Phimosis and Paraphimosis

What is phimosis?

Phimosis is a constriction of the opening of the foreskin in an uncircumcised male so that it cannot be drawn back over the tip of the penis. This condition is a normal occurrence in newborn boys, but over time the skin that adheres to the tip of the penis can be retracted as the foreskin loosens. By age 17, about 99 percent of males will be able to completely retract their foreskin. Phimosis can also occur if the foreskin is forced back before it is ready. This can cause bleeding and a fibrous scar to form, which may prevent future retraction of the foreskin.

What is paraphimosis?

Paraphimosis is a condition that can be experience by uncircumcised males, in which the foreskin is pulled back behind the coronal groove of the penis and cannot be returned to its regular position. When the foreskin is behind the groove, blood flow to the penis is cut off. Lack of blood flow to the penis can result in a serious medical emergency requiring immediate medial attention.

What are the symptoms of phimosis?

Although each child may experience symptoms differently, the following are the most common symptoms of phimosis.

• Bulging of the foreskin during urination, like a balloon inflating.
• Inability to completely retract the foreskin by age 3 (in some children this process may take longer).
• Straining or pushing to urinate.
• Urinary tract infections.
• Balanitis, a puss filled infection of the foreskin.

What are the symptoms of paraphimosis?

• Swelling of the tip of the penis as the foreskin is retracted or pulled back.
• Pain.
• Inability to pull the foreskin back over the tip of the penis.
• Discoloration, either dark red or bluish color, of the tip of the penis.

If this occurs the child should seek medical attention immediately as this can become a medical emergency.

The symptoms of phimosis and paraphimosis may resemble other problems or medical conditions. The specialists at the CHOC Urology Center will work carefully with each patient to ensure a proper diagnosis.

How is phimosis or paraphimosis diagnosed?

A careful physical examination by the child’s physician normally provides satisfactory information to make a diagnosis.

What is the treatment for phimosis and paraphimosis?

Specific treatment for phimosis or paraphimosis will be determined by our specialists based on:

• The child’s age, overall health and medical history.
• The extent of the condition.
• The type of condition.
• The child’s tolerance for specific medications, procedures or therapies.
• Expectations for the course of the condition.
• The family’s opinion or preference.

Treatment may include the following:

• For phimosis, treatment may involve application of a steroid cream to the foreskin three to four times per day for about one month to loosen the adhesive ring. Each time the cream is applied, it should be done while using gentle, steady pressure to retract the foreskin for one minute. (Learn more about using using steroid cream.) If the cream does not work and the child continues to have adverse phimosis symptoms, a circumcision may be recommended.
• For paraphimosis, treatment may involve lubricating the foreskin and tip of the penis and then gently squeezing the tip of the penis while pulling the foreskin forward. A bandage may also be wrapped from the tip of the penis towards the base to try to reduce the swelling. If this is ineffective, a small incision to relieve the tension may be performed. In some cases, an emergency circumcision may be recommended.

If paraphimosis should occur, the child should be taken to the closest emergency room to be examined. Leaving paraphimosis untreated can have very serious consequences to the survival of the penis.