WHAT YOU NEED TO KNOW:

What is acute paraphimosis? Acute paraphimosis is abnormal tightness of the foreskin when it is pulled back. The foreskin is the skin that covers the head (glans) of the penis. The foreskin can usually be pulled back onto the penis. When the foreskin is pulled back, the glans is uncovered. Acute paraphimosis prevents your foreskin from being pulled back.

What causes acute paraphimosis? Any activity or procedure that causes the foreskin to be pulled back can cause paraphimosis. The foreskin may be pulled back when you clean the glans, or during sexual activity. Healthcare providers may pull the foreskin back when they examine your penis or to put in a urinary catheter.

What increases my risk of acute paraphimosis?

• Phimosis: Some boys are born with a small, tight opening of the foreskin. This condition is called phimosis.
  
  
• Poor hygiene: Smegma, urine, and other substances can collect under the foreskin and cause infection or irritation. Smegma is the white, waxy substance your body makes to keep the head of your penis smooth and soft. It is important to keep your penis clean under the foreskin.
  
  
• Infection: An infection under the foreskin or in the urethra (tube in penis that passes urine) may cause inflammation.
  
  
• Past injury: This includes any direct injury to your penis that caused scarring. Scars may make it hard for the foreskin to go back to its original position.

What are the signs and symptoms of acute paraphimosis?

• Swollen glans and shaft
  
  
• Bluish or dark glans
  
  
• Pain in your penis
  
  
• Pain when you urinate, or problems urinating

How is acute paraphimosis diagnosed? Your healthcare provider will ask about your symptoms and examine you. He will ask when your symptoms started and how long you have had them. Tell him about activities that pull your foreskin back. He may ask if you have had an infection or injury to your penis, or used a catheter.

How is acute paraphimosis treated? Acute paraphimosis may go away on its own. The swelling in your penis should decrease after your foreskin has returned to its normal position. You may need the following treatments if your foreskin does not return to its normal position:

• Pain medicine: A numbing cream may be put on your penis to decrease pain. Your healthcare provider will inject local numbing medicine if you need a procedure to treat your paraphimosis.
  
  
• Ice: An ice pack may be placed on the foreskin and glans for 5 to 10 minutes to decrease inflammation.
  
  
• Pressure: Your healthcare provider may squeeze your penis tightly for a short period of time. This will help decrease inflammation. Healthcare providers may wrap your penis with a bandage for 5 to 10 minutes. A bandage with numbing medicine may be used.
  
  
• Sugar: Sugar water may be put on the gauze pressure bandage on your penis. The sugar may help draw out fluid from the swollen area of your penis.
  
  
• Manual reduction: When the swelling decreases, your healthcare provider will try to move your foreskin back into position over the glans. The glans is pushed into the foreskin with slow, steady pressure.
  
  
• Puncture technique: Your healthcare provider will make one or more small holes in your foreskin to help release fluid buildup. With severe swelling, you may need to have the trapped blood drained out of your penis.
  
  
• Surgery: If other techniques do not work, your healthcare provider use tools to put the foreskin in the right position. When the swelling in your penis is severe, a cut is made through the top of the foreskin. This releases the pressure and swelling. You may need a circumcision after this procedure because cutting the foreskin will change how your penis looks.

How can I manage my acute paraphimosis?

• Postpone sexual activity: Do not have any sexual activity for 7 to 10 days, to allow the penis to heal. Sexual activity includes intercourse and masturbation. Ask when you can go back to your usual sexual activities.
  
  
• Keep your penis clean: Clean your penis every day by removing the smegma around your glans. Ask for more information about foreskin care.
  
  
• Move your foreskin back to the normal position: Every time your foreskin is pulled back, make sure it returns to its original position. The foreskin must always cover the glans. Do not force the foreskin back over the glans. Force can cause scars to form on the penis.
  
  
• Consider circumcision: This procedure may prevent paraphimosis from happening again. It may also help keep your penis clean and prevent an infection.
  
  
• Do not use penile rings: Penile rings can cause swelling and infection.

What are the risks of acute paraphimosis? The shape of your penis may change if the foreskin was cut to reduce the pressure from swelling. Severe or long-lasting swelling can damage your penis. If this happens, you may need surgery to restore the appearance or function. If paraphimosis is left untreated, your symptoms may get worse. Paraphimosis can lead to permanent injury or tissue death in your penis.

When should I contact my healthcare provider? Contact your healthcare provider if:

• Your signs and symptoms return or worsen.
  
  
• You have pain during sexual activities.
  
  
• You have questions or concerns about your condition or care.

When should I seek immediate help?Seek help immediately or call 911 if:

• You have sudden pain or swelling in your penis.
  
  
• You lose feeling in your penis.
  
  
• You have an open wound on your penis.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.