Foreskin doesn’t roll back

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Fore skin not rolling back is medically known as “phimosis”. It is a common condition among males. Around 10% of male children has non­retractable foreskin up to the third year of life. The percentage of partially retractable foreskin is much higher. This number goes down to 1­3% by the age of 16.

 

What is “foreskin not rolling back”?

Baby boys have a sheath of skin covering the red top part of the penis (glans penis) since birth.Circumcision is the removal of this skin sheath. Foreskin does not roll back at birth because there are adhesions between the inner layers of this skin sheath and the glans penis. This is physiological phimosis and it disappears with age.Poor hygiene leads to infection and inflammation of the glans penis (balanitis). Rolling back forcefully tears the edge of the foreskin. When these wounds heal, the edge of the foreskin scars. For the foreskin to roll back it has to stretch over the glans penis. Scarring reduces the ability to stretch. This is called pathological phimosis. Elderly men has less elastic skin. So foreskin can’t stretch over the glans penis;  thus causing phimosis.

What are the risks?

While the foreskin is less elastic, forceful retraction can overcome the resistance at the glans penis and roll back. But the foreskin then acts as a tight band around the base of the glans penis and it doesn’t come back to the previous position. This is called “paraphimosis”. This is a very serious problem because the tight band­like action of the foreskin reduces blood supply to the glans penis. Swelling, redness, pain are the first signs of trouble. If untreated the glans penis can die and fall off!Paraphimosis occurs if you retract a baby boy’s foreskin forcefully, forget to replace the foreskin to normal position after cleaning or urinating, have long standing infection of the glans penis or are bed ridden with an in­dwelling catheter without the foreskin replaced to normal position after catheterization. Poorly retractable foreskin means you cannot wash and clean the penis properly. Infections are frequent.Poorly retractable foreskin means you cannot wash and clean the penis properly. Infections are frequent.

What are the tests needed?

Both phimosis and paraphimosis are diagnosed clinically and no tests are needed.

Treatment

Phimosis does not need emergency interventions while paraphimosis is an emergency. Circumcision is the only cure for phimosis.Manual reduction involves forcing the glans back through the foreskin. Wrapping an elastic band from tip to base of the glans, non­crushing clamps and soaking the glans in an ice glove for about 5 minutes reduces swelling before manual reduction. Osmotic reduction uses high concentration solutions (50% dextrose, granulated sugar) to draw out edema fluid from the glans. Puncture reduction involves puncturing the glans with a large needle to drain edema fluid out. Hyaluronidase is an enzyme that breaks down extracellular matrix to reduce swelling. Aspiration means drawing out 3­12 ml of fluid from the glans by puncturing the glans penis with a needle (attached to a syringe) parallel to the urethra, to reduce swelling. If all above methods fail, a 1­2 cm incision to divide the band of foreskin makes it easier to bring the foreskin forwards over the glans.Keep in mind that trauma to the foreskin while reducing may cause phimosis later in about 30% of the cases. So urology referral is essential.

By: Dr. T. M. S. Sameera B. Madugalle M.B.,B.S (COL)

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ඔබට ඇති වෛද්‍ය ගැටළු අසන්න මෙහි ක්ලික් කරන්න, Ask a Doctor | වෛද්‍යවරයාගෙන් අසන්න

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මෙම ලිපිය ඔබට ප්‍රයෝජනවත් වුනානම් හෝ ඔබේ මිතුරියකට ප්‍රයෝජනවත් වේ යයි සිතනවානම්, කරුණාකර පහත ඇති "share" ක්ලික් කිරීමෙන් එය බෙදා හදා ගැනීමට අමතක කරන්න එපා. තවද, මෙම ලිපිය පිළිබඳව ඔබේ අදහස්, යෝජනා සහ අනෙකුත් මවුවරුන්/කාන්තාවන් හට ප්‍රයෝජනවත් වන ඔබේ අත්දැකීම් පහත ලියා තැබීමටද අප ආරාධනා කරමු. ස්තුතියි!

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