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Paraphimosis is a serious condition that happens when the foreskin of the penis gets stuck behind the head of the penis and cannot be pulled back to its original position. This leads to decreased blood flow to the head of the penis, swelling, extreme pain, and even necrosis. It is a medical emergency and requires immediate attention. Paraphimosis can occur in males - infants, young boys, and adults who are not circumcised.

What Is Paraphimosis?

Paraphimosis occurs when the prepuce, also known commonly as the foreskin, has been pulled down and cannot be returned to its original position. It gets stuck in the head or the corona of the glans penis. This condition can be present in male infants, adolescents, and adults. 

This leads to loss of blood supply to the area. The venous blood is also unable to flow out, making the head of the penis look swollen and engorged. It is an extremely painful condition. If not treated immediately, the stagnant blood may even lead to necrosis (decay and death of the tissue). 

Under such a circumstance, the entire head of the penis will have to be cut off. Treatment depends on the patient's age and mainly involves medications and surgery. In infants and young boys, a medicated, lubricating gel is applied to the foreskin and manually retracted. Surgery is advised if this treatment is not effective. 

The surgeon may make a few cuts on the foreskin to loosen it (known as partial circumcision) or recommend a total circumcision. Since there is a high probability that paraphimosis can recur, it is advisable to opt for total circumcision.

What Causes Paraphimosis?

Paraphimosis happens when the foreskin of the penis is pulled back and is unable to come back to its original position. There are several reasons why this could happen. Paraphimosis may occur:

  • When the foreskin is pulled back for cleaning.
  • When a foreskin that is too tight is pulled back forcibly.
  • When a healthcare provider forcibly pulls back the foreskin during a procedure like catheterization to drain urine or during any other procedure on the genitals like a cystoscopy.
  • When you have an infection in the genitals.
  • When there is physical trauma to the genitals.
  • When you have a foreskin that is tighter than normal.
  • When you keep your foreskin retracted for an elongated period.
  • As a result of type II diabetes mellitus (in adults).
  • As a result of an incomplete or badly done circumcision.

What Are The Symptoms Of Paraphimosis?

Paraphimosis is a serious condition that requires immediate medical attention. The symptoms of paraphimosis in kids and adults include:

  • Inability to pull the foreskin back to its original position
  • Swelling of the foreskin and glans
  • Excruciating pain
  • Bluish-black discoloration of the penis
  • Difficulty in passing urine

How Is Paraphimosis Treated?

Paraphimosis is a serious condition that can quickly worsen if immediate medical attention is not provided. Treatment will depend on your age and the severity of the condition.

As a first-aid, you may do the following things before rushing to the emergency room:

  • Apply an ice pack on your penis to reduce the swelling
  • Wrap a bandage tightly around the penis.

Once you reach the hospital, your surgeon will first work on reducing the swelling. The following procedures are employed:

  • Using needles to drain the blood. This is known as the Dundee technique. You will be given anesthesia before this procedure.
  •  Injecting hyaluronidase, an enzyme that acts quickly to bring the swelling down
  • Once the swelling has subsided, your doctor will try manually squeezing the tip of the penis to retract the foreskin. This procedure is done under anesthesia and painkillers, as it is painful. This is the preferred method of treatment of paraphimosis in infants and young boys. 

If the above methods fail to relieve the swelling and the foreskin still remains retracted, the situation becomes critical, and surgery is the only option available. Three types of circumcision surgery can be done for paraphimosis in an emergency setting:

  • Open Circumcision: This is the traditional surgery. Your surgeon will administer local or general anesthesia before the surgery so you do not feel the pain. After careful measurement, the foreskin is extracted with a scalpel. This skin is cauterized or stitched back to the shaft with dissolvable sutures. You will be given medications to deal with the pain and swelling. Recovery takes about 10 days.
  • Laser Circumcision: This is a quick procedure that is done in under 20 minutes. You will be first administered anesthesia, and then your foreskin will be cut off using high-beam lasers. This procedure is minimally invasive, does not require stitches, and does not cause blood loss. You can go home the same day. You need to follow the postoperative instructions carefully to avoid complications. Recovery from laser surgery is faster compared to traditional surgery.
  • Stapler Circumcision: This is an advanced, minimally invasive procedure to treat paraphimosis. In this procedure, the surgeon will use a surgical stapler to retract the foreskin and close the edges. This procedure is done under general anesthesia. There is minimal pain post-surgery, and you can go home the same day. Follow all the instructions given to you on discharge. It will take about 4 -7 days to recover from this surgery.
  • Partial Circumcision: This procedure is preferred in infants and young boys. In this procedure, the topmost part of the foreskin is only removed. It involves making a small cut on several places of the foreskin. This loosens the foreskin and it can be retracted easily. This is done as a daycare procedure under general anesthesia. Your child will take 3 to 4 days to recover from this surgery. Younger kids and babies recover faster. The surgeon will prescribe medicines to help your child with the pain, swelling, and bruising.

What To Expect During The Recovery?

Recovery from circumcision depends on the type of surgery performed. All procedures are performed as daycare procedures which means that you can go home the same day. You need to take complete rest for the initial 24 hours, after which you may be able to get back to your routine work gradually. 

Complete recovery will take anywhere between 7 to 10 days. Young children and infants recover faster than adults. You will be sent home with instructions on how to care for the wound after the surgery.

  • The penis may be swollen and appear bruised during the initial days, though the pain is minimal. You may return to your daily routine a couple of days after the procedure. 
  • Keep the genitals, especially the incision area, clean and completely dry. Moisture in the genitals is a perfect breeding ground for infection causing germs.
  • Avoid showering until your surgeon gives the go-ahead.
  • You will be advised to wear loose-fitting clothes during the recovery period. Wear supportive underwear that will keep your penis protected.
  • Avoid strenuous activities like running or lifting heavy weights, sexual intercourse, and masturbation till you heal completely.
  • Drinking plenty of water is advisable, especially in the first 24 hours after the procedure.

What Are The Complications of Paraphimosis?

Paraphimosis can lead to serious complications if not treated on time. The blood flow restriction and the resultant swelling can have disastrous effects on your penis.

  • Infection of the foreskin and the glans
  • Gangrene (death of the tissue/organ due to lack of blood supply)
  • Scarring 
  • Excessive bleeding 

If the complications are not treated on time, amputation of the penis head may be required.

How To Prevent Paraphimosis?

Paraphimosis is an extremely painful condition that can lead to severe complications in infants, kids, and adults if not treated promptly. Circumcision is the best way to prevent paraphimosis. It also ensures that you do not suffer from the condition once you have been treated for the same. Some other ways of preventing paraphimosis include:

  • Ensuring that the foreskin has been properly restored to its place after cleaning it and after sexual activities.
  • Not indulging in any activity that requires you to retract the foreskin forcefully.
  • Ensure the surgeon has retracted the foreskin to its natural place after a procedure like catheterization.
  • Teaching young boys the importance of personal hygiene, especially of the genitals.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!

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