Saturday, May 7, 2011

Paraphimosis of Penis

Paraphimosis is a condition where the distal reddish part of penis called glans is very much swollen after forcible retraction of the foreskin called prepuce and could not be reduced to its original position covering the glans.

It is mostly seen in children and adolescents; who become curious on their body parts especially when secondary sex characters develop.

When a nearly tight prepuce yields to forcible retraction and goes beyond the glans penis but could not get back to its original position as glans obstructs the act of reduction, acts as a constricting band behind the glans.

This band or ring of foreskin obstructs the return of fluid from from the distal part of penis towards the body and eventually to the system.The ring swells giving rise to cumulative effect to obstruction that sets a vicious cycle hampering return of fluid and giving rise to a grotesque appearance of the whole penis. The shyness of the adolescent and guilty feeling results in late reporting to the doctor that increases the swelling of glans sometimes to a great extent. It may give rise to obstruction to passage of urine.

The condition is very painful and requires immediate medical attention.The prepuce may have to be reduced after relieving the constricting ring. A slit may have to be made, if a non-surgical manual attempt by the doctor fails to reduce it. It may require a formal circumcision, but better deferred; if there is a lot of oedema in the part.

There are many reports which suggest that circumcision may prevent Cancer of penis, HIV/AIDS and Herpes infection in persons undergone circumcision in early life. As per book it has been seen that cancer of penis is very rarely seen in Jews who undergo circumcision in very early childhood as a custom/ritual; but circumcision later in the life does not have the same protective effect. It is not definitely known what prevents this.

More reports are coming in favour of circumcision for its preventive effect on contacting HIV/AIDS and genital herpes. Moreover, it gives a clean feeling and prevents deposit of foul smelling smegma underneath the foreskin.
In some children the prepuce may not be that resilient to open; not at all, at least in first two years of life; but eventually, it opens naturally later on. If it does not, circumcision needs to be taken up after second year of birth.

Routine circumcision is not bad practice if there is no abnormality in the urethra requiring reconstruction in the later life where the foreskin may be very much useful.
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