Phimosis or a narrowed prepuce is a disease of the penis. Penis is a male sexual organ, which is essential for a sexual intercourse. It consists of several parts – the root, body, urethra, glans and prepuce or foreskin. It contains erectile bodies which are responsible for erection. They are of sponge-like structure. During erection the blood flow in the penis is altered. Cavities inside the erectile bodies fill with blood. The erectile bodies enlarge and the erection occurs. It enables penetration into the vagina. If a man reaches the climax, ejaculation occurs. It is a rapid emission of semen or sperm. Erection, ejaculation and fertilization of woman’s ovum by a sperm are necessary for conception.
Development of phimosis
Prepuce is a thin skin which covers the glans. Is has an internal and external layer. The prepuce can normally be retracted over the glans. This happens during erection. If there is phimosis or narrowing of the prepuce, it cannot be retracted over a wider glans. After birth, phimosis is present in almost every boy. It is called physiologic or false phimosis. The internal layer and the surface of the glans stick together. This state usually resolves within 2-3 years. If it persists longer, it requires a treatment. The true phimosis can be inborn or acquired. The acquired phimosis usually results from repeated damage to the prepuce e.g. its repeated violent retraction over the galns. An inflammation of the glans can also be the blame. The inflammation causes scaring and further narrowing of the foreskin.
Symptoms of phimosis
The most common symptom of phimosis is a complete or partial inability to retract the foreskin over the glans. If a man attempts to do so, it is painful and the prepuce may be damaged. It leads to scaring and its further narrowing. A severe phimosis may block the drainage of urine and may also contribute to development of urinary infection. Paraphimosis is a condition in which the prepuce is blocked in the retracted position after a forcible retraction. It results in accumulation of blood in the prepuce and its swelling. If this is not treated, the foreskin may die off. If the phimosis lasts for a long time, it poses a risk of penile cancer. Phimosis does not allow a proper hygiene of the glans and the prepuce. It results in accumulation of white substance called smegma. It consists of shed skin cells altered by bacteria. Smegma irritates the skin of the glans and may contribute to development of cancer.
Diagnosis of phimosis
Diagnosis of phimosis is usually simple and should be done by urologist. The examination consists of inspection and palpation. The severity is assessed and a proper treatment suggested. During an attempt to retract it, the skin often lacerates. The palpation may expel pus from under the prepuce. There is sometimes a need to surgically open the prepucial bag for the diagnosis of the phimosis.
Treatment of phimosis
There is no treatment required for the false phimosis, which affects children. We try not to retract the prepuce till the age of 2-3 years. The retraction only worsens the state. A surgical intervention is recommended in the older age. It is done under a central anesthesia and the layers of the prepuce, which are sticking together, are released. In the true phimosis, which affects adult men, a surgical intervention is also recommended. It is a circumcision. The prepuce is cut off and the glans is uncovered. Circumcision is a relatively simple operation done by urologist sometimes only in regional anesthesia. For a few days following the operation the penis is painful to touch, but this resolves quickly. Circumcision was known in the ancient Egypt. Today it has its place in the Jewish and Muslim culture. There are also conservative methods of treating the phimosis. Corticoid ointments are applied to the prepuce. The corticoids loosen the skin tension and widen the prepuce. From preventive reasons it is worth mentioning again, that if the prepuce cannot be retracted, patients should not try to do so by force and rather seek help of a doctor. You should not underestimate the phimosis, it is the major risk factor of cancer of the penis.