Everything you need to know about phimosis in men. phimosis

04.11.2019 -

Normally, the head of the penis is covered with a skin sheet (foreskin), which is well extensible and easily slides along the surface of the head of the penis, exposing and covering it.

In violation of the extensibility of the skin, an attempt to open the head of the penis is accompanied by unpleasant sensations and pain.

In advanced cases, the head of the penis may not open at all due to tight fusion of the epithelium. foreskin with epithelial lining of the head.

The totality of the described symptoms, along with the fact of a narrow hole in the skin sheet covering the penis, allows us to speak of the diagnosis of phimosis.

So, phimosis in men is the impossibility of exposing the glans penis due to the narrowness of the foreskin and its outlet. In this case, an attempt to open the head is accompanied by discomfort and pain.

Approximately 96% of boys at birth have difficulty retracting the skin from the surface of the head of the penis, which is associated with natural adhesion of the epithelial linings of the foreskin and the head, congenital narrowing of the skin sheet covering the head of the penis, a short frenulum, which reduces the mobility of the skin over the head of the penis.

In this case, we speak of physiological phimosis.

With this variant of phimosis, over time, there is an increase in the mobility of the foreskin (repeated erections, keratinization of the inner epithelium contribute to an increase in skin mobility, separate the adjacent epithelial sheets).

In about 2% of cases, violation of the exposure of the head persists for life.

Rice. 1 - The foreskin is normal and with phimosis. Source - http://www.aboutkidshealth.ca/

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1. How common is phimosis?

2. Causes

Phimosis in men and boys is divided into primary (congenital) and acquired (secondary). With congenital phimosis, there is no clear relationship with any triggering factors.

As a rule, in this case, the physiological course of phimosis is noted and conservative management of the patient is possible. Rarely, congenital shortening of the frenulum occurs, which can cause congenital phimosis.

Secondary (pathological) phimosis develops against the background of a concomitant lesion of the head and skin flap of the foreskin.

The causes of secondary phimosis can be:

1 Infectious and inflammatory lesions of the head and foreskin as a result of non-compliance with the norms of hygienic treatment of the genital organs, repeated balanitis / balanoposthitis, uncontrolled diabetes. With these pathologies, there is a narrowing of the foreskin and a change in its ability to stretch, which leads to a clinic pathological phimosis.
2 Forcible opening of the foreskin in physiological phimosis (attempts by caring parents to open the head of the penis in a boy) can lead to tears, bleeding and subsequent formation of adhesions between the head and its skin.
3 Another cause of pathological phimosis is xerotic balanitis obliterans. Exact etiology this disease not installed.
4 Re-catheterizations Bladder.

3. Phimosis as a variant of the norm

As we noted earlier, phimosis can be physiological and pathological.

Physiological phimosis is present from birth and is not accompanied by any symptoms, with the exception of impaired exposure of the head of the penis. Most often, there is a resolution of physiological phimosis before the end of the boy's puberty.

Pathological phimosis is usually secondary disease developing against the background of concomitant pathology.

For example, with improper hygienic care of the genitals under the foreskin, smegma can accumulate in the space between its leaf and head.

Smegma is dead cells desquamated from the surface of the epithelial lining of the head and foreskin. It can serve as a breeding ground for microorganisms, contributing to the development of inflammation.

Chronic inflammation leads to scarring of the skin flap, the formation of adhesions between the foreskin and the epithelium of the head of the penis. The result of this pathological process- development of secondary phimosis.

4. Symptoms and signs of pathology

1 The narrow ring of the foreskin, its cicatricial deformity, adhesions completely block the exposure of the head of the penis.
2 The appearance of pain in the head of the penis in an erect state.
3 Bleeding from the injured skin of the foreskin, head of the penis.
4 Recurrent infections of the organs of the urinary system.
5 Infection, inflammation of the head of the penis (balanitis).
6 Pain in the foreskin.
7 Weakening of the stream due to blockage of urine outflow through the urethra. Intermittent urination, need to strain, discomfort when urinating.

The table below shows the degrees (stages) of phimosis in adults and children.

Table 1 - Degrees (stages) of phimosis. Source - https://phimosisjourney.wordpress.com/

The classification of phimosis according to the origin, course and mechanism of violation of the exposure of the head is given below.

Table 2 - Classification of phimosis in adults and children

5. What complaints do the child's parents make?

As a rule, the only complaint of the boy's parents is the inability to fully expose the head of the penis when taking a bath, with hygienic care for the genitals.

In response to attempts to retract the skin flap, the child begins to act up, scream.

Less often there is a complaint of swelling of the foreskin at the beginning of urination, which can also be a variant of the norm in children.

6. Examination of the patient

1 In physiological phimosis, the only sign is the inability to fully retract the foreskin. The skin flap over the head of the penis looks normal, without pathological changes.
2 With pathological phimosis, cicatricial narrowing of the foreskin ring can be determined.

Rice. 2 - Physiological phimosis (left) and pathological (right). Source - Medscape.com

7. What is the diagnosis based on?

No laboratory tests are required to make a diagnosis instrumental research. The diagnosis of phimosis is made on the basis of an examination, a characteristic clinical picture.

The attending physician will always distinguish pathological phimosis from physiological, determine the stage of the disease and, if possible, establish the cause of phimosis.

