Phimosis

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Phimosis
Body Parts: Reproductive Site
Medical Subjects: Men's Health
Overview

What Is Phimosis?

Phimosis refers to the fact that the external orifice of the foreskin is too small, or the foreskin is adhered to the glans penis, and the foreskin cannot be turned upward and outward to expose the complete glans penis. 

Phimosis can be divided into physiological and pathological types. The former is found in newborns. At one year old, about 50% of boys' foreskin can be turned up to reveal the penis head, and the proportion rises to 89% at three years old.

If the foreskin can't be everted after puberty, or it can be everted before, but it can't be everted now, it may be pathological phimosis. Pathological phimosis is usually caused by chronic inflammation, because scar tissue is formed at the distal end of foreskin, which makes it impossible to evert.

What harm does phimosis have?

  • Cause inflammation. The foreskin secretes a large amount of sebum, and phimosis makes sebum difficult to discharge, which leads to balanitis, dermatitis and urinary tract infection. Repeated foreskin inflammation easily leads to adhesion between glans penis and foreskin. Chronic stimulation of smegma can also induce penile cancer, and even induce cervical cancer of spouse.
  • May affect sex life. The foreskin binds the glans, which may affect the erection of the penis, and will have certain effects on sexual life, such as pain during intercourse and premature ejaculation. However, there is currently no medical evidence that circumcision can help improve premature ejaculation.

Does phimosis affect penis development?

Whether it will affect penis development is still controversial in the medical field. First of all, it should be made clear that phimosis does not affect the thickness and size of the corpus cavernosum, and from this point of view, it has no effect on development. However, phimosis may limit the position of the corpus cavernosum, and make the penis lean backward, thus "looking small".

Cause

What Causes Phimosis?

Phimosis in infants is actually a very common and normal phenomenon, generally self-healing after the age of 3. Acquired phimosis is mainly caused by dermatitis caused by overlong foreskin and injury of foreskin and glans penis. Foreskin mouth because of injury, caused by the scar, will lead to foreskin mouth contraction scar contracture, and lose the elasticity of the skin and expansion ability, foreskin can not retreat upward, with urethral stricture, dysuria.

Does phimosis exist at birth?

Yes Under normal circumstances, infants' foreskin and glans penis adhere to each other rationally and naturally, and the urethral orifice is small, making it difficult to expose the glans penis. With the development of the body, the prepuce mouth will gradually become larger, and the prepuce will retreat upwards to reveal the glans penis, thus gradually separating the prepuce from the glans penis. Generally speaking, at the age of 3, the foreskin of most children can shrink and turn up.

Symptom

What Are The Symptoms Of Phimosis?

Does phimosis affect sexual function?

Not necessarily.

Phimosis refers to the fact that the outer mouth of the foreskin is too small, or the foreskin adheres to the glans penis, so that the foreskin cannot be turned up and out to reveal the complete glans penis. The phimosis itself is asymptomatic. But people often worry about affecting sexual function.

There are many factors affecting male sexual function, and there are still many controversies in the medical field, which need more research to confirm.

Basically, phimosis will not affect erection, because erection of penis has nothing to do with foreskin.

Phimosis may be related to premature ejaculation, but it is not absolutely related, and the medical profession has proved that circumcision is ineffective in treating premature ejaculation.

If phimosis and prepuce are too long, prepuce incarceration may occur, so what is prepuce incarceration?

Foreskin incarceration often occurs in sexual life or under other conditions, if forced to turn over the long foreskin, in the case of not timely recovery, narrow foreskin mouth will be tight hoop in the penis of the coronal groove, hinder blood circulation, leading to distal foreskin and glans swelling, this kind of situation is called foreskin incarceration.

Does phimosis affect fertility?

Generally speaking, adult phimosis patients can also complete ejaculation, which has no effect on fertility. But phimosis can affect sexual life.

Can phimosis and excessive prepuce induce penile cancer?

The foreskin is too long or phimosis, which is easy to accumulate smegma. Long-term chronic stimulation of smegma may induce penile cancer. It is suggested that people with excessive foreskin should be turned it up and cleaned every day to keep local cleanliness. For phimosis patients, it is recommended to perform surgery in childhood.

Detect

How To Diagnose Phimosis?

If the foreskin can't turn up and out to reveal the complete glans penis, it can be diagnosed.

What diseases should phimosis be distinguished from?

