Types and degrees of phimosis: how are they distinguished and how should they be treated? Phimosis: causes, symptoms, stages of the disease Conservative non-drug.
Phimosis can be congenital (developmental anomaly) or acquired (a consequence of trauma, inflammation of the foreskin - balanoposthitis).
Phimosis is manifested by the inability to expose the head of the penis.
This leads to several consequences.
Complications of phimosis.
Firstly, with phimosis, between the foreskin and the head, a “pocket” is formed that is inaccessible for hygiene measures, in which smegma accumulates - a substance secreted by the glands of the foreskin. With each urination, drops of urine remain between the foreskin and the head, mixing with smegma. As a result, prerequisites for a chronic inflammatory process are created. There is evidence of an increased risk of penile cancer in the presence of long-term phimosis.
Secondly, with phimosis, there are problems with erection (pain) and difficulty urinating.
Thirdly, in some cases, phimosis can turn into paraphimosis - infringement of the glans penis by a narrowed foreskin. Paraphimosis occurs, as a rule, when trying to expose the head. This is an emergency condition, requiring in most cases the intervention of a specialist.
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Phimosis prevention.
Prevention of phimosis is a regular toilet of the glans penis to prevent the accumulation of smegma and the subsequent development of inflammation of the foreskin - balanoposthitis.
phimosis treatment.
Treatment of phimosis can be conservative (non-surgical) and surgical.
The main conservative treatments for phimosis are topical corticosteroid therapy (hormonal ointments) and foreskin stretching. This approach to the treatment of phimosis is effective in 50-80% of cases (depending on the severity of phimosis). But there is a significant risk of recurrence of the disease.
The most rational is the surgical treatment of phimosis. Operations may be accompanied by complete removal ("circumcision" or "circumcision") or resection (shortening) of the foreskin. In the second case, the patient can "order" the size of the foreskin that would suit him. Surgical treatment of phimosis is usually performed under local anesthesia (no anesthesia) and is well tolerated by patients.
Content
Medicine distinguishes a number of male diseases that can be detected starting from infancy (congenital pathologies). These include phimosis - this is a serious pathology, it is characterized by a narrowing of the foreskin of the penis, which does not allow the head of the organ to be completely exposed. The disease is considered common, diagnosed in children and adults, has specific symptoms and requires a specific treatment regimen.
Phimosis in adults and children
Physiological or acquired inability to expose the head of the male genital organ - phimosis (phimosis - "contraction, closure"). The disease is classified into congenital and pathological. It can lead to serious consequences if you ignore the prevention and treatment of the problem. Therapy is prescribed only by a doctor after a detailed examination and diagnosis.
Classification
There is complete or partial phimosis. In the first variant, the absolute impossibility of exposing the head of the penis develops, both in a calm state and during an erection. Incomplete phimosis is characterized by the ability to slightly move the foreskin at rest, but if the penis is erect, then the head and trunk of the organ are strongly compressed, causing paraphimosis. With this disease, the ring of the foreskin infringes on the head.
Another deviation is classified into physiological and pathological (as a rule, it is diagnosed in adult men and there are several types). The most common type of disease is physiological. It is observed in boys up to the 3rd age, sometimes up to 6-7 years. It is associated with an underdeveloped foreskin of the penis. Physiological phimosis is not considered a pathology when the child does not have discomfort when urinating, there is no pronounced inflammatory process. If by the age of 7 the boy does not freely expose the head of the penis, then you need to seek help from a doctor.
Pathological types of phimosis:
The atrophic type is characterized by severe thinning of the foreskin (sometimes it completely atrophies).
Proboscis or hypertrophic phimosis is a strong compaction of the layer of flesh, it grows beyond the head of the penis, resembling a trunk. If the pathology is not treated, then hypogonadism develops - a malfunction of the sex glands, insufficient production of male sex hormones. In addition to this, urine accumulates in the preputial cavity, inflating it, and then comes out drip or thin jets.
The cicatricial (adhesive) type of the disease causes scarring on the foreskin of the penis, tissue changes around the male genital organ. The progression of the disease provokes an increase in the number of scars. In this case, the opening of the channel for urination is significantly blocked. Scarring brings severe pain and discomfort during urination.
Relative phimosis is a narrowing of the foreskin of the penis occurs only during erection (sexual arousal).
There are several scenarios for the development of the disease, which depend on the severity of the ratio of the diameter of the head and the foreskin of the penis. Phimosis degrees:
the first - the head of the penis is exposed only in a calm state, pain will be felt during an erection;
the second degree is characterized by difficulty in moving the foreskin (at rest), in an excited state there is no way to open the head of the penis;
the third degree of severity of the pathology is characterized by the inability to move the foreskin (in isolated cases this can be done partially in a calm state);
the fourth is the most serious - the head does not open at all, complicating urination (urine comes out in a thin stream or drops).
