Paraphimosis

Explanation

If a tight foreskin (phimosis) is pulled back behind the head of the penis (glans), this can act as a tourniquet, restricting the blood supply to the parts of the penis behind the constriction. This most commonly affects the part of the foreskin beyond the constriction, but restricted blood flow can also cause swelling of the glans. The German term for paraphimosis translates as ‘Spanish collar’.

Symptoms

Paraphimosis causes painful swelling of the foreskin and in some cases the glans. Depending on how tight the foreskin is, left untreated the foreskin around the constriction may die and in extreme cases the blood supply to the glans may be impaired.

Treatment

Treatment consists of manual decompression to reduce the swelling, followed by pulling the foreskin back to its normal position over the glans. If the swelling is too severe and this is not possible, the constriction must be relieved surgically (under local anaesthetic). To avoid problems with wound healing, complete circumcision should only be performed once the acute inflammation has resolved.