Phimosis occurs only in men. About 5% of the male population need treatment for this disease. Physiological phimosis is diagnosed in all boys up to the age of three. However, it is not considered pathological.
The disease consists in the fact that the head of the penis is not exposed. There are two stages of phimosis:
- Lightweight, in which the leaves of the foreskin, when excited, make it difficult to open the head of the penis. At the same time, in the normal state, the opening is easy.
- Heavy, which is accompanied by the accumulation of urine during urination, first in the bag and only then it is excreted and then drop by drop.
The main cause of the disease is epithelial adhesion of the head of the penis to the inner side of the foreskin. From the age of three, the preputial sac begins to stretch, which contributes to further disclosure of the head. In connection with physiological changes, the signs of phimosis disappear.
Phimosis of the penis can also have a pathological character. It occurs as a result of the narrowing of the foreskin. This type of disease can be congenital or acquired. With congenital phimosis, the penis looks like a "proboscis". Acquired may occur due to complications after balanoposthitis.
There are 4 degrees of pathological phimosis:
- The first degree is characterized by a calm opening of the head of the penis at rest. When excited, pain may appear.
- With the second degree of phimosis, the head in the normal position of the penis is bare with difficulty; when excited, opening is impossible.
- In the third degree, the head of the penis does not open at rest, there are difficulties when urinating.
- Fourth degree. Its symptoms are - the head does not open, urine comes out very slowly, sometimes with pain, the skin of the foreskin looks like a bag.
Phimosis reasons
For the development of phimosis in an 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.
In adolescence, the risk of wounds and cracks increases, the causes of which are associated with an erection or the onset of sexual activity.
Symptoms of the onset of phimosis of a pathological nature
The first symptoms of phimosis in an initially healthy man are discomfort during sexual intercourse. It can be:
- painful sensations during sexual intercourse. These are symptoms of phimosis of 1-2 degrees.
- early ejaculation;
- decreased potency.
It is not uncommon for men to develop 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 phimosis is found, what to do? There are several ways to treat phimosis.
For the treatment of phimosis without surgery, there is a corticosteroid-type therapy. It is based on regular rubbing of special steroid creams and ointments into the penis. Thanks to this, the skin becomes more elastic, edema disappears, and microcracks are healed. However, this method of treatment is long-term. It will take a lot of time and patience to get a positive result.
Foreskin stretching, in which the skin is stretched with fingers or special tools. This treatment is 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 treatment process.
These methods are suitable for the treatment of stage 1-2 phimosis.
At 3-4 stages of phimosis, the patient is shown an operation. Surgical intervention consists of performing circumcision or cutting off the foreskin. During the operation, the skin is removed in whole or in part, which contributes to the complete elimination of the problem.
As with any surgical treatment, circumcision also has contraindications: it is impossible to carry out the operation in case of inflammation. First, antibacterial treatment is prescribed. Only after completing the full course is an operation to remove the flesh performed.
There are situations when penile edema appears. In this case, the flesh tightening ring is dissected to prevent penile necrosis.
The best treatment for any disease is timely prevention. There are no specific preventive measures to prevent phimosis. 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:
- Development of balanoposthitis, inflammation spreading 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, narrowing of the flesh occurs, which is accompanied by the progression of the disease.
- Adhesion of the skin of the foreskin to the head of the penis. In a normal state, this does not cause any problems for men. But if you try to open the head, pain and bleeding occur.
- Pinching of the glans penis by the tissue of the foreskin. This happens during sexual contact. This anomaly is called paraphimosis. When these signs appear, you must immediately visit a doctor in order to avoid complications.
- Necrosis of the tissues of the head of the genital organ. This happens when the opened head of the penis is compressed by the skin of the foreskin. Normal blood flow to the organ stops, which causes tissue necrosis.
Rarely, but still there are complications after the operation to remove the foreskin. They are of two types:
- Sharp, during which the patient feels urinary retention, bleeding or suppuration of the wound formed after the operation. This complication occurs when an incorrectly or poorly performed operation, 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. For treatment, antibiotic therapy, ointments and creams are used. There may also be inflammation in the external urethral canal. As a result, scarring may occur. This complication is called meatostenosis. The man experiences difficulty urinating: long, sometimes painful. With this disease, repeated surgical intervention is required, in which the correct outline of the canal is formed.
Phimosis is a narrowing of the skin fold of the genital organ (prepuce, skin duality), which makes it difficult to retrace the head of the penis during sexual arousal, during hygiene procedures, etc. This pathology, like many others, goes through several stages. The first is the lightest of them all.