The reasons
There are a number of factors that provoke the development of the disease in a child and an adult man. Causes of phimosis:
genetic predisposition (insufficient elasticity of the foreskin, lack of connective tissue of the penis, which cause narrowing of the prepuce - the foreskin);
trauma to the penis;
inflammation or infectious disease of the penis, which provoke a variety of viruses, bacteria;
pathologies in the process of intrauterine growth of a child caused by exposure to negative environmental phenomena or chronic diseases in a future mother;
complications after urological surgery;
neglect of the rules of personal hygiene, which often leads to the development of an inflammatory process;
metabolic disease;
penis injury;
various diseases: thrush, obesity, flat feet, heart valve defects, varicocele, balanoposthitis, balanitis (skin inflammation), venereal pathologies.
Signs of phimosis
It is possible to identify a male disease by a number of specific signs. The main indicators of pathology in childhood:
the head of the penis comes out of the foreskin (prepuce) with difficulty or is not exposed at all by 6-7 years;
problems with urination (urine accumulates under the skin, and then is excreted in an interrupted, thin stream);
the head of the penis is very difficult to expose, because the epithelial layer completely covers the surface of the organ;
the formation of swelling, redness (hyperemia), the appearance of pain near the preputial sac (skin fold of the foreskin);
anxiety, fever;
severe discomfort, pain when trying to expose the head of the penis.
In the process of growing up a person and the development of his external genitalia, the symptoms change. The main signs of phimosis in a man are as follows:
The formation of bridges from the connective tissue, which limit the mobility of the prepuce. After some time, the jumpers thicken, become more dense.
The accumulation of smegma (a mixture of sebaceous secretion, moisture and dead epithelium), which leads to the development of bacteria, which can cause the formation of purulent discharge.
The prepuce of the penis almost does not move, with an erection, the head is practically not exposed. If a man tries to release the head of the penis, then there is a sharp pain, bleeding, scars on the skin.
Another disease is accompanied by such symptoms:
hygiene problems;
circulatory disorders;
at stages 3-4 of the disease, the flesh sometimes adheres to the head, which is caused by epithelial gluing;
discomfort, burning during urination;
itching, swelling;
decreased sexual desire (libido), erectile dysfunction, a minimum of pleasant sensations during intercourse.
Complications
If the disease is not diagnosed in a timely manner or its treatment is delayed, serious consequences can occur. Complications:
The prepuce (foreskin) adheres to the head of the penis. The most damaged parts of the penis heal as a single scar due to the tight fit to each other. This phenomenon is treated with excision, but the operation is not always possible for a number of reasons.
Balanoposthitis is an inflammatory process of the head and foreskin of the penis.
Paraphimosis is an infringement of the head, which appears in the case of frequent attempts to expose it by force. The prepuce ring tightly compresses the tissues of the head, which leads to swelling of the latter. It cannot independently return to its previous state, there is a violation of blood circulation and necrosis develops (necrosis of the pinched part). In this case, you need to urgently consult a doctor to avoid irreversible necrosis.
The fourth degree of the disease is dangerous because it often provokes cystitis, urethritis, pyelonephritis (inflammatory diseases of the bladder, urethra and kidneys).
phimosis treatment
There are several methods of treating the disease. The doctor prescribes one or more of them, which depends on the degree of phimosis and the path of origin of the pathology. The most common treatments:
manual gradual stretching of the prepuce or the use of special devices for this purpose;
medication treatment (ointments containing steroids);
in some cases, phimosis can only be eliminated through surgery.
conservative non-drug
Due to the fact that the foreskin of the penis is elastic, it can be stretched, thereby curing the pathology. This procedure consists of special exercises. Treatment of phimosis without surgery in adults and children looks like this:
The foreskin is gently and partially pulled over the head of the penis by hand. Exposure is done until a minimal unpleasant sensation occurs. When the procedure is applied to a small child, the parent should exercise the utmost care and perform the movements effortlessly. Such manipulations are done every day for 10 minutes.
Another option is to stretch the preputial ring with two fingers inserted between the foreskin and the head of the penis. Fingers need to be spread apart to get tension. Each time it should be stronger, but not cause discomfort.
In order for the flesh of the penis to remain in a certain position, it is recommended to use special rings. They are put on the penis, worn until discomfort appears. Every day the duration of the exercise increases.
When bathing in the shower or bath, the tissues of the external genital organs become more elastic. Doctors advise to perform the above activities at this point. If you do the exercises daily for 2-3 months, you can achieve a positive result.
Medical therapy
Treatment of a male disease with the help of drugs is recommended to be combined with methods for stretching the foreskin. This is due to the increased effect, activation of the healing of microcracks, pain relief. For therapeutic purposes, corticosteroid ointments are used. They increase the elasticity of tissues, soften them, relieve inflammation. Treatment regimen:
the penis is treated with a thin layer of ointment 2-3 times a day, the head of the penis and the foreskin are lubricated with the drug;
the duration of the therapeutic course is several months;
along with topical corticosteroids, doctors advise the use of antiseptics.
