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Paraphimosis

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

Causes, incidence, and risk factors

Causes of paraphimosis include:

  • Direct trauma to the area
  • Failure to return the foreskin to its normal location after urination or washing (most common in hospitals and nursing homes)
  • Infection, which may be due to poor personal hygiene

Uncircumcised males, and those who may not have been correctly or completely circumcised, are at risk.

Paraphimosis occurs most often in children and the elderly.

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

Signs and tests

A physical examination 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 (compression of) the head of the penis while pushing the foreskin forward may reduce the swelling due to paraphimosis. If this fails, prompt surgical circumcision will be needed.

Expectations (prognosis)

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

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

Calling your health care provider

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, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 538.

Link RE. Cutaneous diseases of the external genitalia. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 15. 

Jordan GH. McCammon KA. Surgery of the penis and urethra. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 36. 

Updated: 10/9/2012

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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