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Paraphimosis

Definition

Paraphimosis occurs when the foreskin of an uncircumcised male cannot be pulled back over the head of the penis.

Causes

Causes of paraphimosis include:

  • Injury to the area.
  • Failure to return the foreskin to its normal location after urination or washing. This is more common in hospitals and nursing homes.
  • Infection, which may be due to not washing the area well.

Men who have not been circumcised and those who may not have been correctly circumcised are at risk.

Paraphimosis occurs most often in boys and older men.

Symptoms

The foreskin is pulled back (retracted) behind the rounded tip of the penis (glans) and stays there. The retracted foreskin and glans become swollen. This makes it difficult to return the foreskin to its extended position.

Symptoms include:

  • Inability to pull the retracted foreskin over the head of the penis
  • Painful swelling at the end of the penis
  • Pain in the penis

Exams and Tests

A physical exam confirms the diagnosis. The health care provider will usually find a "doughnut" around the shaft near the head of the penis (glans).

Treatment

Pressing on the head of the penis while pushing the foreskin forward may reduce the swelling. If this fails, prompt surgical circumcision or other surgery to relieve swelling will be needed.

Outlook (Prognosis)

The outcome is likely to be excellent if the condition is diagnosed and treated quickly.

Possible Complications

If paraphimosis is left untreated, it can disrupt blood flow to the tip of the penis. In extreme (and rare) cases, this may lead to:

  • Damage to the penis tip
  • Gangrene
  • Loss of the penis tip

When to Contact a Medical Professional

Go to your local emergency room if this occurs.

Prevention

Returning the foreskin to its normal position after pulling it back may help prevent this condition.

Circumcision, when done correctly, prevents this condition.

References

Elder JS. Anomalies of the penis and urethra. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 544.

McCammon KA, Zuckerman JM, Jordan GH. Surgery of the penis and urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 40.

McCollough M, Sharieff GQ. Genitourinary and renal tract disorders. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 174.


Review Date: 1/30/2017
Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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