Phimosis is a “male” disease, characterized by the impossibility of exposing the head of the penis. Phimosis, the symptoms of which can be considered both as a normal physiological manifestation and as a manifestation of the pathological one, can be congenital, depending on the nature of the onset, or acquired.
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, a preputial sac develops, which normally is narrow, which, in turn, leads to the formation of conditions for further opening of the head. In other words, within the specified interval, against the background of accompanying physiological changes, the phimosis simply disappears.
As for the pathological manifestation of the disease, such phimosis occurs against the background of the narrowing of the foreskin, which, in turn, can be congenital or acquired. Congenital phimosis is characterized by the fact that the foreskin with him resembles the “proboscis”. When a disease such as balanoposthitis is transmitted until the spontaneous opening of a preputial cavity in a child, the inflammation that is relevant to him becomes the cause of scarring of the tissues in the foreskin area, against the background of which they lose their stretchability. Because of this, pathological phimosis also develops.
Meanwhile, acquired phimosis can be not only the result of the transfer of diseases affecting the penis, but also manifest itself as a temporary condition. For example, infiltration of the foreskin or glans penis can predispose to the development of acquired phimosis on the background of injury or inflammation, edema, etc. Acquired phimosis may also appear in permanent form, that is, again, with the development of irreversible pathological processes, for example, when scarring tissue in the glans penis and
Phimosis, diagnosed in males aged 7 years and older, is considered as a pathological condition of constriction of the foreskin. It is important to take into account the fact that the impossibility of exposing the head of the penis can cause the development of complications not only under the condition of the pathological manifestation of the disease in question, but also under the condition of the physiological variant. In general, the separation of phimosis into physiological and pathological variants in terms of consideration of related complications can be considered conditional, although it is also practically important, it is explained by the further determination of the appropriate treatment strategy for the uncomplicated form of one of the topical variants of this disease.
The physiological form of phimosis is caused by gluing the glans of the penis and the inner leaf of the foreskin. Pathological phimosis, in turn, develops, as we have found above, against the background of certain penile diseases, against the background of balanoposthitis, with concomitant narrowing of the foreskin as a result of scarring of this area, as well as due to the transfer of injury to the penis.
As for the causes of phimosis, which arose against the background of a patient’s previous normal state of health, and, consequently, without prior inflammatory diseases or injuries, it is not always possible to find them out reliably. There is also a factor of genetic susceptibility to the development of this disease, this predisposition is conditioned by the general insufficiency of the elastic component included in the structure of the connective tissue. As diseases often associated with the genetic form of phimosis, flat feet, varicocele, heart defects (in particular, cardiac valves) and another type of disease can be identified.
Phimosis can also develop during puberty due to uneven development of the penis and foreskin. Already in the future, one of the main reasons provoking the progression of the narrowing of the region of the foreskin is considered the disease itself, that is, the phimosis itself. Due to the narrowing of the inner leaflet of the foreskin is subject to constant injury, this is accompanied by scarring of the tissue, accompanied by further narrowing on this background. As a supplement to this state, an increased risk of microtraumas is considered due to the factor of erection in adolescents, due to masturbation, and also because of the onset and subsequent sexual behavior of them.
Depending on the characteristics of phimosis, allocate the appropriate degrees that determine the classification of this disease.
So, I degree phimosis characterized by the possibility of opening the head of the penis only in conditions of rest. Attempting to expose the head in its erect state will invariably be accompanied by soreness, and in general this will be accompanied by difficulties. II degree of phimosis characterized by difficulties in removing the head in a state of rest, the erect state of the penis is accompanied by the impossibility of opening the head. III degree of 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 not possible, there are no difficulties with urination at this stage of the disease. The most severe form of the disease is IV degree of phimosis, in which the head of the penis does not open even partially, which is why there are difficulties with urination. Urination in such a case or occurs either 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 variants of phimosis classification, it is also customary to denote 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 waist that forms below the opened head of the penis on its very trunk. This condition is generally considered as a norm, but only if there is no pain and other problems associated with the disease (this condition, in general, is valid for initiation of any type of phimosis to the norm).
It should be noted that the displacement in one direction or another of the foreskin is difficult for many men during an erection, which may be accompanied even by the impossibility of re-closing the head, swollen in a state of excitement after its hard exposure. It happens so often for the reason that the constricted foreskin as a result of pulling starts to roll up into a tightly covering barrel of a member of a tight roller behind a tense head, especially such a “scenario” is characteristic in manifestation for Asians. In some cases, such a roller is quite difficult to pick up for further retrieval from behind the head. The penis is compressed by it so much that it enhances the state of excitement, as a result of which the head becomes firmer than the trunk. For this reason, it is impossible to squeeze it, which is why it is also impossible to push it back until the erection is weakened, which prevents the opening of the foreskin too narrow for this. The very same weakening of erection in the framework of short terms is considered as an unlikely opportunity. The condition we isolated has an appropriate medical definition – paraphimosis.
Let us supplement the above-mentioned features of the degrees of phimosis by the fact that its I and II degrees can be accompanied by pain that arises at the time of erection due to the tension of the narrow foreskin on the head. Grades III and IV, in turn, are characterized by the absence of pain during erection, which is connected with the very small size that the prepucial ring has reached by this period, and also because the exposure of the head has become impossible.
