Phimosis - Paraphimosis


What is Penile Phimosis?

Phimosis is the condition where the foreskin (i.e. the retractable part of the skin covering the glans penis)  is narrow or closed, leaving only a small passage for the urine to exit. As a result, the foreskin cannot be retracted backwards to fully expose the glans when the penis is both relaxed and erect. Normally the foreskin is elastic for allowing the easy skin movement and retraction during full erection. 

What are the causes of Penile Phimosis?

Phimosis is either congenital (from birth) or acquired (occurring at some time in life). Diseases related to phimosis are: 

  • Chronic inflammations of the glans and foreskin (balanoposthitis) and fungal infections (mycoses) that are not treated properly.
  • Diabetes Mellitus. As DM is one of the major predispository factors for inflammations in the region, it may also lead to phimosis.
  • Injury during sexual intercourse.

What is Paraphimosis?

Paraphimosis is a severe and emergent condition, caused either by prolonged foreskin retraction over the glans penis or by presence of phimosis. In the latter case, the foreskin may be pulled back violently behind the glans, but due to the narrow opening it cannot be brought down to its original position. The narrow opening creates a  tight ring around the penis inhibiting normal blood circulation. If it remains like that for an extended period of time, it may cause ischemia and necrosis of the region. Paraphimosis must be treated by the Urologist without any delay. 

What could Phimosis cause?

Phimosis might cause:

  • Relapsing inflammations of the glans and foreskin
  • Pain and discomfort during sexual intercourse
  • Painful erection, which may lead to erectile dysfunction
  • Full obstruction of the glans, which may result in inability to urinate
  • Premature ejaculation, for the region becomes highly sensitive
  • Paraphimosis
  • Penile cancer (rare), developed on the long term, as long as phimosis has been left untreated for many years 

How is Phimosis treated?

Treatment can be either conservative or surgical. 

  • Conservative treatment. When phimosis is in an early stage and is due to some dermatological disease or inflammation of the region, your physician may recommend the use of some ointments which may be effective. However, when the foreskin has lost its elasticity and resilience and has become scarring, pharmacotherapy is of no use and surgical treatment  is recommended. 
  • Surgical treatment. Circumcision is the surgical procedure performed in the majority of patients with phimosis. The pathological skin is removed, followed by the plastic suturing of the foreskin. It usually takes place under local anaesthesia and the patient is discharged from hospital on the very same day. Complications are very rare (hematoma, trauma infection).  There are some variations of the technique, which mainly have to do with the amount of skin to be removed. The physician discusses with the patient to decide together on the most appropriate technique depending on the case.