Paraphimosis: Conservative Treatment

Paraphimosis is the term used to describe the condition that occurs when a narrow foreskin is forcibly retracted and becomes trapped behind the head of the penis. Forcible retraction of a narrow foreskin should be avoided.2 According to John P. Warren, MD, "Education concerning proper care of the prepuce is the most effective way of preventing paraphimosis from occurring." Parents, doctors, and other caregivers should be instructed to avoid forcible retraction of a boy's foreskin. The foreskin should be returned to the forward position after cleaning or sexual intercourse.4 6 Prolonged paraphimosis can become an emergency condition.1,3,6

If this condition persists the tissue may become oedematous and swell thus further aggravating the problem.3 First aid for this condition is simple. The head of the penis must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.6 The foreskin can then be brought forward to its normal position.

Application of ice may also be helpful.3 Hospital treatment with injection of hyaluronidase has been shown to be successful.1,3,6 Hyaluronidase works by reducing the oedema, after which the foreskin may be returned to its normal position. When the foreskin has been returned to its normal position, no further treatment is necessary.6 Some doctors recommend circumcision but there is no evidence in the medical literature to support this recommendation.

Reynard and Barua recommend the puncture technique.2 Incisions are not necessary. Improved cosmetic outcome is claimed. Again no circumcision is necessary.6

Turner et al. recommend using Adson forceps to apply traction to return the prepuce to its normal forward position.5

Library holdings

  1. DeVries CR, Miller AK, Packer MG. Reduction of paraphimosis with hyaluronidase. Urology 1996 48(3):464-465
  2. Reynard JM, Barua JM. Reduction of paraphimosis the simple way - the Dundee technique. BJU Int 1999;83(7):859-860.
  3. Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin. San Anselmo: NOCIRC, 2000.
  4. Choe JM. Paraphimosis: current treatment options. Am Fam Physician 2000;62:2623-2628.
  5. Turner CD, Kim HL, Cromie WJ. Dorsal band traction for deduction of paraphimosis. Urology 1999;54:917-8.
  6. Berk DA, Lee R. Paraphimosis in a middle-aged adult after intercourse. Am Fam Physician 2004;69(4):807.

(File revised 17 April 2004)

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