Pharmacies offer a wide range of ointments for the treatment of phimosis. The most effective are:
Clobetasol is a local drug that practically does not cause side effects. It is often used for systemic long-term treatment of phimosis. It has antipruritic, anti-inflammatory, anti-allergic, anti-exudative (decrease in vascular permeability) action.
Betamethasone is a synthetic corticosteroid ointment. Compared to natural analogues, it is highly effective. It has an anesthetic effect, relieves tissue inflammation well.
Budesonide gives excellent results in the treatment of phimosis. Eliminates the inflammatory process, allergic reactions, increases tissue elasticity.
Surgery
In some cases, the only way to get rid of phimosis is through surgery. The choice of a specific technique depends on the type and degree of the disease, the age category of the patient, and the capabilities of a particular medical institution. As a rule, surgery is performed under local anesthesia. Contraindications to the use of this type of anesthesia:
high level of emotional lability (unstable mood);
too young age of the child (up to 3 years);
personal intolerance to drugs for anesthesia;
patient refusal.
There are several surgical techniques for the treatment of phimosis.. The most popular and effective ways are:
Circumcision (circumcision) - circular excision of the foreskin. This procedure helps to get rid of paraphimosis, cicatricial type of disease, chronic balanoposthitis. The main advantages of the operation: high efficiency, no recurrence of phimosis, rapid removal of pathology symptoms. The disadvantage of circumcision is that the entire foreskin is cut off as a whole, this leads to the loss of all its functions.
Plastic surgery that combines the removal of phimosis and the preservation of part of the prepuce. Often used:
Preputioplasty (removal of part of the foreskin);
Schloffer's method (incision and stitching of the flesh of the penis so that the opening for the head to go out increases).
Still plastic surgery is carried out according to Roser or Welsh, spiral correction of the prepuce.
A modern option is laser therapy. Operations are carried out by means of a laser. Carry out laser circumcision, plastic, which saves the foreskin of the penis. The tissues of the organ receive minimal damage, because the laser performs high-precision cuts. Positive qualities of laser excision of phimosis:
Mild pain;
There is no danger of bleeding, infection in the wound;
Recovery after such an operation takes less time than rehabilitation after a classic intervention.
Prevention
To avoid the development of the disease or its recurrence, it is necessary to adhere to certain simple rules. Prevention of phimosis is as follows:
- daily thorough hygiene procedures;
- prevention and timely treatment of inflammation of the external genitalia;
- control of the mobility of the foreskin of the penis (in boys);
- regular doctor visits.
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Phimosis is a "male" disease characterized by the impossibility of exposing the glans penis. Phimosis, the symptoms of which can be considered both as a normal physiological manifestation and as a pathological manifestation, can be congenital, depending on the nature of the occurrence, or acquired.
general description
Physiological phimosis is diagnosed in almost all healthy children (boys) under the age of 3 years, here it is not considered as a pathological condition. The causes of phimosis in this case are epithelial gluing of the glans penis and the inner side of the foreskin. From the age of 3 to 6 years, the preputial sac is stretched, which is normally narrow, which, in turn, causes the formation of conditions for further opening of the head. In other words, within the specified interval, against the background of concomitant physiological changes, phimosis simply disappears.
As for the pathological manifestation of the disease, such phimosis occurs against the background of narrowing of the foreskin, which, in turn, can be congenital or acquired. Congenital phimosis is characterized by the fact that the foreskin with it resembles outwardly a "proboscis". When transferring such a disease as balanoposthitis until the spontaneous opening of the preputial cavity in the child, the inflammation that is relevant to him causes scarring of the tissues in the area of the foreskin, against which they lose their extensibility. Because of this, pathological phimosis also develops.
Meanwhile, acquired phimosis can be not only the result of the transfer of diseases that affect the penis, but also manifest itself as a temporary condition. So, for example, infiltration of the foreskin or glans penis against the background of trauma or inflammation, edema, etc. may predispose to the development of acquired phimosis. Acquired phimosis may also appear in a permanent form, that is, again, with the development of irreversible pathological processes, for example, with scarring of tissues in the area of the glans penis, etc.
Phimosis, diagnosed in males aged 7 years and older, is considered as a pathological condition of narrowing of the foreskin. It is important to take into account the fact that the impossibility of exposing the glans penis can cause complications not only under the condition of the pathological variant of the manifestation of the disease in question, but also under the condition of the physiological variant. In general, the division of phimosis into physiological and pathological variants in terms of consideration of concomitant complications can be considered conditional, although practical importance is also present in it, it is explained by the further determination of the appropriate treatment tactics for an uncomplicated form of one of the current variants of this disease.
Phimosis: causes
The physiological form of phimosis is caused by gluing the glans penis and the inner layer of the foreskin. Pathological phimosis, in turn, develops, as we found out above, against the background of certain diseases of the penis, against the background of balanoposthitis with its concomitant narrowing of the foreskin as a result of scarring of this area, and also due to the transfer of penis injury.
