Paraphimosis

Paraphimosis is a painful condition that causes your foreskin to become trapped behind the head (glans) of your penis. If you have paraphimosis, you can’t pull your foreskin down to cover the end of your penis. It can cut off the delivery of blood and oxygen (circulation) to the tip of your penis.

Paraphimosis is a medical emergency. If you have symptoms of paraphimosis, get medical help immediately.

Paraphimosis is rare. About 0.2% of uncircumcised children between 4 months and 12 years old will have paraphimosis. Circumcision is a procedure that removes the foreskin, which usually occurs shortly after birth.

For uncircumcised males 16 and older, the rate of paraphimosis rises to 1%. This is still rarer than other penile disorders that can affect your foreskin, including:

• Balanitis (about 6%)
• Penile adhesions (1.5%)
• Phimosis (about 2.5%)

What are the symptoms of paraphimosis?

The main symptom of paraphimosis is you can’t pull your foreskin forward into its proper place over the tip of your penis (foreskin reduction).

Other paraphimosis symptoms include:

• Pain, which may be severe
• Discoloration (blue, purple, black or brown)

What are the causes?

Paraphimosis often happens when you pull back your foreskin to clean under it or if you’re trying to stretch your foreskin because it’s too tight. It can also happen during certain medical procedures in which a healthcare provider has to move your foreskin, like catheterization.

Other paraphimosis causes may include:

• Infection
• Physical trauma to your penis
• Using too much force to pull your foreskin back
• Forgetting to pull foreskin back over the tip of your penis

Who does it affect?

Paraphimosis affects people who have partially circumcised or completely uncircumcised penises.

What are the complications of paraphimosis?

Without immediate medical treatment, paraphimosis may:

• Impact lymph drainage
• Affect the amount of blood that flows to your penis (ischemia)
• Penile tissue death (necrosis)

How is paraphimosis diagnosed?

Paraphimosis symptoms are typically obvious. You’ll likely notice swelling or discomfort in your penis. A healthcare provider can diagnose paraphimosis after reviewing your symptoms and examining your penis.

Paraphimosis is an emergency. So, when you contact a provider and describe your symptoms, they’ll likely tell you to go to the emergency room right away for treatment.

How do you fix paraphimosis?

To treat paraphimosis, a healthcare provider may recommend treatments like:

• Using a solution to reduce swelling
• Squeezing or pinching the tip of your penis to help the foreskin move back into its typical position over the tip of your penis
• Using a surgical knife (scalpel) to make a slit in the top part of your foreskin from the rounded border at the bottom of your glans (corona) to the tip of your penis (dorsal slit)
• Circumcision to remove some or all of your foreskin

If you’ve had paraphimosis, it’s likely to come back (recur). A provider may suggest removing some or all of your foreskin. If you aren’t a good candidate for circumcision, a dorsal slit will prevent paraphimosis from coming back.

Should I use ice?

Although ice can reduce swelling, it’s not the best way to treat paraphimosis. It can make your blood flow worse.

Can it go away on its own?

No, paraphimosis can’t go away on its own. You must get medical treatment as quickly as possible to treat paraphimosis.

What are some of the complications or side effects of treatment?

Circumcision and dorsal slit are safe procedures. But every type of surgery has risks. Potential circumcision and dorsal slit risks include:

• Bleeding (hemorrhage)
• Infection
• Pain
• Inflammation at the tip of your penis (meatitis)
• The opening at the tip of your penis (meatus) gets smaller (meatal stenosis)

Can paraphimosis be prevented?

Circumcision is the only way to completely prevent paraphimosis. But if you have foreskin, you can help prevent paraphimosis by:

• Ensuring you pull your foreskin down after catheterization, examination or any other type of procedure on your penis
• Pulling your foreskin down after cleaning your penis, doing foreskin-stretching exercises, sexual intercourse or peeing
• Never leaving your foreskin in a retracted position any longer than you need to for cleaning or any other reason
• Cleaning the tip of your penis regularly

How bad is paraphimosis?

With quick, proper treatment, the outlook for paraphimosis is very good. But if you can’t put your foreskin back into position by yourself after treatment, you run the risk of getting paraphimosis again. That’s why healthcare providers usually suggest circumcision.

When should I see a healthcare provider?

Contact a healthcare provider as soon as possible if you can’t move your foreskin back into place. You’ll likely need to see a provider right away or go to the nearest emergency room for treatment.

If you still have your foreskin after treatment, there’s a good chance that paraphimosis can come back. Reach out to a provider quickly if your symptoms return.

If your paraphimosis treatment requires circumcision, call a provider if:

• You have signs of infection, including a fever, chills, swelling, pus or discoloration (red, purple, brown, black) in your affected area
• Bleeding that doesn’t stop
• You have problems peeing again 12 hours after the procedure

What questions should I ask a healthcare provider?

You may want to ask your provider:

• Does my penis have permanent damage?
• How likely is it that paraphimosis will come back?
• Will I be able to keep my foreskin?
• Do I need a dorsal slit or a circumcision?

What happens if you never pull back your foreskin?

In children, you usually can’t pull the foreskin back until they’re at least 5 years old. But sometimes, they may not be able to pull it back until they’re 10 or until their teenage years.

Once you can retract your foreskin, it’s important to clean underneath it to prevent oil, dead skin cells, sweat and other fluids (smegma) from building up. Cleaning also helps prevent inflammation from developing on your penis, including your:

• Glans (balanitis)
• Foreskin (posthitis)
• Glans and foreskin (balanoposthitis)

What is the difference between paraphimosis and phimosis?

Paraphimosis and phimosis are both conditions that affect your foreskin. But paraphimosis is a medical emergency. Phimosis isn’t.

Phimosis can happen when you have an uncircumcised or partially circumcised penis. You can’t pull the foreskin back to reveal the head of your penis. Babies have phimosis at birth, and their foreskin usually loosens as they get older. But you may develop phimosis from infections (including sexually transmitted infections) or scarring.

Phimosis treatment usually involves applying a corticosteroid cream or gel to your penis or antibiotics if you have an infection. If those don’t work, you may need a circumcision.

How do you fix paraphimosis at home?

You can’t fix paraphimosis at home. Get medical help as soon as you can if you have paraphimosis symptoms.