The diagnosis of phimosis of the 1st degree in clinical practice is understood as the initial stage of narrowing of the foreskin, in which unpleasant symptoms are observed only in the presence of an erection. If the penis is in a completely relaxed state, the disease may not manifest itself in any way.
Nevertheless, even a mild phimosis can lead to - infringement of the head by a loop of the foreskin.
Paraphimosis is fraught with genital necrosis. In the absence of timely medical attention, amputation of the penis may be required.
Stage 1 phimosis is observed in children and adults. In childhood, pathology can go away on its own.
This usually happens by the age of 6-7 years, sometimes earlier. Such phimosis in clinical practice is considered to be physiological.
The problem with phimosis in adult patients is pathological, and cannot pass on its own. The disease develops for a number of reasons, and is eliminated only through appropriate therapy.
Symptoms and signs of phimosis 1 degree
Physiological phimosis of the 1st degree in children does not manifest itself in any way. In adult men, pain occurs when the penis is erect.
This phenomenon is due to excessive tension on the prepuce on the head of the penis. In this case, the skin loop can move behind the head, which is dangerous for the occurrence of paraphimosis, however, at the initial stage of the disease, with special diligence, a man can help himself on his own.
At the same time, in the absence of an erection, the duplication of the penis shifts without any problems behind its head and returns to its original position.
Self-elimination of a pinched head by the foreskin is fraught with the formation of microtraumas, which can provoke the progression of the disease.
Against the background of pain, a man may develop erectile dysfunction of a psychological origin - the patient even before the onset of an erection worries about the upcoming discomfort.
Causes of occurrence
Possible causes of the pathological form of phimosis include the following phenomena:
- prepuce injuries resulting in scar tissue formation;
- inflammatory diseases of the glans penis and duplication of various etiologies;
- genetic predisposition, implying insufficient elasticity of the skin.
When preparing to eliminate phimosis of the 1st degree, identifying the causes of pathology is not necessary only if it is supposed to use radical methods.
Phimosis 1 degree: photo
Treatment of phimosis 1 degree
It is necessary to get rid of first degree phimosis as soon as possible after the onset of its first symptoms. It is recommended to use both conservative and surgical methods.- their choice depends on the characteristics of the course of the disease and its causes.
So, with the active formation of scar tissue and the active progress of pathology, an operation is necessary, while hereditary phimosis can be eliminated by physical impact on the foreskin.
Without surgery
Procedure for the procedure:
This method is inconvenient in that it requires a very long application - from 6 months.
Surgical method
Removing the duplication of the penis is considered the most effective method of getting rid of phimosis. This method is shown in the following situations:
- With a tendency to progress of the disease.
- With a high risk of relapse.
- Increased incidence of infection of the glans penis and foreskin (s).
All these phenomena inevitably lead to a deterioration in the condition of a man and a high risk of paraphimosis.
To fix the problem, use one of the methods:
- Surgical intervention using a classic scalpel. The advantage of the operation is its low cost. Disadvantages - long recovery time.
- Removal of the foreskin with a radio wave scalpel. The advantage of the method is low trauma and a short rehabilitation period. Disadvantages - the relatively high cost of the procedure.
- ... The advantages of the method are low trauma and almost zero risk of infection, a short rehabilitation period. The disadvantage is the high cost of the procedure.
A contraindication to circumcision of the foreskin by any of these methods is an inflammatory process in the exacerbation stage.
First-degree progression of phimosis
In the absence of adequate measures to eliminate 1st degree phimosis, there is a likelihood of pathology progress. At the same time, the man has more and more pronounced discomfort due to the progressive narrowing of the prepuce. Against this background, the patient may experience:
- Difficulty urinating due to squeezing of the penis
- inflammatory processes;
- pain in the head of the penis in the absence of an erection;
- accumulation of large volumes of urine under the foreskin.
These situations require immediate response and serious therapy, including surgery or even amputation of the penis.
The video below will tell you how to track phimosis of the 1st degree in boys so that it does not result in a critical form of the disease as they grow up.
Conclusion
Phimosis is in vain considered a condition that needs to be hidden from others, and even more so from doctors. This problem can be solved relatively painlessly if you seek help at the initial stage of the development of the disease.
Otherwise, the pathology threatens with rapid progression and the emergence of life-threatening complications. Independent attempts to eliminate the narrowing of the foreskin can end in failure, therefore, it is better to treat phimosis under the guidance of a doctor.
Phimosis refers to diseases that concern only men. It is manifested by stenosis of the foreskin to a critical state (see photo below). It is often transmitted genetically.
