Paraphimosis

As Paraphimosis is a painful form of foreskin tightening. It is considered a medical emergency.

What is paraphimosis?

The constriction of the venous vessels of the penis leads to edematous foreskin swelling. Tissue fluid accumulates in the process. As a result, tissue located in deeper regions is also compressed.
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From one Paraphimosis is the talk when, as part of a foreskin constriction (phimosis), the foreskin of the penis is pulled back behind the glans (glans penis) and it gets caught on the glans rim.

The paraphimosis also bears the name Spanish collar.

The resting of the acorn on the crown of acorns is reminiscent of the collar of a Spanish nobleman in the 16th century. A painful constricting ring forms, which leads to a reduction in blood flow.

Paraphimosis is the result of an already existing narrowing of the foreskin, which is known in medicine as phimosis. It usually arises from an erection and means a medical emergency.

causes

The reason for paraphimosis is a narrowing of the foreskin. This phimosis is either congenital or acquired during life. Scarring is a possible cause of the acquired form. These are in turn triggered by inflammation, bleeding or tears. What causes congenital phimosis is still unknown.

Acute paraphimosis can occur when the person pulls back their foreskin that is too tight to wash it. After that, however, the foreskin cannot be pushed back again. This problem occurs most often during sexual intercourse as a result of an erection. With a non-erect penis, the foreskin usually still has the normal width. However, paraphimosis can occur due to the increase in the size of the penis due to an erection. Another risk factor is the insertion of a urinary catheter. During this procedure, people sometimes forget to slide the foreskin back after inserting the catheter.

In the case of an acute paraphimosis, the foreskin cannot be returned to its original position. This results in the blood vessels being pressed. In this way, there is a backlog of water and blood in the glans, which in turn causes the glans to swell. This makes it even more difficult for the person affected to bring the foreskin back to its original position.

Symptoms, ailments & signs

The constriction of the venous vessels of the penis leads to edematous foreskin swelling. Tissue fluid accumulates in the process. As a result, tissue located in deeper regions is also compressed. This is where the arterial blood vessels are located. Paraphimosis can affect the arterial blood supply and even bring it to a complete standstill.

If this circulatory disorder is not treated quickly by a doctor, the tissue threatens to die. Doctors refer to this process as a glass walkway. It can cause severe damage to the penis. A typical symptom of paraphimosis is the severe pain that the person suffers from. In addition, the glans and foreskin turn bluish to black.

Diagnosis & course of disease

Paraphimosis is classified as a medical emergency. This means that the patient must immediately consult a doctor or a hospital if he cannot pull back the foreskin on his own. In a clinic, it is advisable to visit a urology department immediately. The doctor makes the diagnosis of paraphimosis on the basis of the typical cord ring that forms in the glans furrow.

Symptoms such as pain, swelling, and discoloration of the penis help back up his judgment. For the course of a paraphimosis it is extremely important to start medical treatment as quickly as possible, otherwise there is a risk of inflammation of the glans. Another possible complication is ulcer formation. In addition, tissue death can occur. However, if the paraphimosis is treated early, it usually takes a positive course.

Complications

Usually, paraphimosis is an emergency. For this reason, a doctor must be consulted immediately, as otherwise serious complications and damage can occur. The affected person's tissue is compressed significantly, causing severe pain. The blood flow to the tissue is also usually interrupted, so that in the worst case the tissue can also die.

Due to the disturbed blood supply, the extremities may also be disturbed or the extremities may die. This damage is irreversible. Paraphimosis can cause severe and irreversible damage to the penis in particular. The pain is usually very severe, so that those affected can also lose consciousness.

The treatment of paraphimosis usually takes place with the help of an intervention. There are no complications. However, the treatment must be done quickly, otherwise irreparable damage to the penis can occur. The life expectancy of the patient is not affected by paraphimosis.

When should you go to the doctor?

If the foreskin is painfully pinched and can no longer be pushed back, a doctor should be consulted immediately. At night and on weekends, it is best to go to the emergency medical service or the nearest clinic. If the symptoms recur, medical advice is required. A doctor must also be consulted in the event of severe pain that restricts well-being or leads to problems during sexual intercourse. The doctor can determine the paraphimosis based on the visible injury as well as the typical swelling and reddening and call a specialist immediately.