8. What to do if there are problems with skin retraction from the head of the penis?

What to do if the head of a child or a man does not open? If you suspect that the child has problems with the foreskin, it is recommended to seek advice from a pediatric urologist / surgeon. An adult man needs to seek help from a urologist in a planned manner (to the clinic).

9. To treat or not to treat?

Medical tactics depends on what type of phimosis the patient has. Therefore, both for the patient, parents (if the symptoms of phimosis develop in a child), and for the attending physician, it is important to learn to draw a clear line between the physiological and pathological variant of the disease.

In pathological phimosis, the patient is shown surgical treatment, with physiological phimosis, a conservative resolution of the disease is possible.

A clear concept of the norm and pathology, the mechanisms of the development of the disease allows you to reduce the frequency of visits to the doctor and independently carry out the prevention of phimosis at home.

10. Features of treatment in children

If parents turn to a pediatrician with a complaint about the inability to remove the skin from the head of the boy's penis for hygienic treatment, then in this case the doctor first differentiates pathological phimosis from physiological.

Further tactics of treating a child depend on the age of the child, the mechanism of development of phimosis, the severity of symptoms, the cause and concomitant pathological conditions.

In the absence of pathological phimosis, parents should be reassured that their child's skin retraction difficulties are normal in this age group.

It is necessary to teach parents the rules of hygienic treatment of the external genitalia of the child (washing the penis with soapy water, followed by rinsing warm water, accurate removal of the foreskin when taking a bath, shower, when urinating, teaching the child to independently remove the foreskin, not to allow effort, pain, discomfort during its removal).

Explain that hygiene, together with the growing up of the child (erections, keratinization of the inner layer of the foreskin), is likely to lead to the restoration of the mobility of the skin flap. In children, phimosis can be treated without surgery.

10.1. Local therapy and ointments

Topical steroid therapy may be the first choice in the conservative treatment of pathologic phimosis.

The effectiveness of ointments, creams based on corticosteroids varies from 65 to 95%. The exact mechanism of action of topical steroid-based ointments has not been established.

It is assumed that healing effect achieved due to the anti-inflammatory and immunosuppressive effect of drugs. The use of topical steroids is accompanied by mild side effects, including pain in the foreskin, its hyperemia.

After a couple of months from the abolition of the course of steroids, it is possible to restore problems with the foreskin. In such cases, it is possible to prescribe a second course.

In order to stop side effects from local steroids, the patient is prescribed topical ointments based on non-steroidal anti-inflammatory drugs (Diclofenac).

10.2. Stretching of the foreskin

The procedure is performed by a urologist on an outpatient basis. Foreskin stretching is inexpensive, effective, and safe. Often, special balloon dilators are used to perform the procedure.

10.3. Surgery

Plastic surgery of the skin flap over the head of the penis is performed when there is a risk possible complications and risks. Depending on the method (skin incision along the posterior surface of the head, followed by transverse suturing of the skin sheet, plasty of the lateral surface of the sheet, dissection of the frenulum).

Plastic surgery is less painful, is accompanied by a lower likelihood of complications, and a faster recovery of the patient. The only negative point of these operations is the possibility of recurrence of phimosis.

11. Treatment tactics in adults

Treatment of phimosis without surgery in adults is not carried out, since the risk of complications (paraphimosis) is high. Adult males usually undergo circumcision. That is why it is better to start treatment of pathological phimosis earlier, in adolescence.

12. When is emergency care needed?

Patients diagnosed with phimosis rarely require emergency medical attention. However, in the case of paraphimosis, it is necessary emergency help urologist. This condition most often occurs when trying on their own, with an effort to open the glans penis.

Paraphimosis - infringement of the base of the head of the penis by a narrowed foreskin. A narrow ring of skin, when retracted beyond the base of the head, can cause a violation venous outflow from the head and lead to its edema.

Rice. 3 - Paraphimosis (compression of the base of the head with a swollen flap of the foreskin). Source - Medscape.com

Edema of the head and skin flap leads to difficulty in returning the foreskin to its normal position. The result of acute infringement may be necrosis of the glans penis.

With paraphimosis, it is necessary to remove the infringement of the head. As a rule, to eliminate paraphimosis, the doctor first uses minimally invasive techniques, and if they are ineffective, he resorts to surgical treatment.

All invasive manipulations must be performed under sterile conditions.

Methods for eliminating paraphimosis:

Figure 4 - Aspiration of blood from the head of the penis. Source - Medscape.com

13. Prevention

Prevention of phimosis consists in proper hygienic care of the area of the head of the penis and the skin above it.

1 Do not try to often remove the foreskin with normal exposure of the head of the penis.
2 If the foreskin is not completely retracted, then do not try to retract it at once.
3 If the head is not completely exposed, it is important to teach the child to gently retract the foreskin while taking a bath / shower, urinating.
4 During the abduction of the skin flap, the child should stop before the appearance of pain, discomfort.
5 It is important not to allow effort when retracting the skin of the foreskin. Excessive exposure can lead to microcracks, skin ruptures, followed by scar formation.
6 During bathing, the foreskin is treated with soapy water, washed with water and dried with a towel. After treatment, it is necessary to return the skin flap to the opposite position, the foreskin should again cover the head of the penis.
7 It is important to avoid the use of concentrated soap solutions, as their use can irritate the skin and mucous membranes, exacerbating the symptoms of the disease.