In the initial stages, it is treated with conservative methods.
If you do not start therapy in a timely manner, then serious problems may arise that disrupt 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 soreness when the skin folds that cover the penis open. In the later stages, it is impossible to bare its head. The disease is of a pathological, physiological type. Phimosis in children is manifested in 96%.
This is caused by the low mobility of the foreskin covering the head of the penis. Usually, this phenomenon disappears without medical intervention by the age of 6.
The onset of phimosis in men and adolescents is a pathological type. The problem won't go away on its own. It is necessary to obtain a doctor's consultation in order to determine the tactics of treating the disease.
The causes of phimosis
Phimosis in children can not only be of a physiological nature, which is not a pathology and passes by the beginning of adolescence.
They often have a pathological form of the disease. Its causes lie in the presence of:
- overweight child, which causes a hypertrophic appearance. Against this background, the accumulation of excess fat occurs, which is the reason for the formation of bacteria in the pubic region;
- inflammatory processes of the urinary system, provoking puffiness;
- underdevelopment of the skin surrounding the penis.
If in childhood a man did not have a problem of narrowing the skin folds of the penis, then this does not mean that he will not meet with her in adulthood. The 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 elasticity 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;
- traumas that can occur as a result of rough sex, violent correction in childhood of physiological phimosis. This situation leads to the formation of adhesions that narrow the preputial cavity;
- sexually transmitted 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 triggered 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 advanced stages, boys complain of painful urination. Parents may notice that the child is pushing, trying to go to the toilet "in a small way."
Symptoms of phimosis in men:
- painful sensations of the penis during erection. This is due to the excessive tension of the prepuce. Displacement of the skin over the head of the penis is possible. These signs appear at stages 1, 2 of phimosis. With a late course, the pain in an excited state passes, it will not work to bare the head due to a significant narrowing of the preputial ring;
- premature ejaculation;
- a decrease in the brightness of sexual sensations;
- reduced potency;
- at a late degree of the disease, symptoms of impaired functioning of the urinary system appear. 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 with the appearance of their penis. They begin to show anxiety about the upcoming soreness even before the onset of an erection. In this situation, phimosis in men will have to be treated not only with the help of a urologist, but also a psychotherapist.
Phimosis stages
Taking into account the severity 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 genital organ is exposed without difficulty. In an excited state, it is not easy to do this due to pain during the movement of the epithelium. Young people have a susceptible head, which opens independently as a result of swelling, often causing paraphimosis.
- Second stage... During erections in a man, the head of the genital organ is barely bare, covering itself with the skin. If you apply effort, then 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, bleeding may open.
On a note, it is forbidden to have sexual intercourse at the third stage of phimosis, as this will lead to greater injury to the skin.
- Stage four. In a patient, the penis is not exposed either during erection or at rest. It is difficult for him to go to the toilet "in a small way." A man in the course of this process feels a bright pain syndrome. This stage is characterized by an inflammatory process, an increase in body temperature, the formation of inguinal lymph nodes, a decrease in potency. The accumulated secret in the head of the genital organ 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. Partial coverage is usually inherited.
Types of phimosis
The following types of pathology are subdivided by medicine:
- physiological is the most common problem. Usually diagnosed in infants under 3 years of age. Appears to be underdevelopment of the skin surrounding the penis. During the first years in children, the skin is adjacent to the head of the genital organ. Then it starts to open up. Until the age of 4, physiological phimosis does not belong to pathology, provided there is no pain during urination and severe inflammation. Usually by the age of 6, phimosis passes, 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 thinned skin, its atrophy.
Diagnostics
Before treating phimosis in men, a standard examination is performed before hospitalization. After a visual examination and conversation, the patient is assigned to pass:
- a blood test for infection;
- blood sugar test;
- a blood test to determine the group and Rh factor;
- urine analysis for bacteria;
- urinalysis for antibiotic susceptibility;
- if during the examination a large volume of smegma is determined, then it is diagnosed for carcinogenicity.
Appointment of instrumental diagnostic methods is carried out in the inflammatory process. If during the examination a formation is found, then a biopsy with histology is indicated. If inguinal lymphadenitis is suspected, do Lymph node ultrasound groin area.
Phimosis treatment
Today, medicine, in addition to circumcision of the foreskin, offers the following types of treatment for pathology:
- drug therapy based on the use of ointments. Effectively treats 1st degree phimosis;
- physical exercise in the form of gradual stretching of the hole to achieve a wider state;
- surgical treatment that reshapes the opening to make it as wide as possible.