The following two cases should be carefully identified with phimosis:

  • The foreskin is too long. If the foreskin is too long, the foreskin can be opened by hand to completely expose the glans, but the phimosis cannot.
  • Occult penis. This type is most easily confused with phimosis, and occult penis can also coexist with phimosis. Both of them have narrow prepuce mouth, but the penis of patients with concealed penis is hidden under the skin, and its appearance is short. The prepuce wraps the glans penis like a bird's mouth, which is not attached to the penis body, resulting in emptiness under the prepuce, which makes it difficult to touch the penis body by hand. Occult penis and phimosis need to be distinguished carefully, because they are treated in very different ways.
Prevention

How To Prevent Phimosis (acquired)?

Acquired phimosis is mostly caused by excessive prepuce, because excessive prepuce easily leads to dermatitis, prepuce and glans penis injury, and finally causes phimosis. So in theory, it can be prevented.

Pay attention to the cleanliness of penis at ordinary times and wash it frequently. If the foreskin can't be turned up, don't do it force. If it can be turned up, the foreskin should be restored to its original position after cleaning, so as to avoid impaction and damage.

Treatment

How To Treat Phimosis?

Does phimosis have to be operated on?

Forcibly turning or surgery is generally not recommended for children before the age of 2.

Because phimosis is easy to hide smegma, which causes dermatitis, balanitis and urinary tract infection, it is suggested that surgery be performed before puberty. Even though the external genitalia of adults has stopped developing, phimosis may still cause infection and affect sexual function, so surgical treatment is recommended.

If phimosis has caused dysuria and inflammation, surgical treatment should be considered as soon as possible.

What is the hand turning treatment of phimosis?

Hand turning method for treating phimosis refers to pulling the foreskin upward when bathing a child, washing the penis head with warm water, then trying to turn the foreskin upward with a little effort, and stopping if the child cries. After cleaning the smegma, restore the foreskin. Pay attention to the gentle operation, step by step, do not be too eager to turn the foreskin up. After persisting for a period of time, the narrow mouth of foreskin will gradually expand, and phimosis can be gradually cured after being treated by this method.

How old is it for children to have surgery, if phimosis and foreskin are too long?

Strictly speaking, the foreskin is too long and phimosis does not limit the specific operation time. If the foreskin is too long, if you clean the skin scale every day and pay attention to cleanliness, you can avoid surgery. Patients with phimosis can consider surgery according to their specific conditions. For example, children with phimosis often have dysuria, repeated infection, etc., and need timely surgical treatment.

There are cases where surgery must be performed:

  • Secondary phimosis (phimosis caused by infection and injury of foreskin and glans penis).
  • Repeated foreskin balanitis, urinary tract infection or combined with urinary tract structural abnormalities.

Surgery cannot be performed under the following conditions:

Acute local infection, congenital deformity of penis, hypospadias or concealed penis. At this point, the foreskin may need to be used for reconstructive surgery, and it is not recommended to perform surgical resection first.

Which operations can treat phimosis? What kind of surgery is better?

The right way for patients is bester, which requires the judgment of specialists in regular hospitals. At present, there are mainly the following surgical methods used in clinic:

  • Traditional circumcision is the most common, with good healing and quick recovery. Children under five years old need general anesthesia because they are difficult to cooperate under local anesthesia.
  • Prepuce cerclage: It is easy to operate without suture. However, it should be noted that after taking a bath, the foreskin should be dried with a hair dryer to avoid infection. This method is more suitable for children.
  • Laser sleeve circumcision: The bleeding during the operation was less, and the subcutaneous foreign body residue caused by excessive ligation of blood vessels was avoided. The visual field during the operation was clear, the cutting edges were tidy, and the postoperative healing was beautiful. However, the operation is complex and takes a long time. The high temperature generated by laser cauterizes the tissue, resulting in prolonged tissue healing time. Non-healing, infection, and dehiscence of the wound may also occur after the operation.
  • Simple expansion method: less used. The narrow foreskin opening is expanded by using the blood vessel forceps, so that the narrow foreskin opening is opened and expanded. The operation time is short and the injury is small, but the foreskin is easily edematous after the operation, and the foreskin mouth still has the possibility of retraction or adhesion.
  • In case of severe and emergency foreskin incarceration, dorsal circumcision or circumcision may be required.

What check need to do before circumcision operation?

Routine andrology should be performed before circumcision to confirm the diagnosis and routine urine tests if necessary to avoid secondary infection after surgery. Coagulation should also be examined in patients with a history of coagulation abnormalities.

What should I pay attention to before phimosis operation?

  • If the foreskin is inflamed or infected before phimosis surgery, it may cause complications such as wound nonunion or aggravation of infection after surgery. It is suggested that anti-infection treatment should be performed first, and then surgery should be performed after inflammation is controlled or subsided.

  • A few days before operation, external genitalia and foreskin should be cleaned frequently to keep them clean and hygienic, so as to reduce the incidence of postoperative infection.