Figure 5 - Vertical incision of the foreskin. Source - Medscape.com

Key points

Key points
1) It is necessary to clearly distinguish physiological from pathological phimosis, normal from pathology
2) Physiological phimosis is present to some extent in 96% of boys and is a variant of the norm
3) Physiological phimosis can independently resolve by puberty and only in 2% passes into a pathological form.
4) In the treatment of physiological phimosis, the most important is the correct hygienic treatment of the foreskin and the head of the penis, the prevention of injuries, infection of the foreskin.
5) In the treatment of pathological phimosis, surgical methods are most effective, but it is possible topical application ointments based on corticosteroids.
6) Among operational methods treatment of phimosis, methods of various plastics of the foreskin and the generally accepted operation of circumcision (circumcision) stand out.

Phimosis of the 1st degree does not pose a threat to life, but its presence makes significant adjustments to the lifestyle of a man, affecting its quality, and most importantly, it significantly affects the intimate sphere.

In the initial stages of the pathology, extremely unpleasant manifestations occur exclusively at the time of sexual arousal, which, of course, affects relationships with members of the opposite sex.

General information

Phimosis is the narrowing of the skin fold of the penis, which makes it much more difficult to move it beyond the head of the penis at the time of erection, as well as during hygiene procedures and in other situations. This disease, like most others, goes through several stages of development, the first of which is considered the easiest.

Phimosis 1 degree in medical practice means the initial form of narrowing of the foreskin. With such a pathology in a man, all the unpleasant symptoms are reduced, as a rule, only to difficulty in erection. If the penis is in a state of complete rest, then the disease may not manifest itself at all.

But, despite this, even phimosis of the 1st degree is capable of provoking the occurrence of paraphimosis - this is what the infringement of the head of the penis with a loop of the foreskin is called. This disease can lead to necrosis of the penis. And in the absence of the necessary treatment, even amputation of the reproductive organ may be required.

Peculiarities

Phimosis of the 1st degree occurs both in adult men and in children. True, in the latter case, the disease can go away on its own, without medical intervention. As a rule, this happens by the age of 6-7, in some situations even earlier. Physicians also call this pathology physiological.

But is it necessary to treat phimosis of the 1st degree in adult men? Such a disease in patients of this age category is exclusively pathological in nature and is not able to go away on its own. In adult patients, phimosis clearly requires mandatory medical intervention. The disease is born against the background of many different causes, and is eliminated solely through appropriate treatment.

Symptoms of the disease

In children, phimosis of the 1st degree does not manifest itself at all. But in mature men, there is a systematic occurrence of pain syndrome at the time of erection of the penis.

This phenomenon is explained by the strong tension of the skin fold on the glans penis. In this case, the prepuce can be displaced beyond the foreskin, which is fraught with the appearance of the same paraphimosis. But at the initial stage of development, with some effort, a man may well help himself with his own hands.

It is noteworthy that in the absence of an erection, the skin fold moves behind the head and returns without any problems.

Among other things, due to the appearance of pain in a patient, erectile dysfunction of psychological pathogenesis may occur. After all, every time a man, even before sexual arousal, will worry about the upcoming discomfort.

Self-elimination of paraphimosis can lead to microtrauma, which can only aggravate the course of the pathology.

For a visual definition of the disease, it is best to familiarize yourself with the photo of phimosis of the 1st degree. Knowing the visual signs of pathology will help to identify the anomaly in time and begin treatment.

Reasons for the appearance

Among the likely prerequisites for the development of phimosis should be highlighted:

damage to the skin fold, due to which dense scar tissue has formed;
inflammatory pathologies of the head of the penis and prepuce of various pathogenesis;
hereditary predisposition, suggesting insufficient plasticity of the skin.

Most often, phimosis develops against the background of balanoposthitis and balanitis.

Often the provocative condition is the negligence of parents in relation to the hygiene of the child. After all, the smegma that accumulates in the foreskin zone is a very favorable environment for the reproduction of pathogenic microflora.

Treatment of phimosis of the 1st degree is directly related to the initial causes of the development of pathology, therefore, it is not necessary to identify them only if it is planned to use radical methods. That is why it is so important to go through all the stages of diagnosis recommended by a specialist - this is the only way to determine the etiology of the disease.

Like 1 degree

It is desirable to get rid of this disease immediately after the onset of the first symptoms. In this case, both surgical and conservative methods can be used. The final choice of therapy depends on the severity of the pathology and the symptoms that appear.

For example, in the case of active formation of dense scar tissue and an intensive course of the disease, surgery is required. But hereditary phimosis can be completely eliminated with the help of physical influence on the foreskin, especially at the initial stage of development.

Conservative methods

Treatment without surgery provides only one way to eliminate phimosis - stretching the skin fold manually or with the help of special medical devices. The necessary manipulations should be performed every day for approximately 20-30 minutes. In addition, skin plasticity can be increased through the use of special moisturizing gels and corticosteroid ointments.

The scheme of the procedure is standard and involves several important steps. Namely:

Feedback on home therapy

Reviews of the treatment of phimosis of the 1st degree in this way speak of the inconvenience of this technique. Indeed, to obtain the effect, stretching sessions should be arranged daily for six months. Such activities, according to the numerous responses of men, are aggravating and take a lot of time.

In addition, not all patients have such an opportunity - every day to arrange such intimate procedures. However, the final choice still remains with the man - for many patients, the treatment of phimosis of the 1st degree at home has become an excellent solution. After all, not every patient will decide on a surgical intervention in such a sensitive place.

