Paraphimosis: a foreskin stuck in the pulled-back position

What is paraphimosis?

When a tight foreskin is pulled back behind the head of the penis and does not return, the foreskin squeezes the penis like a ring. Blood and lymph flow in the head of the penis is disrupted, and the head and the foreskin itself swell quickly. As the swelling increases, returning the foreskin becomes even harder. This is called paraphimosis.

Causes

• a parent or the child forcing the foreskin back and forgetting to return it,
• the foreskin staying pulled back after washing,
• in adolescents, during an erection or sexual activity,
• the foreskin not being returned after a medical procedure (catheter).

Symptoms

• a tight ring of skin behind the head of the penis,
• swelling and color change of the head of the penis and the foreskin,
• pain, sometimes difficulty urinating.

What to do?

Paraphimosis is an emergency. Take the child immediately to a pediatric urologist or an emergency department.

The doctor first applies a numbing gel and squeezes the head of the penis for a few minutes to reduce the swelling. Then the foreskin is carefully returned to its place. In most cases this is enough.

If this fails, the foreskin is returned under general anesthesia or a small incision is made in the constricting ring.

What happens next?

A child who has had paraphimosis has a tight foreskin, so there is a risk of it happening again. Once the swelling has gone down, cream treatment of the phimosis or a planned circumcision is discussed.