  • In addition, it's best to wear loose underwear on the day of operation, keep a good attitude, and don't be too nervous.

What other diseases may be caused after phimosis surgery?

At present, the main surgical methods for the treatment of phimosis are traditional circumcision, prepuce cerclage and laser sleeve circumcision, each of which has its own advantages and disadvantages.

Traditional circumcision

  • Pain, bleeding, infection or wound dehiscence, foreskin edema.
  • Excessive circumcision may result in sensory changes or loss.
  • Downward curve of penis caused by irregular incision and short frenum.
  • Intraoperative accidents can also cause damage to the glans or penis.

Prepuce cerclage

  • The wound healing time is rather long, and obvious pain occurs when the ring is detached.
  • Postoperative infection, easy slippage of prepuce ring after operation, leading to bleeding, wound dehiscence, prepuce edema and laceration.

Laser sleeve circumcision

Postoperative bleeding, infection, wound dehiscence, etc.

Can premature ejaculation be improved after circumcision?

Some patients have been improved after operation, but the exact mechanism is unclear, which may be related to the keratinization of skin at glans penis and the reduction of sensitivity. But at present, its effect is uncertain, there is no reliable medical evidence to prove it, and there is still controversy.

Why do some penis swell up after circumcision?

If the penis is swollen after circumcision, the most common case is edema of foreskin. The main reasons are large wound in operation and early release of bandage after operation. If this happens, don't worry too much, use a bandage to compress it until the edema disappears slowly.

Does the foreskin frenulum need treatment if it is too short?

Patients with short foreskin frenulum often have phimosis and long foreskin at the same time. If it affects normal sexual life, or if foreskin balanitis occurs repeatedly, surgery can be used to extend the frenulum.

Life

What Should Phimosis Patients Pay Attention To In Their Lives?

Sometimes a small lump can be touched on the penis of phimosis infant. What is that?

This kind of hard block is common in the following situations:

  • Smegma. The most common, because phimosis in infants and young children is very common, the sebum secreted by the foreskin is not easy to be discharged, and it will form a small lump when it accumulates in the foreskin, and the lump can be pushed.
  • Cysts of the foreskin or urethral meatus. Cysts are fixed in position and may grow in size and may require surgical treatment.
  • Tumors. Rarely, it usually feels hard, the lump is difficult to push, and it can increase rapidly in a short time. Once it happens, it needs timely treatment.

When phimosis children urinate, a big bag will bulge in front of their penis. Why?

When some infants have phimosis, the urethral orifice is pinhole-like. When urinating, urine is blocked through the narrow foreskin, and a small bag will bulge at the foreskin orifice. Generally, urine can be scattered like a shower head at the same time. This type of phimosis belongs to dysuria. If the situation is getting worse or often causes infection, surgery is recommended.

Phimosis or foreskin is too long, can it be scrubbed and disinfected with alcohol at ordinary times?

It is not recommended to scrub with alcohol. Smegma is very suitable for bacterial growth, which is easy to cause infection and needs to be cleaned frequently. Under normal circumstances, clean water can play a good cleaning role, but disinfectant such as alcohol can stimulate glans penis to cause discomfort or change local flora.

What are the precautions for phimosis patients after circumcision?

After traditional circumcision, attention should be paid to the glans penis. If it turns purple, it means that the bandage is too tight, so it can be relaxed properly, but it should not be too loose. After prepuce cerclage, you should pay attention to whether the position of the ring, and blow dry after bathing to keep it dry and clean.

Common attention should be paid to:

  • Within 1 ~ 2 days after operation, walk as little as possible to prevent postoperative bleeding.

  • After surgery, besides oral antibiotics, you can also take drugs to prevent erection and relieve pain.

  • Eat as light as possible after operation, and eat less spicy and irritating food.

  • Try to think less about or touch pornographic pictures and videos after the operation, avoid erection of penis, so as not to cause the wound to collapse.

  • Don't have sex too early. After the wound is completely healed for one month, you can resume your sexual life. You should wear loose and breathable underwear on weekdays. If you have serious edema or massive bleeding, you should go to the hospital for treatment immediately.

  • Within 4 ~ 6 weeks after operation, see a doctor regularly, and see a doctor at any time if there is any discomfort, so that specialists can evaluate the operation effect and find and deal with related complications in time.

  • Try to keep the wound away from water. Do not let urine infiltrate the wound or wet the bandage gauze.

  • Pay attention to the cleanliness of the adjacent area of penis to prevent pollution.

  • Change your underwear frequently.

How long can you have sex life after operation?

After the wound is completely healed for one month, you can have sex.

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