Phimosis

Phimosis
Phimosis is the inability to retract the foreskin over the glans penis due to narrowing, constriction, and or adhesions. Forceful retraction of the phimotic foreskin during infancy is ill advised and may result in fissures and eventual scarring of the distal foreskin. Poor genital hygiene may result in chronic infection causing adhesions between inner foreskin and underlying glans penis as well as fibrosis resulting inability to retract foreskin. Complication of phimosis includes balanitis, posthitis, paraphimosis, voiding dysfunction, and penile carcinoma.
Patient may present with complains of erythema, itching, discharge, or pain.
Minor phimosis can be managed with improved genital hygiene and sometimes topical application of corticosteroid cream. Mild balanoposthitis can be treated with broad spectrum oral antibiotics. Severe balanitis may require emergency dorsal slit circumcision aided by local anesthesia. Elective circumcision should be considered for persistent symptoms or recurrent infection.
Paraphimosis
Refer to retracted foreskin becoming trapped proximal to the glans penis resulting in edema, inflammation, and pain. Left untreated it can progress to ischemia of the glans penis and eventual gangrene. Treatment consists of initial firm compression to decrease edema followed by manual reduction often aided by placement of a lubricant at the level of the proximal glans penis. However, dry gloved hand are essential in gaining traction of the outer foreskin when pulling it back over the glans into the anatomic position. In rare instances direct incision of the constricting band may be necessary to allow manual retraction. Paraphimosis is frequently the result of partially phimotic foreskin and election circumcision may be indicated.