Treatment to Resolve Paraphimosis
Medically reviewed by Jamin Brahmbhatt, MD
Paraphimosis is a condition in which the foreskin becomes trapped behind the head of an uncircumcised penis. This can quickly become a medical emergency if left untreated as blood flow to the head of the penis is cut off. It can lead to tissue damage and, in extreme cases, gangrene (tissue death).
Paraphimosis can often be corrected with manual manipulation. Failing this, circumcision (surgical removal of the foreskin) or other procedures may be needed.
This article describes the causes and symptoms of paraphimosis and explains when it is time to seek emergency care. It also offers prevention tips and guidance on how to treat mild paraphimosis at home.
Photo composite by Joules Garcia for Verywell Health; Getty Images
Paraphimosis vs. Phimosis
Paraphimosis should not be confused with phimosis. Phimosis is when the foreskin of a penis is tight and cannot be retracted (pulled back) over the head of the penis. Phimosis is normal in uncircumcised children and usually corrects itself by age 13. In others, phimosis can lead to swelling, pain with erections, and even erectile dysfunction.
Paraphimosis and Risks of Pulled-Back Foreskin
Paraphimosis occurs when the foreskin (prepuce) is pulled and gets stuck behind the head of the penis (glans). This creates a restrictive band around the shaft of the penis, cutting off blood flow and causing painful engorgement of the penis head.
Paraphimosis may occur due to incorrect manipulation of the foreskin or not repositioning it properly after urination or cleansing. This condition can also arise when parents prematurely attempt to retract a child's foreskin that is not yet ready to be pulled back.
Caregivers in adult care homes can sometimes cause paraphimosis by forgetting to restore the foreskin after cleaning older adult residents. The same can occur in healthcare settings after a penile examination or the placement of a urinary catheter.
Paraphimosis can even sometimes occur after sexual intercourse, which some colloquially refer to as "nuptial night tragedy."
Risk factors for paraphimosis include:
A tight foreskin
Phimosis
Foreskin infections
Penile injuries
Reliance on a caregiver for daily cleaning
Urinary catheterization (inserting a flexible tube to empty the bladder)
Related: Causes of a Swollen Penis
Signs and Symptoms of Paraphimosis
Paraphimosis can often go unnoticed when the foreskin entrapment first occurs. Over time, however, the constriction of the penis can cause the glans to swell more and more due to the buildup of fluid (known as edema). Within a relatively short time, mild paraphimosis can turn severe.
When symptoms develop, paraphimosis is easy to detect and causes:
An inability to restore the foreskin back over the head of the penis
Painful swelling of the head of the penis
Increasing swelling with a purplish or bluish discoloration
Penile pain
Difficulty or inability to urinate
When to Seek Medical Care
Paraphimosis can be gradual and cumulative, causing relatively little pain in some people, even when the swelling is severe. Pain should not be the measure of whether paraphimosis is serious or not. If you cannot release the foreskin, do not ignore it or go to bed hoping it will settle. Seek immediate care at your nearest emergency department.
Untreated, Worsening Symptoms
Paraphimosis can lead to serious complications if left untreated. Ongoing swelling and constriction can lead to complete strangulation, in which blood flow to the head of the penis is entirely cut off. The restriction of blood flow, in turn, can cause necrosis (tissue death).
If the strangulation persists, gangrene can start to set in. Gangrene is a type of necrosis in which the breakdown of tissues leads to putrification (the process of decaying or rotting). This usually occurs over the course of days rather than hours.
At this stage, symptoms of paraphimosis may include:
High fever with chills
Blackening of the head of the penis
Severe penile pain
Numbness of the penis head
Shedding of damaged skin
In some cases, partial or complete amputation of the penis is needed to prevent what is known as "gas gangrene." This is a complication of gangrene in which bacteria inside dying tissues produce gases that can lead to shock and death, often within 48 hours.
Even if amputation is not needed, gangrene can cause severe disfiguration of the penis and a loss of sexual function.
Related: What Is That Bump on My Penis?
Emergency Paraphimosis Treatment
The first-line emergency treatment of paraphimosis is manual manipulation, also known as manual reduction. This involves using the hands to compress penis head while moving the foreskin back to its normal position. The process may be aided with a lubricant, compression bandages, and a cold compress.
If the pain is severe, an injection of a local anesthetic into the shaft of the penis may be used. A topical numbing cream containing lidocaine is especially useful in children.
