Phimosis – What is it?
In a relaxed state, the head of the penis is partially or fully covered by easily removable and thin skin, called the foreskin. Foreskin is a fold of skin that during erection goes back, allowing free extension of penis. Phimosis is a condition in which the opening of the foreskin is narrower and not elastic, which hinders the free slitter head.
There are two distinct forms of phimosis, which differ in the causes of formation and hence their treatment – physiological and acquired.
1. Physiological (congenital) phimosis
Usually boys are born with the so called physiological phimosis, which is normal, ordinary and expected, as occurs in approximately 90% of baby boys. It is due to the immaturity of this organ and adhesion between the foreskin and glans of the penis. Gradually, when the child grows, crackling torn off and so over time the foreskin is granted (5-7 years).
Usually physiological phimosis requires no active medical intervention as it is enough at each bathing of the child parents to try lightly and gently to slitter head without forcibly pulling and towing. It is no longer recommended the practice in the recent past called forcibly stripping, wherein except for unnecessary pain and unpleasant experience for the child, there can be caused micro-trauma which subsequently cause acquired phimosis.
Care for the penis in circumcised boys
It is very important ritual circumcise to be performed by a qualified doctor! This is often done by the third day after birth or during the first weeks. It is normal to notice yellowish liquid separation and redness of the glans. This means that the healing proceeds normally. It is needed only to maintain strict hygiene in the area of circumcision.
2. Acquired (pathological) phimosis
Acquired phimosis is different than physiological. It is characteristic of aging, and occurs in patients who have had problems before. Then the foreskin becomes hard, as in erectile slitter the head of the skin stands as a tight ring.
The most common reasons for acquired phimosis are:
- Due to inflammation of the foreskin and the glans (ie. Balanoposthitis)
- Diabetes, wherein the infections of the penis are more common
- Lichen sclerosus et atrophicus the foreskin – a disease of unknown cause, leading to the formation of sclerotic and non-elastic portions on the skin and thus a narrowing of the opening of the foreskin
- Improper healing after break
- Trauma and others.
Phimosis Symptoms – What are the complaints?
Inability of the foreskin to relax leads to painful and sometimes impossible slitter of the head during erection.
In more severe forms, narrowing the skin is so great that intercourse is very painful and unpleasant, as some patients even avoid making sexual intercourse. Sometimes, during sexual intercourse it is possible to obtain small lacerations of the skin (cracks) that are also very painful. In the healing of these small lacerations remain micro-scars, which further reduces the elasticity of the foreskin and with time the condition (phimosis ring) becomes more severe – actually a vicious cycle, since each erection and sexual intercourse leading to deepen phimosis.
On the other hand, difficult slitter of the head compromises hygiene, since each washing is uncomfortable, and patients tend to do so as quickly as possible or miss it. This leads to retention of smegma and microorganisms and more frequent inflammation – ie. Balanoposthitis that further deteriorate.
Phimosis Treatment – How to treat phimosis?
Treatment of phimosis is of two types – conservative (with drugs) and surgery. Non-operating can be offered in mild phimosis and reluctance for surgery. A variety of corticosteroid creams are used, however their effect is uncertain and most perishable.
The safest method for treating phimosis is operational. The surgery is called circumcision, the goal is “circular” to remove the narrowed section of the foreskin. The resulting defect is sutured with fine resorbable sutures that after about 15 days fall down by themselves.
The surgery is most often performed under local anesthesia and is tolerated well by patients, although men are usually very scared before it (which is quite normal). There are various techniques and methods of circumcision (scalpel with current laser with different types of surgical clamps or instruments). Ultimately, as this is a cosmetic surgery of the most important organ of a man it has to be taken seriously and to be performed precisely and aesthetically pleasing.
After surgery, the pain is completely bearable and the return to daily activities is possible the next day. However, sexual contacts can be renewed only after complete healing of the skin that occurs after 20-25 days.
Phimosis and Paraphimosis:
Paraphimosis is a complication of phimosis, which occurs when stripping the head of penis; the narrowed section prevents the skin to go back. Therefore, the head of the penis is pressed by the formed ring. This compression leads to a violation of the blood supply with additional swelling of the head that swells and return of the skin becomes even more difficult. Paraphimosis is considered an emergency condition in urology.
How to treat paraphimosis?
Usually the first attempt to return (reposition) the skin is made by a specialist urologist. He may use a special gel containing a local anesthetic. If the skin fails to get back on the head, there may be necessary to perform a small incision at the back of the penis. It is usually sufficient to release the constriction and the skin to return.