Paraphimosis occurs when the foreskin becomes trapped behind the head of the penis and cannot return to its normal position. This can cause infection or progressive tissue damage in the area.

Because it can lead to tissue necrosis, paraphimosis is considered a medical emergency and requires immediate treatment.

The main treatment goal is to reposition the foreskin over the head of the penis. This may involve using lubricating gel with a topical anesthetic or, in some cases, a local injectable anesthetic.

Symptoms of paraphimosis

The most common symptoms of paraphimosis are:

Swelling at the tip of the penis
Severe pain
Changes in color of the tip of the penis, which may appear very red or bluish
Swelling and redness of the foreskin

Paraphimosis usually affects children or adolescents up to 16 years old and is less common in adults.

Difference between paraphimosis and phimosis

Although the terms sound similar, “paraphimosis” and “phimosis” describe different conditions.

Phimosis is the inability, or difficulty, to expose the glans because the foreskin does not have a wide enough opening to retract.

Paraphimosis, however, is a complication of phimosis that occurs when the foreskin does not return to its normal position after being pulled back, which leads to compression of the head of the penis.

How a diagnosis is made

Paraphimosis is diagnosed by a primary care doctor or urologist through a physical exam and review of symptoms. During the exam, the doctor checks the penis and foreskin for swelling, pain, or difficulty urinating.

The doctor may also assess the person’s medical history, looking for prior genital injuries, foreskin manipulation, past infections, or conditions such as phimosis.

In some cases, additional tests may be ordered, such as a urine analysis to rule out a urinary tract infection, along with other lab exams if needed.

Possible causes

Paraphimosis can develop due to:

Forcing the foreskin back too far or incorrectly
Phimosis, which is more common in children and adolescents when the foreskin cannot easily retract over the glans
Injuries to the genital area or foreskin, such as balanitis
Penis piercings
Use of a urinary catheter, especially in older adults

It may also occur after sexual activity if hygiene is inadequate and the foreskin does not return to its normal position once the penis becomes flaccid.

How treatment is done

Treatment for paraphimosis depends on age and severity and should always be guided by a doctor.

1. Compression techniques

The doctor may apply manual pressure to the swollen foreskin for several minutes before slowly pulling it back into place.

Another technique involves wrapping the swollen part of the penis tightly with an elastic band, from the glans toward the base, for 10 to 20 minutes to reduce swelling. The foreskin is then repositioned.

2. Use of topical anesthetics

A topical anesthetic, such as lidocaine, may be applied to the penis for about 30 minutes.

In addition to numbing the area, this medication softens the skin, making it easier to reposition the foreskin.

3. Injection of hyaluronidase

An injection of hyaluronidase may be used to help reduce swelling of the foreskin, especially in children.

4. Puncture and aspiration

If less invasive methods are not effective, the doctor may use puncture and aspiration. This involves making small punctures in the foreskin to manually drain the fluid accumulated in the area.

5. Emergency circumcision

In severe cases, or when other treatments fail, the doctor may recommend emergency circumcision. This surgical procedure involves completely removing the foreskin.

Paraphimosis: Symptoms, Diagnosis & Treatment