As for the causes of phimosis that arose against the background of a previous normal state of health of the patient, and, consequently, without previous inflammatory diseases or trauma, it is not always possible to reliably determine them here. There is also a factor of genetic predisposition to the development of this disease, this predisposition is caused by a general insufficiency of the elastic component included in the structure of the connective tissue. As diseases that often accompany the genetic form of the manifestation of phimosis, one can designate flat feet, varicocele, heart defects (in particular, heart valves) and another type of disease.
Phimosis can also develop during puberty due to uneven development of the penis and foreskin. Already in the future, this disease itself, that is, phimosis itself, is considered as one of the main reasons provoking the progression of the narrowing of the foreskin area. Due to the narrowing, the inner leaf of the foreskin is subject to constant injury, this is accompanied by scarring of the tissues, accompanied by further narrowing against this background. As an addition to this condition, an increased risk of microtrauma is considered due to the factor in the appearance of erections in adolescents, due to masturbation, and also due to the onset and subsequent conduct of their sexual life.
Phimosis: classification
Depending on the characteristics of the manifestation of phimosis, the corresponding degrees are distinguished that determine the classification of this disease.
So, I degree phimosis characterized by the possibility of opening the glans penis exclusively in a state of rest. An attempt to expose the head in its erect state will invariably be accompanied by pain, and in general this will be accompanied by difficulties. II degree phimosis characterized by difficulties in removing the head at rest, the erect state of the penis is accompanied by the impossibility of opening the head. III degree phimosis characterized by the impossibility of opening the head, or perhaps its partial opening at rest with considerable effort for this. Exposure during erection is impossible, there are no difficulties with urination at this stage of the course of the disease. The most severe form of the disease is IV degree phimosis, in which the head of the penis does not open even partially, due to which there are difficulties in urinating. Urination in this case either occurs either in a thin stream or drip. Urination, like ejaculation, is accompanied in this case by swelling of the foreskin like a bag.
In addition to the listed options for the classification of phimosis, it is also customary to designate relative phimosis. This pathology is accompanied by such a narrowing of the foreskin, which becomes noticeable and significant only under the condition of an erect state of the penis. Relative phimosis appears as a tight type of constriction that forms below the opened head of the penis on its very trunk. This condition is generally considered as the norm, but only if there is no pain and other problems associated with the disease (this condition, in general, is fair for any type of phimosis to be included in the norm).
It should be noted that the displacement in one direction or another of the foreskin is difficult in many men during erection, which may even be accompanied by the impossibility of closing the head back, swollen in a state of excitement after its tight exposure. This often happens because the narrowed foreskin, as a result of pulling, begins to curl up into a tight roller tightly covering the shaft of the penis behind the tense head, especially this “scenario” is typical in manifestation for Asians. In some cases, it is rather difficult to pick up such a roller for further extraction due to the head. The penis is compressed so strongly that it increases the state of arousal, as a result of which the head becomes harder than the shaft. For this reason, it is impossible to compress it, which is why it is also impossible to push it back before the erection weakens, which excludes the opening of the foreskin that is too narrow for this. The very weakening of erection within a short period of time is considered as an unlikely possibility. The condition we have identified has an appropriate medical definition - paraphimosis.
Let us supplement the above-mentioned features of the degrees of phimosis with the fact that I and II of its degree may be accompanied by pain sensations that occur at the time of erection due to the tension of the narrow foreskin on the head. III and IV degrees, in turn, are characterized by the absence of pain during erection, which is already associated with the very small size that the preputial ring has reached by this period, and also with the fact that exposure of the head has become impossible.
Phimosis: symptoms
Phimosis in children manifests itself as such basic symptoms as the impossibility of exposing the head and the impossibility of its removal. In some cases, phimosis is not accompanied by any complaints, although more often children with phimosis experience problems with urination. In particular, the process of urination may be accompanied by the need for a certain physical stress, anxiety. The urine then ends up in the preputial cavity, which, in turn, swells, causing urine to flow out through a narrow opening either in a thin stream or in drops.
In some cases, the symptoms of phimosis can be supplemented by symptoms that accompany the inflammatory process, thus manifesting itself in the form of pain concentrated in the area of the foreskin and head, as well as in the form of purulent discharge that appears directly from the hole in the foreskin. As additional manifestations, there is an increase in temperature, an increase in lymph nodes. With the relevance of paraphimosis in a patient, acute pain appears due to pinching of the glans penis, which, in addition, increases in size, which is accompanied by cyanosis of the skin. With the development of this picture of the general condition against the background of phimosis, it is necessary to urgently seek qualified medical care.
Phimosis in men may be accompanied by some additional features. So, I-II degrees of manifestation of the disease are accompanied by the occurrence of pain during erection against the background of a corresponding tension on the head of the foreskin. Due to the appearance of such symptoms, problems with potency may subsequently develop, due to the fact that the patient during intercourse is in tension from the expectation of the future appearance of soreness. By reaching the III-IV degree of phimosis, pain during erection disappears, which is explained by a significant narrowing of the preputial ring, which makes it impossible to expose the head.