Phimosis in children is manifested in such major symptoms as the impossibility of exposing the head and the impossibility of its elimination. In some cases, phimosis is not accompanied by the appearance of any complaints, although more often children with phimosis have problems with urination. In particular, the process of urination may be accompanied by the need for a certain physical exertion, anxiety. Later, urine is in the prepucial 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 accompanying the inflammatory process, thus manifesting itself in the form of pain, concentrated in the region of the foreskin and head, as well as in the form of purulent secretions that appear directly from the hole in the foreskin. As an additional manifestation of a temperature increase, an increase in lymph nodes. With the relevance of paraphimosis in a patient, there is a sharp pain caused by pinching the glans penis, which, moreover, increases in size, which is accompanied by cyanosis of the skin. With the development of this picture of the general condition on the background of phimosis, it is necessary to urgently apply for the provision of qualified medical care.
Phimosis in men may be accompanied by some additional features. So, I-II degree of manifestation of the disease are accompanied by the occurrence of pain during erection against the background of the corresponding tension on the head of the foreskin. Due to the onset of such symptoms, problems with potency may subsequently develop, due to the fact that the patient is under tension from waiting for a future onset of pain during intercourse. By reaching III-IV degree of phimosis, pain during an erection disappears, which is explained by a significant narrowing of the preputial ring, due to which exposure of the head becomes impossible.
Phimosis is accompanied by certain difficulties associated with hygienic measures in the affected area, because of this, smegma stagnation develops. Smegma is a type of fat-like secret produced by the glands of the foreskin. Accordingly, when it stagnates, quite good conditions are created for the 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 formation of smegmoliths (prepucial stones) is conditioned. The inflammation formed during phimosis can be treated with great difficulty, it is accompanied by scarring of the tissues of the foreskin, which causes an even greater aggravation of the phimosis, as well as the transition 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 may arise associated with emptying the bladder, as well as disorders in the upper urinary tract, due to their reduced tone. 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 urinary infections in the future.
Phimosis in children, combined with inflammation with balanopostitis, can provoke enuresis – the problem of urine incontinence at night. In addition, this picture of the disease may be accompanied by the development of spontaneous erections, which leads to the appearance of a psychological trauma in a child.
III and IV degree of phimosis is often accompanied by a partial increment to the head of the penis of the foreskin, also not uncommon and their full increment. Attempts to open the head are accompanied by pain and bleeding. With such a course of the disease there is a need for surgical intervention.
With the continued existence of the disease, the possibility of its complication by tumors affecting the penis is allowed, which is caused by the constancy of the carcinogenic effect of smegma.
Attempts to self-open the head can cause the development of paraphimosis, which, as we have already noted, is infringing the foreskin of the penis head. The exclusion of access to a 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 bluish, swollen. First aid in this case consists in calling the doctor, as well as in applying cold. After 5 minutes after cooling, attempts are made to reposition the head, the lack of a result necessitates further dissection of the clamping ring, which, as is clear, is performed by a doctor in a hospital setting.
Diagnosis and treatment
Diagnosis of phimosis does not require special measures, for it is enough to make a general visual inspection, on the basis of which the diagnosis is made. Additionally, a smear is taken for analysis – on the basis of the results, the causes that provoked inflammation are determined, if, of course, it occurs in a particular case.
With regard to the treatment of phimosis, it can be medicamentous, non-drug, and surgical.
Non-pharmacological treatment of phimosis
The option of gradual manual stretching of the foreskin is considered as the basis of this type of therapy. The proposed method of treatment consists in the transition to masturbation with the full pulling down of the foreskin until the head is exposed. Stretching the foreskin with tension on the head (without undue activity) is carried out gradually, until the moment of pain. This action is performed every day, in time – from 5 to 10 minutes. In accordance with the gradual expansion of the hole, masturbation should become somewhat more limited 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), carry out the pulling off of the foreskin as much as possible, avoiding pain. Similarly, when urinating, attempts are made to open the head with clean hands, the action is performed with little effort, without hurting yourself. In the period of 1.5-2 months, it will be possible to open the head even under the condition of pronounced phimosis.
The application of the method of gentle and gradual stretching determines the possibility of achieving effective results in opening the head in children with the physiological form of phimosis in the period of 1-2 months, with the hypertrophic form of phimosis in children, this result is achieved in a period of 2-4 months.
Provided that there is no damage to scarring, and also if there is no loss of elasticity in the foreskin, the method of its stretching can be successfully applied. It turns out such an effect in the hospital, with local anesthesia. Some surgeons perform plastic surgery of the foreskin area, due to which there is the possibility of correcting the preputial ring (its diameter in particular) without accompanying excision of the foreskin.
We also add that in no case should attempts be made to sharply expose the head during phimosis from grade II and higher!
Drug treatment of phimosis
As the main method of exposure for drug therapy is considered a prolonged and regular use of corticosteroid ointments applied to the region of the foreskin and head of the penis. Due to this, the elasticity of tissues somewhat improves, which makes it possible to stretch them, and this, in turn, can help cure the disease. In addition, the use of glucocorticoid drugs helps reduce puffiness and inflammation, also promoting the healing of microcracks.
Surgical treatment of phimosis