Paraphimosis is the name given to a painful form of foreskin tightening. It is considered a medical emergency.
What is paraphimosis?
Paraphimosis is the term used when, as part of foreskin stenosis (phimosis), the foreskin of the penis is pulled back behind the glans penis, causing it to become attached to the corona of the glans. Paraphimosis is also called Spanish collar. Thus, the resting of the glans on the glans corona is reminiscent of the collar of a Spanish nobleman in the 16th century. This causes a painful lacing ring to form, which results in a decrease in blood flow. Paraphimosis is the result of a pre-existing narrowing of the foreskin, which in medicine is called phimosis. It usually results from an erection and signifies a medical emergency.
Causes
The reason for paraphimosis is a narrowing of the foreskin. This phimosis is either congenital or acquired during life. Possible causes for the acquired form include scarring. These in turn are triggered by inflammation, bleeding or tearing. It is not yet known what causes congenital phimosis. Acute paraphimosis can occur when the affected person pulls back his too tight foreskin to wash it. Afterwards, however, the foreskin cannot be pushed back again. This problem most often occurs during sexual intercourse as a result of an erection. Thus, when the penis is not erect, the foreskin usually still has the normal width. However, the increase in penile girth due to an erection can result in paraphimosis. Another risk factor is the insertion of a bladder catheter. Sometimes during this procedure, the patient forgets to pull back the foreskin after the catheter is inserted. In the case of acute paraphimosis, the foreskin cannot be returned to its original position. This results in the squeezing of the blood vessels. In this way, water and blood back up in the glans, which in turn leads to swelling of the glans. This makes it even more difficult for the affected person to return the foreskin to its original position.
Symptoms, complaints and signs
The constriction of the venous vessels of the penis results in edematous foreskin swelling. Tissue fluid is deposited in the process. As a result, there is also compression of tissue located in deeper regions. 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 physician, the tissue threatens to die. Medical professionals refer to this process as glassgängran. It can cause severe damage to the penis. A typical symptom of paraphimosis is the severe pain suffered by the affected person. In addition, the glans and foreskin turn bluish to black.
Diagnosis and course of the disease
Paraphimosis is classified as a medical emergency. This means that the patient must see a doctor or hospital immediately if he or she is unable to retract the foreskin under his or her own power. In a hospital, it is recommended to immediately visit a specialist urology department. The doctor makes the diagnosis of paraphimosis on the basis of the typical lacing ring that develops in the glans furrow. To confirm his judgment, the symptoms such as pain, swelling and discoloration of the penis contribute. For the course of paraphimosis it is extremely important to start medical treatment as soon as possible, otherwise there is a risk of inflammation of the glans. Another possible complication is the development of ulcers. In addition, tissue death may occur. However, if paraphimosis is treated early, it usually takes a positive course.
Complications
As a rule, paraphimosis is an emergency. For this reason, a doctor must also be consulted immediately, otherwise serious complications and damage may occur. The tissue of the affected person is significantly compressed, causing severe pain. The blood supply 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 die. This damage is irreversible.Paraphimosis can cause severe and irreversible damage, especially to the penis. The pain is usually very severe, so that the affected person can also lose consciousness. Treatment of paraphimosis usually takes place with the help of surgery. No complications occur during this procedure. However, the treatment must be performed quickly, otherwise irreparable damage to the penis may 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 cannot be pushed back, a doctor should be consulted immediately. At night and on weekends, it is best to visit the emergency medical service or the nearest clinic. If the complaints occur repeatedly, medical advice is required. A doctor must also be consulted in the event of severe pain that limits well-being or leads to problems during sexual intercourse. The medical professional can identify paraphimosis by the visible injury as well as the typical swelling and redness and immediately consult a specialist. Often, paraphimosis must be treated surgically. If the above-mentioned complaints occur during sexual intercourse or masturbation, as well as in case of an accident, most likely there is an underlying paraphimosis. Symptoms that occur after the placement of a bladder catheter also indicate the presence of a medical emergency. In addition to the family physician, the urologist can be consulted. Depending on the severity of the symptoms, a dermatologist may also be involved in the treatment. If the symptoms are severe, a visit to the hospital is recommended.