Phimosis: complications
Phimosis is accompanied by certain difficulties associated with hygienic measures in the area affected by the disease, because of this, smegma stagnation develops. Smegma is a fat-like secretion produced by the glands of the foreskin. Accordingly, when it stagnates, quite good conditions are created for bacteria, due to which an inflammatory process may eventually develop, which determines such a disease as balanoposthitis. Due to the accumulation of a significant amount of stagnant smegma, in turn, the possibility of the formation of smegmolites (preputial stones) is determined. The inflammation formed during phimosis can be treated with great difficulty, it is accompanied by scarring of the tissues of the foreskin, which further aggravates the course of phimosis, and also transitions to the next stage of its manifestation (that is, the transition to the next degree).
Due to difficulty urinating against the background of phimosis, problems associated with emptying the bladder, as well as disorders in the upper urinary tract due to their reduced tone, may develop. On top of this, there may be such a problem as the formation of residual urine, which acts as a favorable factor for the development of further genitourinary infections.
Phimosis in children, combined with inflammation in balanoposthitis, can provoke enuresis - the problem of urinary incontinence at night. In addition, this picture of the disease may be accompanied by the development of spontaneous erections, which causes the appearance of a corresponding situation of psychological trauma in the child.
III and IV degree of phimosis is often accompanied by a partial increment to the head of the penis of the foreskin, and their complete increment is also not uncommon. Attempts to open the head are accompanied by soreness and bleeding. With such a course of the disease, there is a need for surgical intervention.
With the long-term existence of the disease, the possibility of its complication with tumors that affect the penis is allowed, which is due to the constancy of the carcinogenic effect exerted by smegma.
Attempts to open the head on your own can cause the development of paraphimosis, which, as we have already noted, consists in the infringement of the head of the penis by the foreskin. The exclusion of going to the doctor in this case can lead to such a serious consequence of negligence in relation to the disease as necrosis of the head. Closing the head with the foreskin is impossible, it becomes cyanotic, swells. First aid in this case is to call a doctor, as well as applying cold. 5 minutes after cooling, attempts are made to reduce the head, the lack of a result necessitates further dissection of the pinching ring, which, as is clear, is performed by a doctor in a hospital.
Diagnosis and treatment
Diagnosis of phimosis does not require special measures, for it it is enough to make a general visual examination, on the basis of which the diagnosis is made. Additionally, a smear is taken for analysis - based on the results, the causes that provoked inflammation are determined, unless, of course, it occurs in a particular case.
As for the treatment of phimosis, it can be drug, non-drug and surgical.
Non-drug treatment of phimosis
As a basis for this type of therapy, a variant of gradual manual stretching of the foreskin is considered. The proposed method of treatment consists in the transition to masturbation with full retraction of the foreskin until the head is exposed. Stretching the foreskin with tension on the head (without excessive activity) is carried out gradually, until pain occurs. This action is performed every day, in time - from 5 to 10 minutes. In accordance with the gradual expansion of the orifice, masturbation should already take on a somewhat more limited character in impact.
Treatment of phimosis is also allowed in the form of the following option: every day, ideally while taking a shower / bath (which is accompanied by an increase in the elastic qualities of the skin), retract the foreskin as much as possible, avoiding soreness. Similarly, when urinating, attempts are made to open the head with clean hands, the action is performed with little effort, without causing pain to oneself. In a period of 1.5-2 months, it will be possible to open the head even if there is pronounced phimosis.
The application of the technique of gentle and gradual stretching determines the possibility of achieving effective results in opening the head in children with a physiological form of phimosis in a period of 1-2 months, with a hypertrophic form of phimosis in children, this result is achieved within 2-4 months.
Provided that there is no scarring, and also if there is no loss of elasticity of the foreskin, the method of stretching it can be successfully applied. There is such an effect in a hospital, with local anesthesia. Some surgeons perform plastic surgery of the foreskin area, due to which it is possible to correct the prepuce ring (its diameter in particular) without concomitant excision of the foreskin.
We also add that in no case should attempts be made to sharply expose the head with phimosis of II degree and above!
Medical treatment of phimosis
Long-term and regular use of corticosteroid ointments applied to the area of the foreskin and head of the penis is considered as the main method of exposure in drug therapy. Due to this, the elasticity of tissues improves somewhat, which makes them stretchable, and this, in turn, can help cure the disease. In addition, the use of glucocorticoid drugs helps to reduce swelling and inflammation, also contributing to the healing of microcracks.
Surgical treatment of phimosis
Surgical methods of exposure to phimosis today are used extremely rarely, and more often only in cases where it is impossible to achieve effectiveness from other measures. As an approved method of surgical treatment, the option of performing three longitudinal incisions with transverse stitching is considered. Treatment of phimosis in children is carried out by exposing the adhesions in the area of the preputial sac by separating them, for which a gauze tupfer and a metal probe are used.