Operation

The elimination of penile prepuce by surgical intervention is deservedly considered the most effective method of therapy for phimosis of any degree. The operation is advisable when:

high likelihood of relapse;
the observed tendency to the rapid progression of pathology;
regular infections of the head of the reproductive organ and foreskin.

All these processes unequivocally provoke a deterioration in the patient's condition and speak of high risk occurrence of paraphimosis.

For the treatment of grade 1 phimosis in adults, one of the surgical options can be used:

Using a traditional scalpel. The main advantage of such an operation is its material availability. But the disadvantages should be attributed a long period restoration of a damaged organ.
Removal of the foreskin with a radio wave scalpel. The advantage of this technique is considered to be a slight injury to the organ and a rather short rehabilitation period. But the disadvantage is the rather high cost of such an operation.
Skin fold removal with a laser. The advantages of such an operation are insignificant damage to the organ, short recovery period and minimal risk of infection. But the disadvantage can be called, of course, the high cost of the procedure, which is clearly beyond the reach of many patients.

A contraindication to the implementation of the operation by any of the described methods is the stage of exacerbation of the inflammatory process.

Likely consequences

In the absence of appropriate measures to get rid of phimosis of the 1st degree, the probability of rapid progression of the pathology is extremely high. The disease passes to the next stage of development, which is characterized by a more pronounced clinical picture. A man experiences increased discomfort, which is explained by the aggravated narrowing of the skin fold. Because of this, the patient may experience:

Such manifestations require immediate medical attention and serious treatment, including surgery or even amputation of the penis.

Conclusion

In fact, phimosis is in vain considered a pathology that must be hidden from others, and even more so from doctors. A similar problem can be resolved relatively painlessly if you resort to appropriate assistance at the 1st stage of the development of the disease.

Otherwise, the pathology can lead to the rapid progression of the abnormal process and the appearance of life-threatening consequences for a man. Self-made attempts to get rid of the narrowing of the foreskin that has arisen can end very badly, so even the 1st degree of phimosis should be treated under the constant supervision of a specialist.

Phimosis refers to diseases that affect only men. It is manifested by stenosis of the foreskin to a critical state (see photo below). Often transmitted genetically.

treated in the early stages conservative methods.

If therapy is not started in a timely manner, there may be serious problems that violate the act of urination, sexual function.

This article details the causes, symptoms, and how to treat phimosis in men.

Characteristics of the disease

Phimosis is a pathology that manifests itself as pain when opening the skin folds that cover the penis. In the later stages, it is impossible to expose his head. The disease is pathological, physiological type. Phimosis in children is manifested in 96%.

This is caused by the low mobility of the foreskin that covers the head of the penis. Usually this phenomenon without medical intervention passes by the age of 6.

The occurrence of phimosis in men, adolescents is a pathological species. The problem will not go away on its own. It is necessary to obtain a doctor's consultation in order to determine the tactics of treating the disease.

Causes of phimosis

Phimosis in children can not only be of a physiological nature, which is not a pathology and disappears by the beginning of adolescence.

They often develop a pathological form of the disease. Its causes lie in the presence of:

an overweight child that causes a hypertrophic appearance. Against the background of which there is an accumulation of excess fat, which is the reason for the formation of bacteria in the pubic region;
inflammatory processes of the urinary system, provoking swelling;
underdevelopment of the skin surrounding the penis.

If in childhood a man did not have the problem of narrowing the skin folds of the penis, this does not mean that he will not meet her during adult life. Causes of phimosis in men:

neglect of hygiene rules. Which leads to the multiplication of bacteria that causes inflammation;
a hereditary factor that is associated with a genetically transmitted reduced extensibility of the skin of the penis. This, if measures are not taken in a timely manner, causes a critical narrowing of the foreskin;
inflammatory foci;
injuries that may occur as a result of rough sex, forced correction in childhood physiological type phimosis. This situation leads to the formation of adhesions that narrow the preputial cavity;
venereal diseases.

Urologists note that it is often impossible to determine the causes of the pathology. It happens that the disease occurs against the background of several factors.

Provoking factors

With unfavorable heredity, the development of phimosis can be provoked by the following factors:

anomalies of the musculoskeletal system, for example, stoop,;
heart disease;
, which causes the presence of glucose in the urine, which provokes infectious processes;
rough masturbation;
frequent catheterization.

phimosis symptoms

Usually, phimosis of the 1st degree in children does not manifest itself in any way. In the later stages, boys complain of pain when urinating. Parents may notice that the child is pushing, trying to go to the toilet "in a small way."

Symptoms of phimosis in men:

pain in the penis during erection. This is due to the excessive tension of the prepuce. Perhaps the displacement of the skin behind the head of the penis. These signs appear at 1, 2 stages of phimosis. With a late course, the pain in an excited state disappears, it will not be possible to expose the head due to a significant narrowing of the preputial ring;
premature ejaculation;
decrease in the brightness of sexual sensations;
reduced potency;
at a late degree of the disease, symptoms of impaired functioning of the urinary system occur. They manifest themselves in the form of a burning sensation during urination, difficulties with this process. The body temperature rises, the patient feels weakness, fever, lymph nodes in the groin area increase.

There are psychological signs of phimosis in men who are often unhappy appearance your penis. They begin to worry about the upcoming soreness even before the onset of an erection. In this situation, it will be necessary to treat phimosis in men not only with the help of a urologist, but also with a psychotherapist.

