Paraphimosis Treatment – Symptoms, Causes & Surgery

Paraphimosis is a condition of the penis that occurs when the foreskin, once retracted over the glans, becomes trapped and unable to return to its normal position.

Paraphimosis is a painful condition that affects only uncircumcised males. If left untreated, this condition can cut off circulation to the tip of the penis and lead to serious complications. 

Paraphimosis is a medical emergency that requires immediate medical attention by a qualified healthcare provider. In this blog, we will discuss everything that you need to know about paraphimosis, including its symptoms, causes, and treatment methods. Read on to understand all about paraphimosis and how to effectively deal with it.

Symptoms of Paraphimosis

Paraphimosis is often confused with phimosis, a urological condition that is characterized by the inability to retract the foreskin over the penis glans.

However, paraphimosis is a much more serious condition that can lead to serious complications if left untreated. 

One of the primary paraphimosis symptoms is the inability of the foreskin to return to its normal position once it has been retracted over the glans. The foreskin and the tip of the penis may be swollen and painful. The tip of the penis may also be dark red or blue due to a lack of blood flow.

You may also notice additional paraphimosis symptoms such as:

• Redness, tenderness
• Inability to urinate
• Dark blue or black tissue on the end of the penis

If you are facing any of the above-given symptoms, it is advised to contact your healthcare provider at the earliest.

Causes of Paraphimosis

The reasons behind its occurrence are manifold and differ from person to person. In most cases, paraphimosis occurs due to forceful retraction of the foreskin to clean under it or excessive stretching of the foreskin due to it being too tight. Some other paraphimosis causes include:

• Infection
• Physical trauma to the genital area
• Pulling the foreskin back too forcefully
• Tight foreskin
• Diabetes

How is Paraphimosis Treated?

A circumcision surgery is generally considered to be the best and the most effective treatment for paraphimosis. Circumcision surgery is a commonly performed urological procedure that involves the removal of the foreskin itself. 

Before moving on to how a circumcision surgery is performed, let us discuss the diagnostic tests that your urologist may perform to understand your condition better. 

Diagnosis

Diagnosis of paraphimosis is a relatively simple procedure that usually concludes with a simple physical examination of the penis. During this examination, your urologist will inspect your penis and check for paraphimosis symptoms and determine the severity of your condition.

The urologist may also ask you some questions regarding the symptoms you are facing and any other problems you may be experiencing related to the penis or the foreskin. It is also advised to inform your urologist about your entire surgical and medical history. If you are on an existing prescription, inform your urologist about it as well.

To better understand your condition, your urologist may also perform some additional tests, such as:

• Skin Test: A skin test is a simple and commonly performed test that will help your urologist identify bacteria, viruses, and fungi. In this test, the urologist will gently rub a cotton swab over the foreskin. The swab will then be sent to a laboratory for analysis.
• Urethral Discharge Swab: A urethral discharge swab will help your urologist identify bacteria and viruses. In this test, the urologist will carefully insert a cotton swab (about 3/4 of an inch in size) into your ureteral opening and gently rotate it. The cotton swab will then be sent to a laboratory for testing and analysis.
• Urinalysis: A urinalysis examines the visual, chemical, and microscopic aspects of your pee. They’ll look for different causes of your condition, including bacteria or high sugar (glucose) levels, which could be a sign of diabetes. You’ll be asked to urinate into a special cup by your healthcare provider. The urine sample will then be sent to a laboratory for testing.
• Blood Test: A blood test is one of the most common tests that your urologist may perform to monitor your overall health and check for signs of any infection that may have caused your foreskin infection. In a blood test, the urologist will use a thin needle to draw a small amount of blood from a vein in your arm. This blood sample will then be sent to a laboratory for testing and analysis.

Paraphimosis Surgery

Now that we have discussed the diagnosis of paraphimosis let us move on to the surgery itself. There are primarily 3 methods of performing circumcision surgery to treat paraphimosis. While all 3 methods are considered safe and effective, they differ in procedure and equipment.

• Laser Circumcision: Laser circumcision is an advanced and minimally invasive urological procedure that is performed to treat paraphimosis. The entire procedure is typically performed under local anesthesia and does not take more than 10-15 minutes to complete.

  In a laser circumcision, the urologist uses a highly focused beam of light to cut and remove the foreskin. This laser is manually operated by the urologist and gently moved along a predetermined incision line. Laser circumcision is an extremely precise procedure and, as a result, is widely considered to be best for smooth wound edges and preservation of tissue around the surgical site. Additionally, due to its high operating temperature, it also ensures minimal bleeding.This results in better cosmetic results, minimal risk of complications, and shorter recovery periods compared to traditional methods. Laser circumcision is commonly recommended by most urologists for its better results and faster recovery. Chances of complications in laser circumcision are negligible, and the procedure has proven to provide patients with a better postoperative quality of life.

