Phimosis and Paraphimosis

ByPatrick J. Shenot, MD, Thomas Jefferson University Hospital
Reviewed/Revised Aug 2023
View Patient Education

Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency.

    Phimosis

    Phimosis is normal in children and typically resolves by age 5. Treatment is not required in the absence of complications such as balanitis, urinary tract infections (UTIs), urinary outlet obstruction, unresponsive dermatologic disease, or suspicion of carcinoma.

    Phimosis and Paraphimosis
    Phimosis
    Phimosis

    This photo shows the penis of a young boy with phimosis.

    DR P. MARAZZI/SCIENCE PHOTO LIBRARY

    Paraphimosis
    Paraphimosis

    In paraphimosis, the pulled-back (retracted) foreskin is trapped, causing swelling of the glans.

    © Springer Science+Business Media

    Betamethasone cream 0.05% two to three times a day applied to the tip of the foreskin and the area touching the glans for 3 months is often effective. Stretching the foreskin gently with 2 fingers or over an erect penis for 2 to 3 weeks with care not to cause paraphimosis is also successful. If conservative measures are ineffective, circumcision is the preferred surgical option.

    In adults, phimosis may result from balanoposthitis or prolonged irritation. Risk of UTI, penile cancer, HIV, and sexually transmitted infections is increased. The usual treatment is circumcision.

    Paraphimosis

    Paraphimosis can occur when the foreskin is left retracted (behind the glans penis). Retraction may occur during catheterization or physical examination. If the retracted foreskin is somewhat tight, it functions as a tourniquet, causing the glans to swell, both blocking the foreskin from returning to its normal position and worsening the constriction.

    Pearls & Pitfalls

    • Always remember to reduce the foreskin after urethral catheterization.

    Paraphimosis should be regarded as an emergency, because constriction leads quickly to vascular compromise and necrosis of the glans penis. Firm circumferential compression of the glans with the hand may relieve edema sufficiently to allow the foreskin to be restored to its normal position. If this technique is ineffective, a dorsal slit done using a local anesthetic relieves the condition temporarily. Circumcision is then done when edema has resolved.

    Drugs Mentioned In This Article

    quizzes_lightbulb_red
    Test your KnowledgeTake a Quiz!
    Download the free Merck Manual App iOS ANDROID
    Download the free Merck Manual App iOS ANDROID
    Download the free Merck Manual App iOS ANDROID