Phimosis and paraphimosis

Both terms are closely linked but are not exactly the same thing. Let’s see the particular characteristics of each pathology and their possible solutions.

What is phimosis?

It is a pathology that causes a tightness of the foreskin in men’s penises, (the foreskin is the skin that covers the glans). It causes discomfort and pain, and it can even impede a full retraction of the glans. The tightness results from the formation of a ring of fibrous tissue that hinders the soft slip of the foreskin both in erect and flaccid state. Phimosis thwarts an adequate hygiene as well as a pleasurable sexual activity, since it may cause pain during intercourse. Sometimes, it can be the cause of infections in the genital area.

Is phimosis a common condition?

Phimosis is a very common problem, especially in young boys. However, in most cases, this condition is naturally corrected during the first years of infancy and when he is 3 years old the foreskin usually becomes more flexible and fully retractable. Nevertheless, around 2% of adults has phimosis, so it is not a pathology only suffered by children. There are cases in which phimosis does not pose problems, and therefore it is not necessary to undergo a surgical treatment. In case of doubt or if phimosis is associated to discomfort and pain, a consultation with a urology or andrology expert should be booked as soon as possible.

Are there different kinds of phimosis?

Firstly, we should make a distinction between congenital and acquired phimosis. Congenital phimosis is the condition that baby boys manifest at birth, when there is little laxity in the foreskin but which is usually resolved by itself over the years. On the contrary, acquired phimosis may appear after an inflammation of the glans or because of an infection. Usually, men with diabetes are more prone to suffer from a case of acquired phimosis.

We can also classify phimosis as follows:

• Pinpoint phimosis: the foreskin orifice has an imperceptible diameter whose width and appearance are seemingly normal.

• Scar tissue phimosis or non-retractable partial phimosis: the skin around the foreskin orifice has hardened because of previous inflammations or infections.

• Partial phimosis: the anatomical structure of the patient prevents the glans from getting out and there is a failure in retracting the skin.

Similarly, this pathology is classified according to the degree of severity: so we find 1^st degree phimosis, which is the most serious one because the glans cannot be uncovered whatsoever; and of 5^th degree phimosis, which is a very minor condition when the glans has virtually no difficulty to be uncovered.

What is paraphimosis?

It is a worsening of phimosis, because the base of the glans gets trapped by the foreskin when it retracts thus leading to both a compression and a congestion of the glans. It is thus more serious and dangerous than phimosis because it could cause a necrosis in the penis due to a shortage of blood supply. It is essential to go to a specialist in order to try to manually reduce the problem. If this is not possible, then the patient must undergo a surgical intervention to eliminate the compression and/or congestion of the area.

Which treatments are available in each case?

First of all, the patient must go to a specialist in order to be diagnosed and then determine the best treatment for each case. Both phimosis and paraphimosis can be detected with a simple anatomical and visual exam during the first visit. Once the doctor has completed the diagnosis, and depending on the degree of the pathology, there will be different options of treatment which may include any of the following: daily and progressive stretching exercises for the foreskin, application of prescribed corticosteroids creams or a surgical procedure. The latter treatment may consists of circumcision or preputioplasty, which is in some cases more appropriate and leaves the foreskin untouched.

How is the post-surgery process?

Both circumcision and preputioplasty are outpatient surgeries, so the patient will be able to go back home the very same day of the intervention. He can resume his normal life the following day, as long as he doesn’t make any effort or lift heavy weights. It is also important to keep a meticulous hygiene to clean the post-surgical wounds and closely follow post-op instructions provided by the doctor.