Stages of phimosis

Given the brightness of the severity of symptoms, phimosis has the following stages, each of which is characterized by distinctive features:

First stage. At rest in a man, the head of the penis is exposed without difficulty. In an excited state, this is not easy to do because of the pain during the movement of the epithelium. Young people have a receptive head that opens spontaneously as a result of swelling, often causing paraphimosis.
Second stage. During erections in a man, the head of the penis is exposed with difficulty, self-closing with the skin. If you apply efforts, you can only worsen the course.
Third stage. In a man, even at rest, the head of the penis cannot open. At this stage, there is a violation of urination, it is difficult for the patient to urinate. This process is accompanied by burning and pain. If the foreskin is exposed in an excited state, then bleeding may open.

On a note, it is forbidden to have sexual intercourse in the third stage of phimosis, as this will lead to greater injury to the skin.

Fourth stage. In a patient, the penis is not exposed either during an erection or at rest. It is difficult for him to go to the toilet "in a small way." A man during this process feels a bright pain syndrome. This stage is characterized by an inflammatory process, an increase in body temperature, the formation inguinal lymph nodes, lowering potency. The accumulated secret in the head of the penis causes the development of smegmolytic formations.

Phimosis in adult men of the first three stages is relative. The fourth degree is pronounced. There is also an incomplete form of the disease. It is manifested by incomplete coverage of the foreskin of the head of the penis. Usually partial coverage is inherited.

Types of phimosis

Medicine subdivides the following types of pathology:

physiological is the most common problem. Usually diagnosed in infants under 3 years of age. It appears to be an underdevelopment of the skin surrounding the penis. During the first years of children skin covering adjacent to the head of the penis. Then it starts to open up. Until the age of 4, physiological phimosis does not apply to pathology, provided there is no pain during urination and severe inflammation. Usually, by the age of 6, phimosis disappears, the head opens freely;
hypertrophic phimosis occurs against the background of a thickened skin, due to its going beyond the border of the head, resembling a "proboscis". In the absence of therapy, the pathology will turn into hypogonadism;
cicatricial is considered a consequence of injury, determined by adhesions, scars of different sizes;
atrophic characterizes the refined skin, its atrophy.

Diagnostics

Before treating phimosis in men, a standard examination is carried out before hospitalization. After a visual examination and conversation, the patient is prescribed to pass:

blood test for infection;
blood sugar test;
blood test to determine the group and Rh factor;
urinalysis for bacteria;
urine test for sensitivity to antibiotics;
if during the examination a large amount of smegma is determined, then it is diagnosed for carcinogenicity.

The appointment of instrumental diagnostic methods is carried out in the inflammatory process. If during the examination a formation was found, then a biopsy with histology is indicated. Assuming inguinal lymphadenitis, do Ultrasound of the lymph nodes groin area.

phimosis treatment

Today, medicine, in addition to circumcision of the foreskin, offers the following types pathology treatment:

drug therapy based on the use of ointments. Effectively treats phimosis of the 1st degree;
physical exercises in the form of gradual stretching of the hole to achieve a wider state;
surgical treatment that reshapes the hole, making it as wide as possible.

Medical treatment

Drug therapy is aimed at increasing the elasticity of the skin, effectively relieves the inflammatory process, and eliminates burning. If the patient has phimosis of the 1st degree, then with the help of ointments, surgery can be avoided.

Medications local action effective in the absence of injuries, pain.

Non-surgical therapy is based on the use of steroid ointments, which accelerate the normal growth, expansion of the foreskin.

Cortisone;
mometasone furoate;
Betamethasone.

To achieve effectiveness, steroid ointments should be applied as follows:

First, treat the skin with antiseptics, Miramistin, Chlorhexidine.
After drying, apply the preparation prescribed by the doctor to the treated area.
When part of the cream is absorbed, you need to carefully lift the skin fold and gently stretch it in different directions. If there is even the slightest discomfort, then the stretching procedure should be stopped. When the pain subsides, the stretching is repeated.
Exposure to the skin with ointment should be carried out within 15 minutes.
Then treat the foreskin and glans penis with an antiseptic.

To achieve the result, the treatment is carried out for at least six months. Local therapy has the following advantages:

non-surgical treatment;
no injury;
economy of therapy;
preservation of the foreskin with erogenous, sexual, sensory, protective functions.

For information, children are prescribed to treat phimosis, increase elasticity, reduce inflammation, swelling and accelerate the healing of small cracks. prednitop.

Surgery

When conservative therapy did not give the expected result, the man has prolonged phimosis, the operation is the only method of treatment. Surgery is required for the following symptoms:

painful urination;
accumulation of secret under the skin;
swelling of the penis;
inflammatory process in the area of the glans penis;
with splicing and scars.

The surgery does not take long. If the patient does not have the fourth stage with the involvement of the inflammatory process, the deterioration of the urinary system, then after the phimosis operation, he goes home the same day. The initial stages of the pathology are treated under local anesthesia. A prolonged state requires the introduction of anesthesia.

For the treatment of phimosis, self-absorbable suture materials are used. The organ is fully sensitive. Complications, infection, inflammatory processes worsening of the disease.

For your information, cicatricial phimosis in men is treated only with a surgical method.

