Paraphimosis: Symptoms, Treatment, and Prevention

Paraphimosis is a penile condition that is characterized by failure of foreskin to return to normal position after being pulled over behind penile tip. The retracted penis and foreskin may induce inflammation and leads to swelling and build-up of fluid; further preventing the return of foreskin to its original position. It is imperative to keep in mind that Paraphimosis is different from phimosis that is characterized by the inability to retract or pull over the foreskin over penile tip at all; whereas in Paraphimosis, the skin can be pulled back but it doesn’t return to the normal position.In most cases, phimosis is a non-serious condition and occurs usually in younger males. Paraphimosis, on the other hand, is a medical emergency that is very painful and needs urgent and emergent intervention. In some serious and rare cases, Paraphimosis can lead to interrupted blood flow to the penis that may culminate in the damaged penile tip or even lost tip in poorly managed cases.

What causes Paraphimosis?

Paraphimosis is caused by one of the following:

• The inability of the foreskin to return back to normal; thereby leading to swelling due to fluid buildup. Some risk factors during which foreskin retraction may occur are; after urination, after cleaning or as part of medical examination
• Very tight foreskin that interferes with the ability to pull it back over to its natural position
• Penile piercing
• Males who use constriction rings to improve the erectile or sexual activity

• Vigorous sexual activity

Risk factors of Paraphimosis:

• Improperly performed circumcision
• Poor personal hygiene that may cause infection
• Repeated trauma or injury to foreskin that may lead to scarring
• Spider or insect bite that may lead to swelling of penis or foreskin
• In young boys, Paraphimosis is usually a result of forceful penile retraction

In older men, risk of Paraphimosis increases with a history of uncontrolled diabetes, or after catherization (if foreskin is not handled properly during the process).

Classic symptoms of Paraphimosis:

Following are classic symptoms of Paraphimosis:

• Inability to retract penile foreskin
• Swelling of penis
• Severe pain
• Formation of black or dark blue tissue at the tip of penis
• Formation of tight skin band around the tip of penis

Paraphimosis can be managed by manipulation, but in some cases minor surgical intervention may be needed. The mainstay of manipulation is to reduce the swelling by applying saline swab or ice packs. With manipulation not working, your doctor may use other methods to reduce the swelling such as puncture therapy under some form of sedation or local anesthesia. Optimal genital and personal hygiene can greatly help in preventing Paraphimosis or improving the outcome.

Complications of Paraphimosis:

In untreated cases, Paraphimosis can lead to a variety of complications:

• Gangrene
• Damaged penile tip
• Loss of blood flow

The outlook can be greatly improved if the condition is treated as soon as possible. In recurring cases, circumcision is ideally recommended. In severe cases, loss of blood flow or persistent inflammation can lead to loss of penile tip.References:

1. Burstein, B., & Paquin, R. (2017). Comparison of outcomes for pediatric paraphimosis reduction using topical anesthetic versus intravenous procedural sedation. The American Journal of Emergency Medicine.
2. Palmisano, F., Gadda, F., Spinelli, M. G., & Montanari, E. (2017). Glans penis necrosis following paraphimosis: A rare case with brief literature review. Urology Case Reports.

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