If edema is severe, an injection of hyaluronidase into the head of the penis can help. This is an enzyme that breaks down compounds that contribute to edema, allowing trapped fluids to be reabsorbed by tissues.
Failing these interventions, surgery may be needed to release the trapped foreskin. There are two options commonly used: dorsal slit and circumcision.
Dorsal Slit
Dorsal slit is a simple procedure in which the outer rim of the foreskin is cut to widen the opening. It can be done in the office with local anesthesia or in the operating room under general anesthesia. This method is often elected by individuals who wish to keep their foreskins while addressing conditions like phimosis or paraphimosis.
In emergency situations, a dorsal slit may be the initial treatment option. If the dorsal slit does not sufficiently resolve the issue, then circumcision can be considered as a future option. This approach provides a stepwise strategy for treatment, starting with less invasive measures.
Circumcision
Circumcision is a surgical procedure involving the complete removal of the foreskin. It uses precise cuts with a scalpel, followed by stitches to aid healing. This definitive method effectively prevents the recurrence of paraphimosis.
In severe cases, particularly when other treatments are ineffective, circumcision may be the necessary course of action.
Circumcision or Not?
The decision to undergo circumcision, even in emergency situations, can be difficult based on your religious, cultural, or personal beliefs. It is important to understand, however, that circumcision does not reduce penile sensitivity or sexual function, as some people may believe.
If you are in a situation in which circumcision is advised and you want to keep your foreskin, ask the surgeon if a dorsal slit is a reasonable option and, if not, why.
Related: Circumcision: 6 Factors to Consider
Treating Mild Paraphimosis at Home
Paraphimosis can sometimes be treated at home with manual reduction if the swelling is relatively mild. The steps, as follow, are similar to what would be performed at a hospital emergency department and may be suitable for adults and children:
Wrap the penis snugly in plastic wrap to gently compress it without causing pain.
Apply an ice pack on the swollen areas for no more than 10 to 15 minutes. Keep the ice pack moving and place a cloth between the skin and the ice pack to prevent frostbite. You can apply the ice pack several times, waiting 30 to 40 minutes between applications.
When the swelling goes down, remove the plastic wrap.
Wash your hands and put on a pair of surgical gloves if you have any. If your nails are long, trim them.
Using both hands, hold the penis securely using your middle and index fingers. For children, one hand will usually do.
Next, apply steady, gentle pressure with one thumb to push the head through the opening of the foreskin while using the other thumb to encourage movement of the foreskin toward you.
You can use a personal lubricant to reduce friction but avoid lotions or soaps that can cause stinging if they get into the opening of the penis.
If these measures don't work, seek emergency care. Do not continue if the reduction causes pain or the swelling gets worse.
Even if you are able to reduce at home, to avoid future occurrences, make an appointment with a healthcare provider to discuss circumcision.
When to Roll Foreskin Back Down
The foreskin is meant to retract, and doing so is a part of good penile hygiene. This allows the head of the penis to be cleaned of accumulated oils and dead skin cells (called smegma). This, in turn, prevents infection, unpleasant odors, or inflammation of the penis head, known as balanitis.
Pulling the foreskin back also avoids dribbling while peeing and prevents urine from pooling in the foreskin, which can irritate the head.
For most uncircumcised people, the foreskin also retracts manually or on its own during an erection, exposing the sensitive head to stimulation during sexual intercourse.
Foreskin retraction also allows for an examination of the penis by a urologist, medical procedures like cystoscopy, or the placement of a urinary catheter.
To this end, proper foreskin care is needed to reduce your risk of paraphimosis. This includes:
Regularly cleaning the head and inner foreskin with water and a gentle soap
Always pulling the foreskin back over the head after cleaning, peeing, or having sex
Ensuring that healthcare providers or caregivers return the foreskin to its normal position after an exam, procedure, or cleaning
Never leaving the foreskin behind the head of the penis for extended periods
Teaching your child how to care for their foreskin if uncircumcised
If any of these are issues for you, you may want to consider circumcision, which is the only guaranteed way to prevent paraphimosis.
Related: Pros and Cons of Circumcision
Summary
Paraphimosis is a medical emergency where the foreskin of the penis gets stuck behind the head. This cuts off circulation and causes pain, redness, and swelling of the penis head. If left untreated, paraphimosis can lead to tissue death and, in extreme cases, gangrene.
Paraphimosis can often be treated with manual manipulation to gently ease the foreskin back over the head. If this doesn't help, surgery may be needed, including circumcision.
Related: 11 Penile Disorders You Should Know About
Read the original article on Verywell Health.