Drug treatment
Drug therapy is aimed at increasing the elasticity of the skin, effectively relieves the inflammatory process, eliminates the burning sensation. If the patient has phimosis of 1 degree, then with the help of ointments, surgical intervention can be avoided.
Local medications are effective in the absence of injuries, pain.
Non-surgical therapy is based on the use of steroid ointments, which accelerate normal growth, expansion of the foreskin.
- Cortisone;
- Mometasone furoate;
- Betamethasone.
To be effective, steroid ointments should be applied as follows:
- First, treat the skin with antiseptics, Miramistin, Chlorhexidine.
- After drying, apply the medication prescribed by the doctor to the treated area.
- When a 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 stretch is repeated.
- The effect on the skin with the ointment should be carried out within 15 minutes.
- Then treat the foreskin and glans with an antiseptic.
To achieve a result, treatment is carried out for at least six months. Local therapy has the following benefits:
- non-surgical treatment;
- absence of injuries;
- cost-effectiveness of therapy;
- preservation of the foreskin with erogenous, sexual, sensory, protective functions.
For information, children are prescribed for the treatment of phimosis, increasing elasticity, reducing inflammation, swelling and accelerating the healing of small cracks Prednitop.
Surgery
When conservative therapy did not give the expected result, the man has prolonged phimosis, surgery is the only method of treatment. Surgery is required for the following symptoms:
- painful urination;
- accumulation of secretions 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, deterioration of the urinary system, then after the operation of phimosis, he goes home on the same day. The initial stages of pathology are treated with local anesthesia. A protracted state requires the introduction of anesthesia.
For the treatment of phimosis, self-absorbable suture materials are used. The organ fully retains its sensitivity. Complication, infection, inflammatory processes, worsening of the disease are completely excluded.
For your information, cicatricial phimosis in men is treated only with a surgical method.
If phimosis is diagnosed, the operation is performed using 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 arousal and in a calm state, which does not affect sensitivity. This type of surgery is performed in 1 or 2 stages. After it, the seams heal quickly, the possibility of bacteria penetration decreases due to the exclusion of the accumulation of secretions. The downside is that phimosis often reappears in men;
- complete circumcision carried out if phimosis of the 2nd degree is diagnosed. The operation belongs to the category of simple ones, after a few hours the patient goes home. A positive point is the exclusion of relapses of the disease. A complication in the form of puffiness is possible;
- laser therapy characterized by the absence of postoperative complications. During the procedure, the prepuce is excised by the beam, the pathological tissue is removed, the vessels are sealed. That minimizes trauma, eliminates blood loss. During laser treatment, surgical wounds heal quickly, the postoperative period passes quickly. The procedure is performed with phimosis 1, 2 degrees;
- prepucioplasty not performed in the presence of scars on the penis, with the exception of the tip of the prepuce. The doctor dissects the adhesive process, which impairs the movement of the foreskin. Next, transverse seams are applied. The operation is carried out at 2, 3 stages of phimosis, characterized by the absence of complications, minimal pain;
- metaplasty is carried out at 4 stages of phimosis, with a critical narrowing of the urethra. This method is used to correct the penis.
After the operation of phimosis, a sterile bandage should be applied for 10 days. If there are seams, then they are processed with brilliant green. It is not recommended to wash the genitals for 7 days. Sexual life is allowed 2 weeks after the removal of the stitches.
If the operation was carried out 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 alternative methods that go as an adjunct to the main treatment.
Nutrition
Home treatment for phimosis involves dietary control. 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, proper nutrition is important, based on food rich in vitamins. Vitamin complexes help to strengthen the immune system, strengthen the body's forces to fight the inflammatory process.
Herbs
Treatment of phimosis in men at home involves herbal medicine. Herbal decoctions have 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... Pour everything into 1 liter. boiling water, leave for half an hour. The product is used as a sitz bath. To enhance the action, you can add 1 tsp. baking soda, which allows tissues to stretch better;
- 1 tsp pour calendula 1 tbsp. boiling water... Insist 30 minutes. After cooling, use a compress to relieve the inflammatory process, heal wounds. The compress is put on at night.
Exercises
The initial stage of phimosis is excellently treated with stretching. For adult men, the procedure can be performed using a special device, Glancha, invented in Japan. Surgical steel is used to manufacture the structure.
The tool stretches the skin, thereby eliminating the problem. For adolescents, it is more advisable to stretch it manually. To get the most out of it, follow these guidelines:
- before starting the procedure, you need to cut your nails, wash your hands, treat them with an antiseptic;
- then the man needs to take a herbal sitz bath. It allows you to steam the foreskin, preparing it for the procedure;
- to avoid soreness, apply an ointment prescribed by a doctor to the skin;
- for 15 minutes, with fingers inserted into the opening of the foreskin, stretch in various directions;
- after manipulation, treat the skin with an antiseptic;
- herbal compresses can be applied to avoid inflammation;
- 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 intercourse.
