Phimosis is the inability to retract the foreskin over the glans due to a contracted opening, while paraphimosis occurs when the foreskin cannot be replaced after retraction behind the glans. For paraphimosis, gentle compression is applied to reduce swelling before replacing the foreskin; if this fails, the tissue must be incised. Phimosis is treated with antibiotics and hot compresses. Follow-up care for both conditions should include circumcision once swelling subsides.

1. Phimosis and Paraphimosis
Presentation
Phimosis is the inability to retract the foreskin over the glans, and is usually due to a
contracted preputial opening. Patients with phimosis may seek acute medical care when
they develop signs and symptoms of infection, such as pain and swelling of the foreskin
and a purulent discharge. Paraphimosis occurs when the foreskin cannot be replaced in
its normal position after it is retracted behind the glans. The tight ring of preputial skin
which is caught behind the glans creates a venous tourniquet effect and leads to
edematous swelling of the glans.
What to do:
• For paraphimosis, squeeze the glans firmly for at least ten minutes to reduce the
edematous swelling. Wrap the shaft and swollen glans with a gauze pad followed
by a two inch elastic bandage that will produce constant, gentle compression.
After ten to fifteen minutes, remove it, then push the glans proximally and slide
the prepuce back over the glans. If manual reduction fails, anesthetize the dorsal
foreskin and carefully incise the constricting tissue.
• Treating phimosis usually involves the management of acute infection. Frequent
hot compresses or soaks are needed along with antibiotics such as cefadroxil
(Duricef) for a balinitis.
• In both paraphimosis and phimosis, followup care should be provided. When
swelling and inflammation subside, circumcision should be performed.

2. Discussion
Poor hygene and chronic inflammation are the usual causes of stenosing fibrosis of the
preputial opening. In the case of a neglected paraphymosis, arterial occlusion may
supervene and gengrene of the glans develop. When phimosis results in acute urinary
retention, the tip of a hemostat can be inserted into the scarred end of the foreskin and
gently opened, allowing the patient to void satisfactorily until urologic cosultation can
be obtained. One common cause of paraphymosis is retracting the foreskin to clean the
glans and place a Foley catheter, but forgetting to reduce the foreskin afterwards.