The paraphimosis often has to be treated surgically. If the symptoms mentioned occur during sexual intercourse or masturbation, as well as in an accident, it is most likely due to paraphimosis. Symptoms that occur after a urinary catheter is inserted also suggest the presence of a medical emergency. In addition to the family doctor, the urologist can be visited. Depending on the severity of the symptoms, a dermatologist can also be involved in the treatment. A visit to the hospital is recommended if the symptoms are severe.

Therapy & Treatment

If an acute paraphimosis occurs, the patient can first try to move the foreskin back to its previous position. However, even if this procedure is successful, a specialist should be consulted afterwards. This can prevent further paraphimoses from occurring in the future. For example, the foreskin can be surgically removed by circumcision.

If you do not succeed in pulling back the foreskin on your own, seek medical help immediately. On the way there, it is recommended to cool the penis with ice. Treatment by an experienced urologist makes the most sense. This gently squeezes out the swollen glans. Since this process is very painful, the patient is given an anesthetic beforehand. By pressing out, the foreskin can be brought into its starting position more easily.

A less painful alternative is to squeeze the swollen glans in a compress that is soaked in a solution of table salt. The process takes about ten minutes. It is sufficient to only numb the penile nerves. In most cases, the squeeze will allow the doctor to move the patient's foreskin forward again.

If it is a severe case of paraphimosis in which, for example, the foreskin has already started to die, surgery is required, but this rarely happens. The doctor often recommends an operation to avoid scarring. A circumcision, in which the foreskin is cut, usually takes place when it cannot be successfully returned to its original position.

Outlook & forecast

Paraphimosis is a medical emergency. If the foreskin, which has been streaked over the glans, can no longer be returned to its original position, this blocks the blood flow in the penis. Such an incident, also known as "Spanish collar" in medical jargon, can cause permanent damage. If the condition is not treated promptly, there is a risk of loss of the limb. At the same time, early treatment is almost always successful. If no vessels have died yet, the male reproductive organ recovers completely within a few days. Subsequently or immediately after the incident, the foreskin is usually shortened surgically in order to avoid renewed paraphimosis or phimosis.

In the event of paraphimosis, a urologist should be consulted immediately. The doctor can loosen the foreskin and give a prognosis. Initially, a swelling may remain on the glans after the procedure. Inflammation and pain are also typical symptoms, but they should subside quickly. Depending on the treatment method, the therapy can already be relatively painful, as the swollen glans has to be squeezed out. The treatment is usually carried out under anesthesia and accordingly has the potential for side effects. In the case of emergency medical treatment, a further examination by a specialist is necessary.

prevention

To avoid paraphimosis in the first place, it is advisable not to forcefully pull back the narrowed foreskin. After washing, it is important to immediately return them to their original position.

Aftercare

In the case of paraphimosis, the measures and options for follow-up care are significantly limited in most cases. For this reason, the person affected should consult a doctor very early so that there are no further complications or complaints in the further course. In any case, it is an emergency that must be treated immediately by a doctor so that there is no irreversible damage to the patient.

As a rule, a surgical procedure is necessary in the case of paraphimosis, through which this complaint is alleviated. The affected person should rest after such an operation and protect his body. Exertion or physical and stressful activities should be avoided. The region around the penis in particular should be treated carefully and carefully.

After the wound has healed, regular check-ups and examinations by a doctor are still necessary in order to identify and treat other damage at an early stage. As a rule, the paraphimosis can be completely cured again if a doctor is consulted in good time. The patient does not have any further measures or options for aftercare. The disease does not reduce the life expectancy of the person affected.

You can do that yourself

Paraphimosis is a medical emergency. The person affected should immediately call an emergency doctor or go to the nearest hospital. To avoid injuries, the foreskin must not be jerked. It is advisable to cool the penis slightly and to take a comfortable position in which the shaft is as free as possible. This can delay any interruption of the blood flow.

After medical treatment, the patient should initially refrain from sexual activity. If the outcome is positive, the swelling should subside within a few days. The patient should speak to the urologist about circumcision to prevent paraphimosis from occurring again.

If complications arise as a result of paraphimosis, an operation must be performed immediately in many cases. After the procedure, the usual medical guidelines apply. Physical exertion should be avoided, while light physiotherapy exercises can aid recovery. Sexual activities should be avoided for a few days after surgery. If there are major complaints in connection with a paraphimosis, it is best to inform the responsible urologist or the medical emergency service.