Sexual Health

Phimosis and Paraphimosis

Phimosis is a foreskin that cannot be retracted over the glans; paraphimosis is a retracted foreskin trapped behind the glans and is a urological emergency because its constricting ring can cause progressive oedema and ischaemia.

Definition

Phimosis is inability to retract the foreskin over the glans. It is physiological in many infants and young boys and pathological when caused by scarring or disease. Paraphimosis is entrapment of a retracted foreskin behind the glans, producing a constricting ring that can cause oedema, ischaemia and necrosis.

First principles

Distinguish normal childhood development from scarring

A non-retractile foreskin is normal in babies and young boys and usually needs reassurance, hygiene advice and avoidance of forced retraction. Pathological phimosis is suggested by a scarred or white fibrotic ring, acquired loss of retractility, recurrent inflammation, pain or urinary difficulty. Lichen sclerosus is an important cause in children and adults.

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