The development of cicatricial changes necessitates a complete circular excision of the foreskin, this procedure is better known as circumcision. In certain cases, a Schloffer operation is performed as a method of exposure that replaces circumcision. It consists in making a zigzag incision along the foreskin and then stitching the edges together. Such an operation is performed under local anesthesia, such an effect allows you to completely save the foreskin while achieving the desired result - expanding the hole.
Friends, you are doing the right thing when you write letters to me about what you do not understand, what worries and alarms you. This raises your parent (and grandparent too) culture. For example, here are two...
Hello, Doctor! Yesterday I received a letter from my daughter from Murmansk, in which she writes that my 7-year-old grandson has phimosis. I called her as soon as I read the letter, and she told me not to worry and not worry that this is not such a serious disease ... And that it is not even a disease at all. Doctor, I beg you - tell me - what kind of phimosis is this? I have never even heard of this!
- Vasily Anatolyevich Peskarev, Kovrov, Vladimir Region
And another letter...
Hello! Doctor, my 3 year old son was diagnosed with phimosis. Our pediatrician said that most likely my boy will need to be operated on, otherwise, if the operation is not performed, there may be complications. Sometimes even hard. I'm in a trance, my husband and parents too! What is phimosis? Do you really need to have surgery? Or can it be avoided?
- Ekaterina Moskvicheva, Arkhangelsk
Hello!
Phimosis… What is it? Consequences and prevention
What is phimosis? To begin with, I will explain what the foreskin is. Skin in the form of a fold surrounds the head of the penis; the inner sheet of this skin fold passes into the skin of the head itself. By the way, it is in the inner leaf that small glands are located that produce a sort of "lubricant" - smegma, in which many pathogenic microbes live and multiply rapidly.
Which leads to diseases such as balanitis (inflammation of the skin of the head of the penis and balanoposthitis, when the case is not limited to the head alone, but extends to the inner leaf of the foreskin. Sometimes the process goes so quickly, if not violently, that foci of necrosis (necrosis) form.
The circumstance will be mentioned in place that men belonging to those cultures where it is customary to “circumcise” the foreskin do not know what phimosis and the complications associated with it are (and they, these complications can indeed be serious). Moreover, in a “circumcised” man, the skin of the glans penis is denser, which means it is less sensitive, which leads to a longer sexual intercourse (this type of impotence, such as early ejaculation, is less common). And, what is important to note, women whose sexual partner has a “circumcised” penis are much less likely (at times, as they say) to get inflammatory diseases of the vaginal vestibule, vagina, cancer of the cervix and uterine body.
What is the conclusion? All in a row "cut off"? But among Christians, this is somehow not accepted. So, if you respect yourself (so as not to get balanitis or balanoposthitis) and your woman (so that she does not get inflammatory or God forbid! - tumor diseases) - you need to wash your genitals at least once a day with water (preferably warm) with soap; while carefully shifting the foreskin and exposing the head of the penis. This is a must do!
An unscrupulous man (unfortunately, a fairly common occurrence with us) is a huge misfortune for a woman. , and even in such families where the culture is not very high, but the boys ...
When a man has problems with his penis - phimosis, balanitis, balanoposthitis, etc. - he cannot have sexual intercourse - it simply hurts him. And even very much! And if it hurts, then there can be no talk of an erection. What kind of erection is there ... The man is nervous, worried, and a psychogenic factor joins the physical illness. And if still (don't give it, don't bring it), at the moment of "failure" a woman will laugh at him - that's all ... What is called a pipe business ... Immediately, a psycho-organic base is formed for the development of persistent impotence.
Why am I writing all this?
Yes, to ensure that men wash themselves as thoroughly as possible. And they did not forget to teach their male offspring to sexual hygiene. Because only under this condition, men (and boys, that is, future men too) will have a regular one. Namely, regular sex life is the best prostatitis prevention, and.
I cannot but note the fact that a full-fledged sexual life (not violent, but full-fledged) also prevents many diseases of the cardiovascular (myocardial infarction, arrhythmias,) and endocrine systems.
Live long, my friends and with pleasure! And women. And men.
How to treat phimosis?
As for the possibility non-surgical (i.e., conservative) treatment of phimosis…
With hypertrophic phimosis (that is, an excess of the foreskin that prevents the removal of the head), when there are no complications (repeated inflammation of the foreskin, urination disorders), conservative treatment is also possible - while gradually stretching the foreskin. This therapeutic action can be performed by the boy's parents even at home.
Three times a week, while bathing with decoctions of herbs (string, chamomile), the foreskin is displaced until the child develops pain, after which a few drops of sterile vaseline oil are introduced into the preputial space. The duration of treatment is different - from 3-4 weeks to several months.
The procedure should be performed very carefully in order to avoid paraphimosis - that is, such a state of the foreskin in which it is located behind the head of the penis and return the head to a state where the foreskin closes it is not possible.