Prophylaxis
To avoid the occurrence of phimosis, especially in 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;
- routine examination by a urologist;
- serious choice of a sexual partner;
- condom use;
- adherence to a healthy lifestyle, regimen. Adequate sleep, rest is a guarantee of men's health;
- rejection of bad habits;
- daily sports. But the loads 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 spending time in the fresh air.
Forecast
Phimosis at an early stage is easily treatable. Medical statistics claim that recovery occurs in 100% of cases. Later stages lead to a chronic course of the disease.
In exceptional cases, the outflow of urine is difficult. Sometimes it can stop altogether. This condition poses a threat not only to health, but also to the patient's life.
Late 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 stagnation of sperm, the development of smegmolytes.
This condition forms an acute inflammatory process. Smegma stagnation often causes cancer, 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 that does not adversely affect health and sex life.
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I am engaged in the prevention and treatment of coloproctological diseases. Higher medical education. Specialty: Phlebologist, Surgeon, Proctologist, Endoscopist. ...
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.
At the initial stages of pathology, extremely unpleasant manifestations arise exclusively at the moment of sexual arousal, which, of course, affects relations with representatives of the opposite sex.
General information
Phimosis is a 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 mildest.
Phimosis 1 degree in medical practice means the initial form of narrowing of the foreskin. With such a pathology in a man, all 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 onset of paraphimosis - this is how the infringement of the head of the penis by the loop of the foreskin is called. This disease can lead to penile necrosis. And in the absence of the necessary treatment, even amputation of the reproductive organ may be required.
Peculiarities
Phimosis of the 1st degree occurs in both adult men and 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 years, in some situations even earlier. This pathology is also called physiological by doctors.
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 compulsory medical intervention. The disease arises against the background of many different causes, and is eliminated exclusively 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 an erection of the penis.
This phenomenon is due to the strong tension of the skin fold on the glans penis. In this case, the prepuce can be displaced behind 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 comes back without any problems.
Among other things, due to the appearance of pain, the patient may experience erectile dysfunction of psychological pathogenesis. After all, every time a man, even before sexual arousal, will worry about the upcoming discomfort.
Self-elimination of paraphimosis can lead to the occurrence of microtraumas, 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. Knowledge of the visual signs of pathology will help to identify the anomaly in time and begin treatment.
Reasons for the appearance
Among the probable prerequisites for the development of phimosis, the following 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 a provoking condition is the negligence of the parents in relation to the child's hygiene. After all, smegma accumulating 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 the use of radical techniques is planned. That is why it is so important to go through all the diagnostic stages recommended by a specialist - this is the only way to determine the etiology of the disease.
As 1 degree
It is advisable to get rid of this disease immediately after the onset of the first symptoms. In this case, you can use both surgical and conservative techniques. 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 the intensive course of the disease, an operation 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 techniques
Treatment without surgery provides only one way to eliminate phimosis - stretching the skin fold by hand or with the help of special medical devices. The necessary manipulations should be performed every day for about 20-30 minutes. In addition, the plasticity of the skin can be increased by using special moisturizing gels and corticosteroid ointments.
The scheme of the procedure is standard and involves several important stages. Namely:
Home therapy responses
Reviews about the treatment of phimosis 1 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 numerous responses from men, are burdensome and take a long time.
In addition, not all patients have such an opportunity - to arrange such intimate procedures every day. However, the final choice remains with the man - for many patients, treatment of phimosis of the 1st degree at home has become an excellent solution. After all, not every patient decides to undergo surgery in such a sensitive place.
Operation
Elimination of penile prepuce by surgical intervention is deservedly considered the most effective therapy for phimosis of any degree. The operation is advisable when:
- high likelihood of relapse;
- the observed trend towards the rapid progression of pathology;
- regular infections of the head of the reproductive organ and foreskin.
All these processes unambiguously provoke a deterioration in the patient's condition and indicate a high risk of paraphimosis.
For the treatment of phimosis 1 degree in adults, one of the options for surgical intervention can be used:
- Using a traditional scalpel. The main advantage of such an operation is its material availability. But the disadvantages include a long period of recovery of the damaged organ.
- Elimination of the foreskin with a radio wave scalpel. The advantage of this technique is considered to be minor organ trauma and a rather short rehabilitation period. But the disadvantage is the rather high cost of such an operation.