• Stapler Circumcision: Stapler circumcision is another procedure that your urologist may recommend to treat paraphimosis. Stapler circumcision is a surgical procedure that utilizes a stapler device, an advanced and disposable surgical tool, to remove the foreskin.This stapler device is placed over the penis glans and fits snugly around the head of the penis. As the stapler device is fired, it cuts and removes the foreskin in a quick motion while simultaneously closing the incision wound with a silicone ring. This silicone ring helps minimize bleeding and promote healing. When the incision wound has completely healed, which generally takes anywhere from 7 to 14 days, the silicone ring will fall off on its own as well. Once the foreskin has been successfully removed, the device is taken off, and the penis is pressed with a gauge to stop any bleeding that may have occurred.

  The wound is dressed, and you will likely be moved to a recovery area. If your condition is stable after the surgery, you can go home.

  The entire procedure is typically performed under local anesthesia and does not take more than 15-20 minutes to complete.

• Open Circumcision: Often referred to as open dorsal slit technique, open circumcision is a traditional method of foreskin removal surgery. In an open circumcision procedure, the surgeon uses a scalpel and surgical scissors to carefully cut and remove the foreskin by making incisions along the upper length of the foreskin from the tip of the corona to expose the penile glans.Due to its more invasive approach to foreskin removal, open circumcision surgery takes longer to heal and carries an increased risk of complications. Actual cases of any postoperative complications, however, are rare.

  Open circumcision is typically performed under general anesthesia but depending on your overall health and preference, your urologist may use general anesthesia. Open circumcision is usually performed on an outpatient basis as well but compared to stapler or laser circumcision, it takes significantly longer to complete.

What to Expect After Paraphimosis Surgery?

Paraphimosis surgery is typically performed on an outpatient basis, meaning you will likely be able to go home on the same day of the surgery.

After the surgery, it is normal to feel some swelling and discomfort. However, these side effects should subside on their own a few days after surgery. It is also likely that your urologist will schedule some postoperative follow-up consultations to ensure a smooth recovery. 

During these visits, your urologist will examine the surgical site and check for signs of excessive bleeding, infection, or any other complication.

The doctor will also likely ask if you have noticed any signs of post-op complications. Once the incision wound has healed, the silicone ring will fall off on its own in about 7-14 days after surgery. 

It is also imperative to avoid sexual intercourse for at least 4-5 weeks after surgery. Engaging in sexual activities before giving your penis sufficient time to heal can lead to serious complications such as skin tears or STIs.

You should also avoid strenuous exercises like running or weight lifting as they may strain the muscles surrounding the penis and delay recovery.

Recovery After Paraphimosis Surgery

In most cases, a complete recovery after paraphimosis surgery can take anywhere from 7-14 days. Most patients are able to return to their daily life in just 2-3 days after surgery.

However, every patient’s healing ability is different and depending on your overall health, method of surgery and quality of postoperative care, recovery time may differ. 

After the surgery, it is common for patients to feel swelling and bruising on or around the penis. This side effects should be ancticipated and should subside on their own in a few days after surgery.

To provide some relief, your urologist may recommend placing an ice pack on your groin for 10 to 20 minutes as well. Keeping the bandages covering the penis clean and hygienic for the first days after surgery is also crucial. This will help minimize chances of any infection further and recovery faster. 

To ensure smooth recovery and minimize chances of any complications, your urologist may also instruct your to follow some simple tips and guidelines such as:

• Keep the penis region clean and dry. While bathing is allowed, you should wait at least 2 days after surgery before taking a full body wash.
• Instead of baggy boxer shorts, wear underwear that supports the penis.
• Stay hydrated and drink plenty of water. Drinking at least 2-3 liters of water daily is advised. Water can help decrease urine acidity and lessen any discomfort you may feel while urinating.
• You can apply petroleum jelly to the tip of the penis. Petroleum jelly can assist you in lessening the stinging sensation experienced when urinating.
• Avoid swimming pools, public lavatories, or public baths. 
• Avoid having sex or masturbating for at 5-6 weeks after surery or until your doctor thinks it’s safe to do so. 
• Avoid any strenuous exercise or activities that may exert excessive pressure on your groin region.

Benefits of Paraphimosis Surgery

Alongside its ability to effectively treat paraphimosis, a circumcision surgery has various additional medical benefits such as:

• Easier Hygiene: As the foreskin is removed, it becomes much easier to regularly wash the penis. This will help prevent excess accumulation of any harmful bacteria and smegma under the foreskin and minimize chances of a penis infection.
• Decreased Risk of Urinary Tract Infections: A Urinary Tract Infection (UTI) is an infection in any part of the urinary system. The risk of contracting UTI in males is low but these infections are found to be more common in uncircumcised males.  
• Decreased Risk of Sexually Transmitted Infections: Studies suggest that compared to uncircumcised adults, circumcised adults are at a lower risk of certain STIs such as HIV and HPV. But, this protection is considered modest and safe sex practices, such as use of condom, remain essential.
• Prevention of Foreskin Related Problems: Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.
• Decreased Risk of Penile Cancer: Although cancer of the penis is rare, it’s less common in circumcised men.