If phimosis is diagnosed, surgery is performed different methods which the surgeon chooses based on the stage of the disease and the patient's condition. Types of surgery:

partial circumcision characterized by the removal of a small area of the foreskin. This operation removes the cause of the problem. After the procedure, the head of the penis will be covered both in the excited and in the calm state, which does not affect the sensitivity. This type of surgical intervention is performed at 1 or 2 stages. After it, the sutures heal quickly, the possibility of bacteria penetration decreases due to the exclusion of secretion accumulation. The downside is that phimosis often recurs in men;
full circumcision carried out if phimosis of the 2nd degree is diagnosed. The operation is classified as simple, after a few hours the patient goes home. The positive point is the exclusion of recurrence of the disease. Possible complication in the form of swelling;
laser treatment characterized by the absence postoperative complications. During the procedure, the prepuce is excised with a beam, the pathological tissue is removed, and the vessels are sealed. This minimizes injury and eliminates blood loss. During laser treatment surgical wounds heal quickly, the postoperative period passes quickly. The procedure is performed with phimosis 1, 2 degrees;
preputioplasty not carried out in the presence of scars on the penis, with the exception of the tip of the prepuce. The doctor dissects the adhesive process, which worsens the movement of the foreskin. Next, transverse sutures are applied. The operation is performed at stages 2, 3 of phimosis, characterized by the absence of complications, minimal pain;
metaplastic carried out at 4 stages of phimosis, with a critical narrowing urethra. With help this method penis correction.

After the phimosis operation, a sterile dressing must be applied for 10 days. If there are seams, then they are processed with brilliant green. The sexual organ is not recommended to be washed for 7 days. Sexual activity is allowed 2 weeks after the stitches are removed.

If the operation was performed with a laser, then sexual contacts are allowed after 1 month.

Complementary home treatments

Treatment of phimosis in men at home is carried out only after visiting a doctor and establishing the stage of the disease. Home therapy is performed at 1, 2 degrees and is based on folk methods that come as an addition to the main treatment.

Nutrition

Home treatment of phimosis involves monitoring nutrition. A man needs to exclude the use of salty, pickled foods, carbonated drinks, so as not to disrupt the functioning of the urinary system. During this period it is important proper nutrition based on food rich in vitamins. Vitamin complexes allow to strengthen immune system, strengthen the body's strength to fight the inflammatory process.

Herbs

Treatment of phimosis in men at home involves herbal medicine. Herbal decoctions have an antimicrobial and anti-inflammatory effect, not only treat the disease, but also heal small cracks, relieve irritation. The following are commonly used tools:

take 1 tsp. string, chamomile, calendula. All pour 1 liter. boiling water, insist half an hour. The product is used as a sitz bath. To enhance the action, you can add 1 tsp. baking soda, which allows better stretching of tissues;
1 tsp calendula pour 1 tbsp. boiling water. Insist 30 min. After cooling, use a compress to relieve the inflammatory process, heal wounds. The compress is placed at night.

Exercises

The initial stage of phimosis is perfectly treated with stretching. For adult men, the procedure can be performed using a special device, Glansha, invented in Japan. Surgical steel is used to make the structure.

The tool stretches the skin, thereby eliminating the problem. It is more expedient for teenagers to stretch by manual method. To get the most benefit, follow these guidelines:

before starting the procedure, you need to cut your nails, wash your hands, treat them with an antiseptic;
next, the man needs to take a herbal sitz bath. It allows you to steam the foreskin, preparing it for the procedure;
to avoid soreness on the skin, apply the ointment prescribed by the doctor;
within 15 minutes, with fingers inserted into the opening of the foreskin, stretch in various directions;
after manipulation, treat the skin with an antiseptic;
to avoid inflammation, you can apply herbal compresses;
in the absence of pain, exercises are performed three times a day;
in case of formation of small cracks, use Solcoseryl cream.

Important! During stretching, it is necessary to completely exclude sexual contact.

Prevention

To avoid the occurrence of phimosis, especially for men in whom this disease is inherited, the following preventive measures are important:

daily hygiene;
do not use soap and lubricants based on alkali, glycerin;
timely treatment of inflammatory diseases of the genitourinary system;
immediate treatment of microcracks, wounds with antiseptics;
annual testing for sexually transmitted diseases;
scheduled examination by a urologist;
a serious choice of a sexual partner;
condom use;
compliance healthy lifestyle life, mode. Full sleep, rest is a guarantee of men's health;
rejection of bad habits;
daily sports activities. But the load should be moderate. Swimming has proven itself well as a fight against diseases of the genital organs;
if the work is connected with a computer, staying all day in the office, then you need to monitor the time spent in the fresh air.

Forecast

Phimosis at the initial stage is easily treatable. Medical statistics claims that recovery occurs in 100% of cases. Late stages lead to a chronic course of the disease.

In exceptional cases, the outflow of urine is difficult. Sometimes it can stop completely. This condition poses a threat not only to health, but also to the life of the patient.

Untimely treatment often leads to paraphimosis, which is characterized by a painful and swollen head of the penis. During intercourse, pinching of the foreskin can occur, causing soft tissue necrosis. Insufficiently stretched skin around the penis leads to sperm stagnation, the development of smegmolites.

This condition forms an acute inflammatory process. Stagnation of smegma often causes oncological diseases which worsens the chances of a full recovery.

Phimosis in men is not a life-threatening condition. It is easily treated at 1, 2 stages. Surgery can be performed, which will not adversely affect health and sexual life.