- Removal of a skin fold with a laser. The advantages of such an operation are minor organ damage, a short recovery period and a minimal risk of infection. But the disadvantage is, of course, the high cost of the procedure, which is clearly not affordable for many patients.
Contraindication to the implementation of the operation by any of the methods described is the stage of exacerbation of the inflammatory process.
Likely consequences
In the absence of appropriate measures to get rid of phimosis 1 degree, the likelihood of a rapid progression of pathology is extremely high. The disease passes to the next stage of development, which is characterized by a more pronounced clinical picture. The man has increased discomfort, which is explained by the aggravating 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 stage 1 of the development of the disease.
Otherwise, the pathology can lead to the rapid progression of the abnormal process and the appearance of consequences for a man's life. Self-made attempts to get rid of the resulting narrowing of the foreskin can end very badly, therefore, the treatment of phimosis, even 1 degree, should be under the constant supervision of a specialist.
The main problem of patients with phimosis is pain when trying to expose the head in an erectile state of the penis. In some cases, it is completely impossible to open it, regardless of whether there is an erection or not. In addition, there may be problems with urination, as well as the accumulation of spegma in the pouch and the classic hygienic inconveniences associated with the limitation of the ability to clean the head. When neglected, doctors also detect inflammation of the outermost epithelium and urethra. The above symptoms are typical for both adolescents and men.
Types and types
Doctors distinguish between 4 degrees of severity of a phimous condition:
- 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
- 2nd degree. During an erection, the head does not open at all, there are difficulties with its withdrawal in its normal state.
- 3rd degree. The glans can be partially exposed only in the non-erect state of the penis.
- 4th degree. The head is not exposed at all, during urination the stream does not flow freely, but inflates the preputial sac, and then with rare drops or a very thin stream flows out of the scarlet slit of the end of the penis. As a rule, in this case, there is chronic inflammation due to the impossibility of removing secretions from the head, and also in some cases smegmolytes are formed - solid formations from stagnant smegma. Sometimes an infection of the urethra develops.
The main subspecies of phimosis include:
- Physiological phimosis. One of the most common types of the problem, the overwhelming majority occurs in children under three years of age. In fact, this phenomenon is an underdevelopment of the foreskin after the period of infancy: in the first year of life in all male babies, the epithelium is practically closed and tightly adheres to the head of the penis. After some time, it "opens", therefore, until the age of three or four years, physiological phimosis can be considered a variation of the age norm, naturally, if it does not cause severe inflammation, as well as pain during the act of urination. By the age of five to six years, this type of phimosis passes on its own, and the head of the penis can open freely. If this event does not occur, then you need to contact a specialist.
- Hypertrophic. This type of phimosis is identified by the thickening of the foreskin epithelium, its protrusion beyond the head in the form of a "trunk". If not properly treated, this phimosis spills over into hypogonadism.
- Atrophic. In this case, the foreskin is significantly thinned and even completely atrophied.
- Cicatricial. Here, along with classical phimosis, there is the formation of scars of various sizes on the edges of the foreskin.
Thus, physiological phimosis IS NOT a pathology in children under 5-6 years old and there is NO NEED to treat it.
Causes
There are no absolutely clear and clear reasons for the occurrence of phimosis in the stronger sex. The most probable are:
- Congenital genetic problems, which are the initial factor of systemic insufficiency of the elastic element of the connective tissue in the human body.
- Inflammatory processes like balanoposthitis, which often lead to cicatricial phimosis.
- Physical injury to the penis, head or epithelium.
- Diseases of the circulatory system.
- Age-related changes (aging and "sclerosis" of the skin).
Complications of phimosis
Phimoses can cause a number of negative consequences, some of which require urgent surgical intervention.
First of all, the consequence of the problem is regular inflammation under the foreskin, caused by the stagnation of the secretion. In addition, the above-described condition often leads to infection of the urethra due to improper excretion of urine and its return to the urinary tract.
The most dangerous consequence of phimosis is paraphimosis - a sharp infringement of the head of the penis, flesh. Paraphimosis usually occurs due to attempts to bare the head during intercourse or masturbation. At the same time, the foreskin blocks the blood flow of the end of the penis, which in turn leads to edema of the organ, its blue discoloration and other negative condition. If it is impossible to return the epithelium to its original state on its own, then emergency surgery will be required in the form of a longitudinal section of the epithelium or excision of its "leaves".
Treatment of phimosis without surgery
In the overwhelming majority of cases, eliminate phimosis rationally by an operative method, however, there are also non-operative methods, although they do not work immediately and in some cases do not have the proper effect.
