Paraphimosis is a condition in which the constricted foreskin of the penis was pushed back and the glans of the penis is pinched or constricted.

This causes the glans and the retracted foreskin to swell painfully. Often the paraphimosis is one Phimosis, a narrowed foreskin, at the bottom. A paraphimosis is a urological emergency and needs quick medical and professional help, otherwise the glans is threatened to die off.

Symptoms of paraphimosis

Paraphimosis was formerly known as the Spanish collar, as its appearance is reminiscent of a broad ruff worn by Spanish nobles in the 15th century. This Spanish collar forms when a Constriction of the foreskin (phimosis) exists and the foreskin is withdrawn from the glans and is not returned to its original position. Then the too tight foreskin forms one Lacing ring behind the glans around the penis shaft. In the following, this constriction of the Blood drainage from the glans and the foreskin preventedwhich is why it becomes a swelling both the foreskin and the glans. Now the vicious circle closes, because now the foreskin is difficult to push back over the glans. However, this situation must be remedied quickly, because otherwise enough fresh blood (arterial blood) to supply the penis and the glans can no longer reach the glans and the Glans die off (necrosis, gangrene).

The withdrawn glans prevents blood from flowing out of the glans. This creates a very painful swelling of the foreskin and the glans because the tissue fluid (colloquially: water retention) collects there and cannot be transported away.

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If the paraphimosis persists for a long time, the supply of arterial blood, in which nutrients and oxygen are transported, also dry up. The foreskin and glans then turn bluish - black and are in acute danger. In summary, the symptoms are mainly swelling, pain and, in later stages, discoloration.

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Causes of Paraphimosis

Often paraphimosis develops if one is forgotten tight foreskin, which was pushed back as part of hygienic measures, to touch the glans again. But it can also go through medical manipulation happened in which the repositioning of the foreskin was forgotten after inserting an indwelling urinary catheter.

With children It can happen that a paraphimosis is caused when a manual attempt is made to remove a phimosis (narrowing of the foreskin), which may not actually be present.

From sexual maturity, paraphimosis can also occur Masturbation arise or during or after Sexual intercourse be evoked. In connection with sexual activity, paraphimoses are also possible in people who have no signs of a constricted foreskin when not erect, but whose foreskin constriction is based on the penis during erection increases in size.

Diagnosis of paraphimosis

This is important for a doctor in the process of making a diagnosis Conversation with the patient. As part of this conversation, the doctor usually finds the first clues that speak for a paraphimosis, such as a slight forehead tightness or one Phimosis. Often times the patient describes it as part of an erection (regardless of whether it was masturbation or sexual intercourse) this clinical picture developed.

The preliminary diagnosis after this interview is made by the doctor physical examination, so the Inspection of the penis, supported. Paraphimosis can be recognized by the swollen glans and the swollen foreskin, which is wrapped around the penis shaft as a lace ring and is a visual diagnosis.

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Therapy of paraphimosis

Conservative therapy - reduction

The Reduction, i.e. pushing the foreskin back over the glans, is therapeutically essential. In addition, the reduction should be as possible fast otherwise the Death of the glans and foreskin threatens.

There are several ways in which a reduction can be made. For one thing, you can be conservative, so non-surgical reposition, on the other hand you can operational reposition. First, however, an attempt should be made to reverse the paraphimosis conservatively.

Under no circumstances should you try to permanently reverse the paraphimosis without medical help. If an attempt by the person concerned is unsuccessful, a urologist should be consulted. Cooling measures on the way to the doctor can help.

This engagement is very painfulwhich is why at least one local anesthesia given to numb the nerves supplying the penis. With this conservative, manual reduction, the glans are pressed down while pulling the foreskin forward. To make it easier for the glans to slide back, the glans is usually greased a little beforehand, for example with Vaseline, and the edema is piqued. This means that one tries to express the water retention very carefully with a fine cannula. If a manual reduction does not succeed after a few short-term attempts, the paraphimosis must be treated surgically.

Operative therapy - emergency surgery

Every paraphimosis is an emergency because the Vitality of the penis components Foreskin and glans is acutely threatened. The longer a paraphimosis remains untreated, the higher the risk of irreversible damage to the structures involved.

Surgery will be necessary if the manual repositioning attempt without success stayed. As part of this surgical procedure, the incised foreskin that has become a lace ringso that blood flow can resume. If necessary, in this operation, if desired by the patient or his relatives, one can also be performed in the same operation clipping be made to prevent recurrence of paraphimosis to prevent. Even after a successful manual attempt at repositioning, the patient or, in the case of a child, their relatives should consult a urologist about whether circumcision would not make sense over the long term to prevent further paraphimosis. If the paraphimosis has lasted too long and the Glans and foreskin dead must always be operated on immediately become.

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Paraphimosis in the infant and child

In early infancy and childhood, the foreskin is often stuck to the glans (96%). Do not try to forcibly separate the foreskin from the glans.

This early gluing, or foreskin tightening, dissolves in most boys by the age of three to five by itself on. Phimosis is only present in 8% of male children.

With The frequency decreases with increasing age for the appearance of phimosis.If the foreskin does not detach easily from the glans, no attempt should be made to push the foreskin back forcibly, as this can cause the tight foreskin to wrap around the shaft of the penis and develop paraphimosis.

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Paraphimosis in the adult

In an adult man, the foreskin should be easy and painless in every condition over the glans and let it lead back. If this is not the case, it is called phimosis, which can either be congenital or during life from scarring may have arisen. With foreskin constrictions in adulthood, erections are painful for the person concerned. Paraphimoses often develop in adults through erections or if it is forgotten to push the foreskin back over the glans after nursing or medical interventions.

Consequences of paraphimosis

The consequences of paraphimosis depend on how long this condition has lasted. When a paraphimosis quickly repositioned are those Consequences low.

Infections of the foreskin or glans can develop, but this should prevent urological follow-up care. Even if in this case the obvious consequences or consequential damage fortunately did not occur, the patient or his relatives should talk to the doctor about a clipping speak to prevent further paraphimosis.

If a paraphimosis had to be surgically reduced, the healing process must go to one problem-free wound healing Be careful to avoid infection.

Paraphimoses that last too long can do that Death of the foreskin and glans have as a consequence. The skin initially changes color bluish-blackish. At this stage, surgery is absolutely necessary and the consequences are dramatic.

It follows from this: In order to prevent lasting consequences of paraphimosis, one should try to reposition as soon as possible dare and if this does not work, see a doctor immediately. In this case, shame or embarrassment leads to dramatic consequences that could have been avoided with professional help.