A vicious circle appears: pressure increases swelling of the glans penis, and swelling also increases pressure.
If the foreskin is not returned in time, necrosis of the infringing ring and partly of the glans penis may develop and, as a rule, develop. And this is already a big problem - after all, we are talking about an extremely dangerous situation: due to the abundant blood supply to the tissues of the penis, edema of it grows very quickly, while the narrowed ring of the foreskin becomes a kind of noose for the head of the penis ... You yourself understand what this can lead to ...
I say this so that you know that any therapeutic actions should be carried out only after a specialist doctor has taught you these actions ...
And one more thing ... Always seek the help of a doctor if something is not clear to you!
In general, the success of treatment for phimosis depends on the perseverance of the boy's parents and, of course, the severity of phimosis. In the presence of a scar zone of narrowing, conservative treatment is unlikely to be effective.
In recent years, phimosis has been corrected with hormonal ointments, which are placed in the preputial space. These ointments ease the stretching of the foreskin.
I repeat once again - the treatment is carried out by the parents with the obligatory control of the doctor!
As for surgery...
Surgical intervention can be performed at any age, immediately after the diagnosis of phimosis, in a planned manner, i.e. with the full health of the child: the absence of infectious diseases during the last month before the operation and after the examination, if the tests are normal.
The circumcision of the foreskin is most often performed - circumcision - a circular excision of the leaves of the foreskin. This operation usually lasts no more than 10-12 minutes and is usually performed under general anesthesia.
Before deciding on a surgical intervention to circumcise the foreskin, the surgeon must make sure that the meatus is in the correct anatomical position - at the top of the glans penis. If an abnormal location of the external opening of the urethra - hypospadias (there is such a congenital disease, it occurs in 1 out of 160-170 boys) is detected, the foreskin circumcision is not performed, since the question of the tactics of surgical treatment of hypospadias must first be resolved.
Often, phimosis is combined with a short frenulum of the foreskin, which deforms the meatus (the mouth of the urethra) and distorts the head of the penis. In this case, simultaneously with circumcision, a dissection and plasty of the frenulum are also performed.
Advice to parents: in the first week or two of a boy’s life, you need to show him to an andrologist, that is, a specialist dealing with the male reproductive system, who will examine the baby and determine if he has any trouble in this area or not.
If it is not possible to contact an andrologist, the baby should be examined by a urologist or pediatric surgeon. In the future, it is necessary to regularly undergo dispensary examinations, especially.
I hope, Ekaterina Vasily Anatolyevich, that this information will help in the treatment of your loved ones.
Phimosis is a condition in which the foreskin of the penis cannot be pulled back past the glans. Phimosis in men and adolescents can lead to pain during urination, erection, but in some cases, pain does not occur. This word came from the Greek "phimos" (φῑμός), which means "balloon".
The reasons
Primary or congenital phimosis occurs in young children, infants, and this is normal. It is physiological but does not cause any side problems such as bladder obstruction, hematuria, or preputial pain.
Secondary or acquired phimosis also has several possible causes: most often this is due to poor hygiene, chronic balanoposthitis (inflammation of the inner foreskin), but strong retraction of primary phimosis is also possible. Secondary or acquired phimosis in an adult male is often accompanied by hematuria (blood in the urine) or pain when urinating. Acquired phimosis is typical for both children and adults.
Secondary or acquired phimosis, caused by poor hygiene and/or chronic balanoposthitis, can eventually lead to paraphimosis (an acute condition where the foreskin is strongly compacted around the penis and infringes on it).
Typical of paraphimosis is pain and swelling of an uncircumcised or improperly circumcised penis. Even an active sexual life has been reported to predispose to paraphimosis.
There are other causes of phimosis that prevent retraction (narrowing) of the foreskin.
Pathological factors are rare and the reasons why phimosis occurs in adult men are different.
Scleroatrophic causes are considered as common or even basic in the occurrence of pathological phimosis in an adult. This is a skin condition of unknown origin that causes a whitish ring of hardened tissue (scar) that forms near the tip of the foreskin. Inelastic tissue causes cicatricial phimosis in men.
Worth knowing! At birth, the inner layer of the foreskin is sealed onto the penis. The foreskin is usually not retracted in early childhood and may be up to 18 years of age.
Photo of cicatricial phimosis:
Cicatricial phimosis has the appearance of a whitish ring of compacted tissue, formed near the tip of the foreskin. Phimosis can also occur:
- After chronic inflammation, re-catheterization or forced retraction of the foreskin.
- In diabetics due to the presence of glucose in the urine, which leads to infection in the foreskin.
- Due to rough masturbation.
- Due to trauma during intercourse.
- Due to repeated infection of the genital tract.
Worth knowing! Sometimes the cause of the disease may be unclear, so it is difficult to distinguish physiological from pathological phimosis if a man has pain when urinating, or he experiences other discomfort while urinating. However, "balloon" does not indicate obstruction of the outflow of urine.
stages
The main stages of phimosis:
- The head of the flesh is very compacted behind.
