What Is Paraphimosis

When the retracted foreskin of an uncircumcised male cannot be returned to its normal anatomic position, you have the urological emergency known as paraphimosis. Prompt intervention is required, as the situation can result in gangrene and amputation of the glans penis.

It's not pretty.

What happens is that retracted foreskin causes causes venous occlusion, edema, and eventual arterial occlusion – the foreskin is constricting the shaft so tightly that the flow of blood to the penis' head is restricted. Worse, it's often caused by health professionals performing a clinical check of the penis or urethra and who simply do not know any better!

But well-meaning caregivers aren't the only culprits. There are reports of coital paraphimosis leading to penile necrosis – cell death – as well as penile piercings leading to paraphimosis. Other cases have been reported sourced to erotic dancing. Most of the cases occur in nursing homes and hospitals, where the prepuce is retracted by a healthcare worker who forgets to reduce it. Often times, the condition will arise after catheterization. Usually the foreskin will reduce on its own, but if there is but the slightest resistance to retraction, paraphimosis is likely, for as the blood pools up, the condition gets worse.

You have not heard much about paraphimosis in the US for the simple reason that most Americans are circumcised. According to the National Hospital Discharge Survey (NHDS), circumcision rates in the US declined from an all-time high of 78-80 percent in the mid-to-late 1960s to 55-60 percent in 2003. The NHDS found that in 1999-2010, 59 percent of newborn boys were circumcised.

So if this happens, what can you do? Early on, of course, you can remedy your situation by simply pulling the foreskin back up where it belongs. If the situation has gotten out of hand – which it can, quickly – you may require an emergency dorsal slit procedure to save the penis.

The dorsal slit – as specific to paraphimosis –  is a vertical incision at the junction of the rolled foreskin (identified as the point between the mucosal, smooth skin and the preputial thicker, dull skin). This releases the constricting skin. The foreskin is then mobilized so that it can slide over the glans and back. The cut edgesare then oversewn.

And let's not put too fine a point on this: a paraphimosis hurts! It will hurt prior to any procedure to alleviate it, and all remedies must needs be preceded by either general or local anesthesia.

Sources: MedScape