Stretching the foreskin
The main and pretty good method of non-operative getting rid of phimosis. It consists in a periodic step-by-step stretching of the foreskin. The simplest way is masturbation with the maximum possible pulling of the epithelium and the corresponding exposure of the head of the penis.
Gradual stretching should be done before the onset of moderate pain and repeated in several approaches two to three times a day (10-15 minutes). In the process of expanding the passage, it is possible to increase the amplitude of translational movements, up to complete exposure of the head. For greater efficiency, you can take a hot bath before the procedure and, when the skin becomes more elastic, perform the act of masturbation with maximum amplitude.
An alternative method of stretching is to insert two little fingers into the preputial sac and periodically pull them apart to stretch. This procedure is less traumatic than classical masturbation, but it is less effective.
Drug treatment
The basis of drug therapy for phimosis is the application of corticosteroids to the head of the penis in the form of ointments - this type of drug gives elasticity to the epithelium, and also relieves inflammation and swelling.
Clobetasol and betamethasone are considered to be the most effective ointments for this task. They must be applied daily and once to the head of the penis for two months. In this case, the method can be combined with the above-described stretching of the epithelium.
Treatment of phimosis with surgery
The most effective method of getting rid of phimosis is still considered to be surgery. Surgical intervention usually consists in the formation of three zigzag-longitudinal incisions of the foreskin with their subsequent stitching.
In the treatment of phimosis in children, a more gentle method is used, based on the neutralization of adhesions at the head, using a special metal probe. However, if the foreskin is covered with scars, then complete circumcision of the epithelium in a circle will be a safer and more effective method. In rare cases, to preserve aesthetics, more expensive plastic surgery is used with the preservation of the foreskin, but in some cases, after this event, a relapse of the problem may occur.
The effectiveness of surgical intervention for the treatment of phimosis is approaching one hundred percent.
Postoperative period
Despite the high efficiency of surgical intervention, some doctors note the regular occurrence of various complications in the operated patients. Most often these are minor bleeding caused by not too careful suturing, as well as meatitis and meatostenosis - the former are inflammation of the outer part of the urethra, while the latter are caused by the narrowing of the channel of this component of the genitourinary system.
In order to avoid such problems in the first ten days, you must regularly take baths with potassium permanganate, use antibacterial creams approved by your doctor. In some cases, repeated surgery may be necessary, most often to eliminate defects in the appearance of the foreskin (plastic) or to restore the meatus - the correct contours of the urethra.
Useful video
Elena Malysheva in the program "Life is great!" about male problems
Doctor Komarovsky on what will happen if phimosis in a child is not treated
FAQ
What is the name of the operation for phimosis?
The operation for phimosis can be called differently, depending on the type of surgery performed. Most often, in this case, two types of operations are used:
- Circumcision is a classic circumcision of the foreskin. In this case, the epithelium is cut circularly while maintaining the basic structure of the frenum. If necessary, the sutures are connected with a cutgut, after the measures, a bandage is applied based on a petroleum jelly component, after a couple of hours the patient can walk and urinate on his own.
- Operation Schlofer. Here, the surgeon makes a zigzag incision and sutures the epithelium at the sites of shear transitions. As a result, the foreskin is preserved, and the opening increases.
Treatment of phimosis of the 2nd degree
Treatment of phimosis of the 2nd degree is possible only by surgery. During the operation, the foreskin is removed, which allows you to permanently eliminate the cause of the disease. Without timely surgical intervention, the disease gradually progresses, causing serious complications. The most dangerous consequence is paraphimosis.
With phimosis of the 2nd degree, a man has difficulties in removing the glans in a calm state of the penis. It is impossible to remove the foreskin during an erection. These unpleasant symptoms complicate sex life, creating discomfort during sexual intercourse. Therefore, when the first signs of the disease appear, you should immediately consult a specialist.
Diagnosis of grade 2 phimosis is straightforward and does not require special measures. Generally, a general visual examination is sufficient for the physician. In the presence of an inflammatory process, an additional smear is taken for analysis - it allows you to identify the causes that provoked the disease.
Radio wave treatment
Today, one of the most effective methods of treating phimosis is circumcision with Surgitron, a modern device for radio wave surgery. The equipment makes an incision of soft tissues non-contact and bloodless, acting on the affected area with waves with a frequency of 3.8-4.0 MHz. The main advantages of this method of treating phimosis of the 2nd degree include:
- no pain and discomfort, since the device does not cause muscle spasms and does not affect sensitive receptors;
- high accuracy of action, which eliminates the risk of injury to healthy tissues;
- excellent cosmetic effect - after circumcision of the foreskin, no scars remain on the skin;
- absence of relapses and postoperative complications - suppuration, inflammation, swelling;
- antiseptic effect, eliminating the risk of infection entering the wound.
