anesthetics (EMLA) in the form of a cream is applied over the penis to reduce pain and inflammation.

  • Hyaluronidase can be injected into the foreskin to reduce the swelling.

  • The pus present in the penis is usually drained with the help of needles.

  • A gauze roll soaked in mannitol solution is left around the penis for some time to reduce the swelling.

• Aspiration - The excessive blood and pus present in the penis are drained with the help of a needle and a syringe. A salt solution (saline) is injected to flush the penis and remove the pus. This procedure relieves the patient and needs to be repeated until the swelling lasts.

• Surgical Reduction - Surgical reduction is made when the manual methods fail to relieve the swelling. First, the penis is disinfected with a povidone-iodine solution. An incision is made in the foreskin to relieve the tension. The tip of the penis is squeezed, and the foreskin is pulled down slowly. Local anesthesia or a painkiller might be given before the procedure so that it can be done smoothly.

What Are the Complications of Paraphimosis?

If the paraphimosis is left untreated for long, severe complications occur. The complications of paraphimosis have been listed below:

1. The tip of the penis might get damaged due to swelling making urination difficult.

2. If the foreskin remains retracted for long, the cells and the tissues stop receiving blood and die. This condition is known as ischemia.

3. Gangrene is one of the most serious complications of paraphimosis. It is a life-threatening condition that occurs due to bacterial infection of the penis and scrotum.

4. Loss of penis tip might occur due to gangrene, causing severe problems for the patient.

How to Prevent Paraphimosis?

If a person has undergone circumcision, paraphimosis will never occur. However, uncircumcised boys can prevent paraphimosis in the following ways:

• It is important to maintain good hygiene and clean the tip of the penis regularly after urinating.

• Always pull the foreskin back to the normal position if it has been retracted for cleaning purposes after urination or intercourse.

• If a catheter has been inserted for some purpose, the doctor must pull the foreskin to cover the tip of the penis without fail.

• Do not leave the foreskin retracted for long, as it can cause swelling.

Conclusion:

Paraphimosis occurs when the person is unable to pull the foreskin to cover the tip of the penis. It is commonly seen in uncircumcised boys as they retain the foreskin. If the condition remains untreated for long, the bacteria get trapped in the area resulting in a life-threatening condition known as gangrene. However, the patient need not worry as the condition is not incurable. Surgery is done if the manual compression methods do not provide relief. The patient must not feel embarrassed and consult the doctor at the earliest for diagnosis and treatment.