Phimosis – when the foreskin is too tight
Phimosis is the term for a narrowing of the foreskin on the Penis, which makes it not over the glans slide back. In babies and young children, phimosis is a normal condition – most of the time, the foreskin detaches in the kindergarten age alone. Even in adults, such a constriction of the Foreskin may occur. Cause scarring, as a result of inflammation or injury to the Penis is usually.
In children, phimosis can be treated by an ointment and gentle Stretching of the foreskin. A circumcision surgery is usually only necessary if complications occur such as recurrent inflammation.
What is a phimosis?
A phimosis refers to a foreskin narrowing, through which the foreskin can not (absolute phimosis), or only incomplete or more difficult (relative phimosis) over the glans to pull back.
95 percent of all male newborns come with a phimosis to the world, which grows in most of the cases, up to school age. Up to the age of three to five years, a phimosis as a physio is not considered to be logical (morbidly).
Phimosis in children is often
A phimosis is common in children: In the sixth year, eight percent of children have a constriction of the Foreskin, with 16 years, still a percentage of young people is affected.
Why in some children the congenital constriction of the Foreskin or too late releases is not known.
Lichen sclerosus as a cause
A phimosis occurs for the first time in the school age, may be a so-called Lichen sclerosus the cause. This chronic inflammatory skin disease can affect, among other things, the genital area and lead to boys and men, a keratinization and hardening of the foreskin.
Other signs of Lichen sclerosus is off-white, hard skin elevations that occur on the back, neck, and genitals. The disease can be due to an ointment with cortisone treated.
Scars as a cause in adults
A recent phimosis in adulthood is often due to scarring of the foreskin, which may be caused by recurring inflammation of the Penis. Also by injury of the foreskin – such as by forcing it Back can occur scars. Therefore, a stretching of the foreskin should always be performed very carefully.
Adults with phimosis should be examined in addition to Diabetes mellitus, because diabetics have an increased risk for infections particularly in the genital area, resulting in a phimosis is favored.
Signs of phimosis
The main symptom of phimosis is not, or is difficult to back-sliding foreskin. In the case of an absolute phimosis the glans, and, where appropriate, the urethral opening not be visible.
In adolescents and adult men, it may thus, under certain circumstances, to pain during erection, during intercourse or during Masturbation.
Complications: inflammation, and urinary retention
A phimosis can lead to problems with urination, if the urine can not flow out because of the narrowed foreskin right: signs, a thin or deflected urine stream, as well as a “bloated” foreskin, under which the urine collects. In the extreme case, no or only a droplet-by-step water is possible – in such an acute urinary surgery is retention then usually necessary.
Due to the restriction of the urinary outflow a phimosis urinary tract infections can cause such as a bladder infection. In addition, a phimosis complicates the intimate hygiene Under the foreskin can accumulate a mixture of glandular secretions and dead skin cells (called Smegma), which forms an ideal breeding ground for bacteria. So it can easily come to an inflammation of the glans and foreskin (Balanoposthitis).
If there are no complaints or complications occur, must not be treated phimosis in young children: a problem-free can be maintained with a treatment, even up to elementary school age.
By the age of seven to eight years of the beginning of a therapy is recommended, as up to this age a non-operative (conservative) treatment is more likely to be successful than in older children. It is also useful to treat a phimosis before the age of puberty, since a narrowed foreskin can lead to the start of the sexuality complaints.
Treatment by ointment and stretching
In a child with uncomplicated course of phimosis can usually be tried initially, a conservative treatment. Here, about four to eight weeks, is applied twice a day an ointment or cream with cortisone-like drugs such as betamethasone on foreskin ring.
After two weeks, the parents can begin to stretch the foreskin gently and try to push back. Avoid stretching therapy, but, in any case, a violent pull Back, as it can lead to cracks in the foreskin or in the worst case, to a Constriction of the glans by the constricted foreskin (paraphimosis).
Phimosis: OP in some cases, essential
The conservative treatment is not successful or complications, is usually an Operation is necessary. In General, a phimosis should be operated in the following cases:
- Recurrent urinary tract infections or inflammation of the Penis
- Malformations of the urinary tract with increased risk for urinary tract infections
- Obstruction of urination with the “Ballooning” of the foreskin
- Lichen sclerosus
- Scarring on glans and foreskin
A certain age, when one should operate a phimosis. The decision for or against surgery is done individually depending on the complaints and clinical picture. Adults with phimosis, however, as a rule, treated by surgery, since you usually scars or Lichen sclerosus are the cause.
Surgery: circumcision or foreskin plastic
During the Operation a phimosis, various methods are available for selection: most commonly, performed a circumcision (Circumcision), in which the foreskin is either completely or partially removed. Parts of the foreskin are received, may, under certain circumstances, again is a phimosis occur (relapse).
Another possibility with preservation of the foreskin called the foreskin plastic: the foreskin is sutured in multiple longitudinal cut and expanded. Here, the increased risk of recurrence due to scar formation. The procedures are usually carried out in children in a short General anesthesia in an adult man is also an Operation in local anesthesia is possible.
A Paraphimosis (“Spanish collar”) refers to the Constriction or strangulation of the glans in the case of a phimosis. The cause is usually forced Back the foreskin, the the narrowing is not back to the front of the slide. It is a lacing ring that interferes with blood outflow. This manifests itself through a swollen, bluish-red tip of the penis and strong pain.
A Paraphimosis is an emergency and must be repaired without delay by a urologist, tissue damage can occur. The urologist will then try to correct the paraphimosis by Hand – for severe pain if necessary, an anesthetic may be used at Affected. The paraphimosis cannot be solved, is usually performed, a small incision of the foreskin.