Treatment and therapy
If acute paraphimosis occurs, the patient can first try to return the foreskin to its previous position by himself. However, even if this procedure is successful, a specialist should be consulted afterwards. This can prevent further paraphimosis from occurring in the future. For example, the foreskin can be surgically removed by circumcision. If it is not possible to pull the foreskin back on one’s own, medical help should be sought immediately. On the way there, it is recommended to cool the penis with ice. The most sensible treatment is by an experienced urologist. The latter gently squeezes out the swollen glans. Since this process is very painful, the patient receives an anesthetic in advance. By pressing out the foreskin, it is easier to bring it back to its original position. A less painful alternative is to squeeze the swollen glans in a compress soaked in a solution of table salt. The procedure takes about ten minutes. It is sufficient to anesthetize only the penile nerves. In most cases, the doctor can move the patient’s foreskin back in the anterior direction by squeezing it. If it is a severe case of paraphimosis, where, for example, the foreskin has already started to die, surgery is required, but this rarely happens. The doctor also often advises surgery to avoid scarring. Circumcision, in which the foreskin is circumcised, usually takes place if it cannot be successfully returned to its original position.
Outlook and prognosis
Paraphimosis is a medical emergency. If the foreskin striated over the glans cannot be returned to its original position, this blocks blood flow in the penis. Such a prolapse, also called “Spanish collar” in medical jargon, can cause permanent damage. If the condition is not treated promptly, loss of the member is imminent. At the same time, early treatment is almost always successful. Provided that no vessels have died, the male sex organ recovers completely within a few days. Subsequently, or already immediately after the prolapse, the foreskin is usually shortened surgically in order to avoid a recurrence of paraphimosis or phimosis. In case of paraphimosis, a urologist should be consulted immediately. The doctor can loosen the foreskin and give a prognosis. Initially, swelling may remain on the glans after the procedure. Inflammation and pain are also typical symptoms, but these should subside quickly. Depending on the treatment method, even the therapy can be relatively painful, as the swollen glans must be squeezed out.Treatment is usually performed under anesthesia and accordingly carries the potential for side effects. In the case of emergency medical treatment, further examination by a specialist is necessary.
Prevention
To prevent paraphimosis from occurring in the first place, it is advisable not to forcefully pull back the constricted foreskin. After washing, it is important to immediately return it to its original position.
Aftercare
In most cases of paraphimosis, the measures and possibilities of aftercare are significantly limited. For this reason, the affected person should see a doctor at a very early stage to avoid further complications or discomfort in the further course. In any case, this is an emergency that must be treated immediately by a physician to prevent irreversible damage to the patient. As a rule, paraphimosis requires surgical intervention to alleviate this complaint. The affected person should rest and take care of his body after such an operation. They should refrain from physical exertion or stressful activities. Especially the region around the penis should be treated carefully and cautiously. After the wound has healed, regular check-ups and examinations by a doctor are still necessary in order to detect and treat other damage at an early stage. Usually, paraphimosis can be completely cured if a doctor is consulted in time. Further measures and possibilities of aftercare are not available to the patient. The disease also does not reduce the life expectancy of the affected person in this case.
What you can do yourself
Paraphimosis represents a medical emergency. The affected person should immediately call the emergency doctor or go to the nearest hospital. To avoid injury, do not jerk the foreskin. It is advisable to cool the penis slightly and to adopt a comfortable position in which the shaft is as free as possible. This may delay any cessation of blood flow. After medical treatment, the patient should initially refrain from sexual activity. If the course is positive, the swelling should subside within a few days. The patient should discuss circumcision with the urologist to prevent recurrence of paraphimosis. If complications arise as a result of paraphimosis, surgery must be performed immediately in many cases. After the procedure, the usual medical guidelines apply. Physical exertion should be avoided, while light exercises from physiotherapy can support recovery. After a surgical procedure, sexual activity should be avoided for a few days. If major discomfort occurs in connection with paraphimosis, it is best to inform the urologist in charge or the emergency medical service.