- When excited, the head practically does not open, the limiting factor is also present at rest.
- The head of the penis opens with difficulty only at rest, and only if you try hard to do it.
- Absolutely no retraction of the foreskin.
Photo types of phimosis degree:
There are four stages of phimosis: from the head of the flesh compacted behind to the impossibility of pulling the foreskin Signs and symptoms
Visible signs of phimosis:
- The tip of the foreskin is too narrow to pass through the penis.
- The inner surface of the foreskin is fused with the head of the penis.
- The frenulum is too short to allow full retraction of the foreskin (a condition called "brevis frenulum").
Symptoms of phimosis:
- there may be pain when urinating;
- burning;
- inflammatory process in the genital area.
Some men do not know which doctor to turn to, or simply tolerate such a problem. A specialist in diagnosis and treatment is called. By contacting a doctor in a timely manner, you can avoid serious consequences and cure the disease in time.
Diagnostics
In the case of phimosis, doctors usually make the diagnosis through a physical examination. If there is an infection, the skin may be held.
Modern medical treatment
Physiological phimosis is normal and does not require intervention, usually resolving during puberty.
Worth knowing! If phimosis in men does not cause acute or serious problems, non-surgical measures may be effective. The choice of treatment is often determined by whether circumcision is seen as a last resort, to be avoided or used as the preferred course.
Medical science has developed three classes of treatment other than radical circumcision for narrow foreskin:
- The first is medical treatment using topical application of an ointment to the foreskin.
- The second is the gradual stretching of the opening of the foreskin to make it wider.
- The third is surgical reshaping of the prefixed hole to make it wider.
Topical Medications
Since the 1990s, topical steroid and non-steroid drugs have been used to treat phimosis at home. They are relevant in the absence of pain, injury, and because of the low cost.
The use of steroid ointment for phimosis results in accelerated normal growth and expansion of the foreskin, which occurs over several years and usually results in a non-retraction condition.
Benefits of using steroid gels:
- Treatment is non-surgical.
- No trauma and no surgical risk.
- Treatment is inexpensive.
- The foreskin and all its protective, erogenous, sensory and sexual physiological functions are preserved.
Topical steroid creams aimed at treating phimosis in men:
- Betamethasone;
- mometasone furoate;
- Cortisone.
Creams are effective in treating the disease and can serve as an alternative to circumcision. Steroids work by reducing the body's inflammatory and immune responses, as well as thinning the skin.
Dilation and stretching
Skin that is under tension expands due to the growth of additional cells. A permanent increase in size occurs due to gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching can be performed without the help of a doctor. The advantage of treating phimosis in men with the stretching method is that it allows you to save all the tissue of the foreskin and nerves of sexual pleasure. This method has been successful for many.
Stretching the foreskin can be done manually or with special instruments.
Conservative Surgical Alternatives
Surgical methods range from complete removal of the foreskin to smaller operations to reduce skin density. In medicine, this practice is called circumcision:
- The dorsal fissure (supersyncy) is a single incision along the upper length of the foreskin from the tip to the crown, which allows the glans to be exposed without removing any tissue.
- The ventral fissure (subincisor) is an incision along the underside of the foreskin from the tip of the frenulum to the base of the brain, with the frenulum removed in the process. Often used when frenulum breve occurs along with phimosis.
- Preputioplasty is the medical term for plastic surgery of the foreskin. Prepulsion surgery is a more conservative alternative to traditional circumcision or dorsal fissure excision. Many physicians offer surgical alternatives due to the many problems, risks, complications, and disadvantages that can occur after circumcision surgery.
- Circumcision. For many years, before modern techniques were developed, radical circumcision was the only treatment for tight foreskin. However, radical circumcision is now obsolete. This is more painful and involves a difficult recovery than the conservative treatment of phimosis in men. Radical circumcision also destroys many functional tissues, leads to severe loss of sexual sensation, and disrupts normal male sexual mechanical functioning.
Photo treatment of phimosis in men using circumcision:
Complications
Chronic problems of acquired phimosis can lead to discomfort and pain during intercourse and even urination. Urine cannot find the correct release with blockage of the penis aperture. Urination becomes extremely painful. In very serious cases, the outflow of urine may stop altogether. This threatens the life of a man, and immediate medical attention is needed. With early treatment, recovery from phimosis is faster.
The most acute complication is paraphimosis. In this condition, the glans is swollen and painful, and the foreskin is immobilized when swollen in a partially retracted position. The proximal penis is flaccid.
Some studies have shown that phimosis is a risk factor for penile carcinoma.
Prevention
A healthy diet and lifestyle can help treat a yeast infection that often causes phimosis in men.
Intimacy with a regular, proven, healthy partner will also help to avoid the development of the disease.
Avoiding glycerin, alkaline soaps, and lubricants containing additives can also stop the disease and work as a cure for phimosis.