Causes of phimosis

For the development of phimosis in initially healthy boy there are the following reasons:

genetic predisposition;
flat feet;
varicocele;
heart disease, including heart valves;
uneven development of the penis and foreskin during puberty.

Later, the main reasons for the narrowing of the flesh are phimosis itself: due to the fact that the foreskin is narrow, the leaf inside it is injured. In this case, scars appear on the tissues, which contributes to an additional narrowing of the flesh.

AT adolescence increases the risk of wounds and cracks, the causes of which are associated with an erection or the onset of sexual activity.

Symptoms of pathological phimosis

The first symptoms of phimosis in the original healthy man- discomfort during sexual intercourse. It can be:

pain during sexual contact. These are symptoms of phimosis 1-2 degrees.
early ejaculation;
decrease in potency.

Often men have psychological problems. This is due to the abnormal appearance of the penis. As a result, a man has various complexes, therefore, not only urological treatment is prescribed, but also psychotherapeutic.

phimosis treatment

If you find phimosis, what should you do? There are several ways to treat phimosis.

Corticosteroid-type therapy is available to treat phimosis without surgery. It is based on the regular rubbing of special steroid creams and ointments into the penis. Due to this, the skin becomes more elastic, swelling disappears, and microcracks are tightened. However, this treatment is lengthy. To receive positive result it will take a lot of time and patience.

Applying foreskin stretch in which the skin is stretched with fingers or special tools. This treatment also quite long and unpleasant. Manipulations are carried out daily, at least half an hour. Treatment of phimosis without surgery can last from several months to six months. When stretching the foreskin, steroid ointments can be used in parallel, which will help speed up the healing process.

These methods are suitable for the treatment of stage 1-2 phimosis.

At the 3-4 stage of phimosis, the patient is shown an operation. Surgical intervention consists of circumcision or circumcision of the foreskin. During the operation, the skin is removed completely or partially, which contributes to the complete elimination of the problem.

Like any surgical treatment circumcision also has contraindications: it is impossible to perform the operation in case of inflammation. First, antibiotic treatment is prescribed. Only after passing full course an operation to remove the flesh.

There are situations when swelling of the penis appears. In this case, the constricting ring of flesh is cut to prevent necrosis of the penis.

The best treatment for any disease is early prevention. Specific preventive measures to prevent phimosis no. This is due to the fact that the disease is genetic in nature.

However, from birth, it is worth keeping the health of the penis under control. To do this, you must regularly and thoroughly wash the glans penis and foreskin. To avoid inflammation, it is necessary to periodically clean the penis.

Complications of phimosis

Phimosis of the penis can lead to the following complications:

The development of balanoposthitis, inflammation extending to the head of the penis and foreskin. The causes of complications are the appearance of wounds and cracks on the petals of the foreskin due to tight stretching. At the same time, microcracks do not bleed and do not cause discomfort. But when the wounds heal, scars form. The skin in these places is no longer so elastic. Because of this, there is a narrowing of the flesh, which is accompanied by the progression of the disease.
Growth of the skin of the foreskin to the head of the penis. In the normal state, this does not cause any problems in men. But if you try to open the head, pain and bleeding occur.
Pinching of the head of the penis by the tissue of the foreskin. It happens during sexual contact. This anomaly is called paraphimosis. When these signs appear, you should immediately visit a doctor in order to avoid complications.
Necrosis of the tissues of the head of the penis. This happens when the opened head of the penis is compressed by the skin of the foreskin. Normal blood flow to the organ is interrupted, which causes tissue necrosis.

Rarely, but still there are complications after the operation to remove the foreskin. They are of two types:

Acute during which the patient feels urinary retention, bleeding or suppuration of the wound formed after the operation. This complication occurs when the operation is performed incorrectly or poorly, sutures are applied. Acute symptoms also appear due to damage to blood vessels during surgery.
Chronic: meatitis or inflammation in the external opening of the urethra. With this disease, painful urination appears, redness appears in the canal itself. Antibacterial therapy, ointments and creams are used for treatment. There may also be inflammation in the external urethral canal. As a result, cicatricial narrowing may occur. This complication is called meatostenosis. A man experiences difficulty urinating: long, sometimes painful. With this disease, repeated surgical intervention, at which the correct outlines of the channel are formed.

Phimosis 1 degree - an anomaly in the structure of the male genitalia, making it difficult to open the foreskin. In children of the first year of life, it is narrowed and connected to the head by means of cords, so the opening of the penis is observed in only 5% of infants. This condition is normal, it does not cause any problems with urination. By the age of 5, the foreskin begins to easily shift down, while the child does not experience any discomfort. In other cases, complete removal of the head becomes possible at the age of 10-17. This is due to an increase in tissue elasticity during puberty.

Collapse

The diagnosis of "phimosis" is made when it is impossible to painlessly open the foreskin. Pathological condition contributes to problems with urination. Urine comes out in an intermittent stream, part of it accumulates in the preputial cavity, which leads to the appearance of inflammatory changes. The development of the pathological process is accompanied by the occurrence of pain, purulent discharge from under the skin, smell. Y manifests itself in the form of a painful erection, the inability to have sexual intercourse with women and masturbation. The main complication of the pathology is paraphimosis - pinching of the head of the penis with impaired blood supply to the tissues. Its main symptoms are pain and blueness of the skin of the affected area. With paraphimosis, urgent surgical intervention is necessary.

