Basic understanding of the Phymosis and Paraphymosis (2021 update)

         Phymosis is a condition where the foreskin is too tight to be pulled back over the head of the penis. Phymosis is normal in babies and toddlers, but in older children it may be the result of a skin condition that has caused scarring. It is usually not a problem unless it causes symptoms.

         Most uncircumcised baby boys have a foreskin that will not retract because it is attached to the glans.This is perfectly normal for about the first 2 to 6 years. By around the age of 2, the foreskin should start to separate naturally from the glans.The foreskin of some boys can take longer to separate, but this does not mean that this is a problem, it will just detach at a later stage.

        NEVER TRY TO FORCE YOUR CHILD'S FORESKIN BACK BEFORE IT IS READY  BECAUSE IT MAY BE PAINFULL AND DAMAGE THE FORESKIN!!!

        Phymosis  is not usually a problem unless it causes symptoms  such as redness, soreness and swelling.If your child's glans is sore and inflamed, they may have balanitis (inflammationvof the head of the penis).There may also be a thick discharge underneath the foreskin. If both the glans and foreskin are inflamed, it is known as balanoposthitis. 

        Most cases of balanitis can be easily managed using a combination of good hygiene, creams or ointments , and avoiding substances that irritate the penis. Balanoposthitis can also sometimes be treated by following simple hygiene measures, such as keeping the penis clean by regularly washing it with water and a mild soap or moisturiser.

        SURGERY

        May be needed if a child  has severe or persistent balanitis or balanoposthitis that causes the foreskin to be painfully tight. There are 2 procedures that are usually performed:

       1.Duhammel's dorsal debridation - in which after anaesthesia the surgeon retracts the foreskin and make an incision on the dorsal part of the forskin in order to remove the strangulation ring that the foreskin is making around the glans.

       2.Circumcision - in which after anaesthesia the surgeon removes all the foreskin . These procedure is performed if usually the Duhammel's dorsald debridation has failed or in ritual cases.

                 

        PARAPHYMOSIS

        Paraphymosis is where the foreskin cannot be returned to its original position after being retracted. It causes the gland  to become painful and swollen . 

        PARAPHYMOSIS IS A SURGICAL EMERGENCY !!!

        It may be possible to reduce pain and inflammation by applying a local anaesthetic gel to the penis and pressing on the glans while pushing the foreskin forward. In difficult cases , it may be necessary to make a small slit in the foreskin to help relieve the pressure. In severe cases of paraphymosis , circumcision may be recomended. In very severe cases of paraphymosis, a lack of blood flow to the penis can cause tissue death (gangrene) and surgical removal of the penis may be necessary.