What Happens if Paraphimosis is Left Untreated?

Paraphimosis is a urological condition that is considered to be an emergency. If left untreated, paraphimosis could lead to serious complications.

Paraphimosis could potentially disrupt or even stop the blood flow to the tip of the penis. As a result, it could lead to damage to the head of the penis, gangrene, loss of the penis tip and in some severe cases, complete loss of the penis.

If you are noticing paraphimosis symptoms, it is highly advised to seek medical attention immediately. Timely treatment of the condition can help minimize chances of any complications help lead a better, healthier life.

Risks and Complications of Paraphimosis Surgery

Chances of any complications after a paraphimosis surgery are extremely rare. However, as is the case with any other surgical procedure, they could still happen. Some complications that are associated with paraphimosis surgery are given below:

• Excessive Bleeding: Mild to moderate bleeding after paraphimosis surgery is considered normal and usually does not require any medical intervention. However, if bleeding is excessive and persistent, it could be a sign of a complication. In such a case, try applying direct, firm pressure on the surgical site for a couple minutes to control the bleeding. Once under control, contact your healthcare provider.
• Infection: Prior to surgery, your urologist will make sure to maintain sterile conditions and minimize chances of an infection as much as possible. However, in some cases, it can still happen despite the safety measures. If caught early, most infections can be treated with antibiotics and topical creams. Signs of infection after paraphimosis surgery include fever, chills, redness and drainage of yellowish pus from the incision site.
• Inclusion Cysts: As the surgical site is healing, inclusion cysts may form along the incision line. These cysts generally result from smegma accumulating in the incision site or from the epidermis rolling in at the time of the surgery. Inclusion cysts are typically asymptomatic and do not require any intervention. Sometimes, however, they can become infected and become problematic. In such cases, surgical excision may be necessary. 
• Meatal Stenosis: Meatal stenosis is an uncommon complication that may occur after paraphimosis surgery. Meatal stenosis is a condition where the opening at the end of the penis becomes narrower than normal, leading to difficulty urinating.  Steroid creams may provide you with some relief. However, in most cases, a surgical procedure known as meatotomy is considered to be the best treatment. 
• Urethrocutaneous Fistula: Occurence of fistula between the urethra and the skin is another rare yet potential complication that can occur after paraphimosis surgery. Urethrocutaneous fistula usually occurs due to an injury to the urethra. In the case of such complications, surgical correction is necessary.

Frequently Asked Questions

What is the average cost of paraphimosis surgery in India?

On average, paraphimosis surgery cost in India can start from Rs. 26,000 and go as high as Rs. 35,000. However, depending on several factors such as your surgeons expertise, method of surgery, hospital charges and cost of preoperative diagnostic tests, the overall cost of surgery may differ.

Is paraphimosis an emergency?

Yes, paraphimosis is considered to be a medical emergency that requires immediate medical attention by a healthcare provider. If left untreated, paraphimosis can cut off blood flow to the penis and cause permanent damage.

Can I manually reduce paraphimosis?

If you are struggling with paraphimosis symptoms, it is best to seek medical attention by a qualified healthcare provider. It is advised to refrain from force your foreskin down over the head of the penis. Any forceful movements could cause further injury to the foreskin and cause excessive pain.

Can paraphimosis go away on its own?

No, paraphimosis cannot go away on its own. If you are struggling with symptoms of paraphimosis, it is best to contact your healthcare provider and undergo treatment.

Does insurance cover paraphimosis surgery?

Yes, paraphimosis surgery is covered by most health insurance plans in India. Paraphimosis is a urological emergency that requires circumcision for effective treatment. If paraphimosis treatment is delayed or the condition is left untreated, paraphimosis it could lead to serious consequences. Hence, paraphimosis surgery is considered to be a medically necessary. 

Conclusion

Paraphimosis is a urological emergency that is occurs when the foreskin, once retracted over the glans, is unable to return to its normal position. As previously mentioned, paraphimosis is often confused with phimosis, a condition of the penis that is characterized by the inability to retract the foreskin.

But paraphimosis on the other hand, is a much more serious situation that can be extremely painful. If left untreated for a long period of time, paraphimosis could lead to serious consequences that require additional, more complex procedures for treatment.

If you are struggling with symptoms of paraphimosis, get in touch with our team of urologists at the earliest and undergo safe and effective paraphimosis surgery near you.

All our urologists are highly experienced and proficient in performing a multitude of urological procedures including circumcision. So contact us and get instant relief from painful paraphimosis symptoms.