What causes it?

The causes of narrowing may be congenital or secondary. Primary is considered a feature of the structure of a man's penis, the factors contributing to its occurrence have not been identified. It can be hereditary, which is associated with a predisposition to reduce skin elasticity. The acquired form of this pathology occurs against the background of injuries or inflammatory diseases, in which healing occurs with tissue scarring.

Depending on the nature of the severity of symptoms, four degrees are distinguished.

Stage 1 - the most mild form pathology, the head of the penis is completely removed in the normal state and is almost not exposed at the time of erection. This degree of the disease does not affect the processes of urination. With masturbation, there is a slight soreness. With the forced opening of the head, the mucous membranes become covered with small cracks, which increases the degree of stenosis of the foreskin.

At the next stage of the disease, the skin can be difficult to retract in a calm state. During sexual arousal, the head of the penis is practically not exposed. Entry into sexual intercourse is possible, but the man experiences severe pain. Urination does not cause special problems. The severity of the disease can be aggravated by cracks in the mucous membranes, swelling of the skin and the addition of a bacterial infection.

Phimosis grade 3 is characterized by incomplete opening of the head of the penis in the normal state and the impossibility of opening during erection. Sex and masturbation are associated with severe pain Therefore, such patients, as a rule, do not lead a sexual life. Under the foreskin accumulates a secret produced by the glands of external secretion. Phimosis stage 3 can be supplemented by balanoposthitis - a lesion of the head. Inflammation of the preputial region is not detected, urination is not disturbed.

Phimosis 4 degrees - the most severe form, in which the head of the penis is not displayed both in erection and at rest. 3-4 stages of phimosis are usually detected even in childhood, since severe stenosis of the foreskin contributes to the disruption of urine excretion processes. It drips and can remain under the skin, causing irritation and inflammation. This stage of the pathology is dangerous due to the possibility of soldering the skin with the head of the penis.

It is necessary to start the examination with a visit to the urologist, who conducts initial inspection and analyzes the patient's symptoms. most often found problems with urination, the appearance of bad smell or discharge from the urethra. Adult men complain about the impossibility of opening the head and the occurrence of pain during sexual contact.

Elimination of phimosis of the 1st degree can be carried out by conservative methods, involving a gradual stretching of the skin up to normal state. To do this, the man is forced to displace the foreskin to increase its elasticity. Before this procedure, a man is recommended to take hot bath. The process of opening the head must be stopped when discomfort occurs. Additionally assigned local treatment - hormonal ointments contribute rapid healing wounds and prevent inflammation. One of the most effective ways elimination of phimosis of the 1st degree - manual opening of the foreskin, which is carried out in treatment room urologist or surgeon.

If a conservative treatment is not effective, or its implementation for some reason becomes impossible, then an operation is prescribed. There are several ways to surgically eliminate phimosis. The procedure can be carried out both under general and under local anesthesia. During the operation, the foreskin is completely removed. After cutting, the head remains open, which has its advantages and disadvantages. A contraindication to the removal of the foreskin is balanoposthitis. Dissection of adhesions with a probe and a gauze tupfer is performed in the treatment of phimosis in children older than 3 years.

Excision of scars is used in cases where the cause of the narrowing is improper tissue healing that occurs against the background of inflammation or injury. Longitudinal dissection of the foreskin is prescribed for forms of phimosis complicated by balanoposthitis. The operation is also performed as first aid for infringement of the glans penis. The narrowed foreskin is cut with a scalpel, freeing the head and restoring blood circulation. During the recovery period, medication is prescribed, after which, at the request of the patient, circumcision is performed. There is no need for this procedure after a longitudinal incision. Men go for such an operation for aesthetic reasons.

Any disease is easier to prevent than to treat. Phimosis is no exception. The first stage of this pathology occurs during childhood, so parents should carefully monitor the condition of their son's genitals. It is necessary to observe the rules of personal hygiene and regular visits to the urologist. It is impossible to open the head of the child's penis manually, this can aggravate the severity of the pathology. All manipulations should be performed by a urologist, who should be contacted when the first signs of phimosis appear. An adult man must observe the rules of hygiene and eliminate inflammatory processes in a timely manner. Regular screening for sexually transmitted infections is recommended.

Everything you need to know about phimosis in men. phimosis

1. How common is phimosis?

2. Causes

3. Phimosis as a variant of the norm

4. Symptoms and signs of pathology

5. What complaints do the child's parents make?

6. Examination of the patient

7. What is the diagnosis based on?

8. What to do if there are problems with skin retraction from the head of the penis?

9. To treat or not to treat?

10. Features of treatment in children

10.1. Local therapy and ointments

10.2. Stretching of the foreskin

10.3. Surgery

11. Treatment tactics in adults

12. When is emergency care needed?

13. Prevention

General information

Peculiarities

Symptoms of the disease

Reasons for the appearance

Like 1 degree

Conservative methods

Feedback on home therapy

Operation

Likely consequences

Conclusion

Characteristics of the disease

Causes of phimosis

Provoking factors

phimosis symptoms

Stages of phimosis

Types of phimosis

Diagnostics

phimosis treatment

Medical treatment

Surgery

Complementary home treatments

Nutrition

Herbs

Exercises

Prevention

Forecast

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Symptoms of pathological phimosis

phimosis treatment

Complications of phimosis

What causes it?

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