On average, circumcision of the foreskin by Surgitron takes about half an hour. The rehabilitation period after circumcision is much easier and faster in comparison with other methods of treatment. The patient does not need hospitalization, he is discharged on the same day. No special care is required after surgery. It is necessary to follow the rules of personal hygiene and visit a doctor in a timely manner.
For more information on the treatment of stage 2 phimosis, sign up for a preliminary consultation at our clinic. The doctor will conduct an examination, prescribe additional studies, if necessary, and develop an individual course of therapy. Following the recommendations of the andrologist, you will quickly recover from the procedure. To make an appointment, receive additional information and clarify the cost of services, please call.
The causes of phimosis of the 1st degree, treatment of the disease and a photo of the disease
Phimosis is not a deadly disease, but its presence in the lives of men makes noticeable adjustments in their lifestyle and, which is more noticeable for men, in their intimate life.
At the initial stage of the disease, extremely unpleasant symptoms appear only in the presence of sexual arousal, which inevitably affects relationships with the opposite sex.
What is phimosis?
Phimosis is a narrowing of the skin fold of the genital organ (prepuce, skin duality), which makes it difficult to retrace the head of the penis during sexual arousal, during hygiene procedures, etc. This pathology, like many others, goes through several stages. The first is the lightest of them all.
The diagnosis of phimosis of the 1st degree in clinical practice is understood as the initial stage of narrowing of the foreskin, in which unpleasant symptoms are observed only in the presence of an erection. If the penis is in a completely relaxed state, the disease may not manifest itself in any way.
Nevertheless, even a mild phimosis can lead to paraphimosis - infringement of the head by a loop of the foreskin.
Paraphimosis is fraught with genital necrosis. In the absence of timely medical attention, amputation of the penis may be required.
Stage 1 phimosis is observed in children and adults. In childhood, pathology can go away on its own.
This usually happens by the age of 6-7 years, sometimes earlier. Such phimosis in clinical practice is considered to be physiological.
The problem with phimosis in adult patients is pathological and cannot go away on its own. The disease develops for a number of reasons, and is eliminated only through appropriate therapy.
Symptoms and signs of phimosis 1 degree
Physiological phimosis of the 1st degree in children does not manifest itself in any way. In adult men, pain occurs when the penis is erect.
This phenomenon is due to excessive tension on the prepuce on the head of the penis. In this case, the skin loop can move behind the head, which is dangerous for the occurrence of paraphimosis, however, at the initial stage of the disease, with special diligence, a man can help himself on his own.
At the same time, in the absence of an erection, the duplication of the penis shifts without any problems behind its head and returns to its original position.
Self-elimination of a pinched head by the foreskin is fraught with the formation of microtraumas, which can provoke the progression of the disease.
Against the background of pain, a man may develop erectile dysfunction of a psychological origin - the patient even before the onset of an erection worries about the upcoming discomfort.
Causes of occurrence
Possible causes of the pathological form of phimosis include the following phenomena:
- prepuce injuries resulting in scar tissue formation;
- inflammatory diseases of the glans penis and duplication of various etiologies;
- genetic predisposition, implying insufficient elasticity of the skin.
Phimosis 1 degree: photo
Treatment of phimosis 1 degree
It is necessary to get rid of first degree phimosis as soon as possible after the onset of its first symptoms. It is recommended to use both conservative and surgical methods - their choice depends on the characteristics of the course of the disease and its causes.
Without surgery
The only method of non-surgical removal of phimosis is stretching the prepuce by hand or using special medical devices. It is recommended to carry out procedures every day. You can increase skin elasticity by applying moisturizers and corticosteroid ointments.
Procedure for the procedure:
- Preparation. To begin with, it is recommended to treat the foreskin with a solution of Chlorhexidine or Miramistin. Then, after preliminary drying of the skin, it is necessary to generously lubricate it with an external agent appointed by a specialist.
- After part of the cream or ointment has been absorbed, the skin fold is gently lifted with gentle stretching to the sides. If discomfort appears, the stretching should be stopped. After the pain subsides, the procedure is repeated.
This method is inconvenient in that it requires a very long application - from 6 months.
Surgical method
Removing the duplication of the penis is considered the most effective method of getting rid of phimosis. This method is shown in the following situations:
- With a tendency to progress of the disease.
- With a high risk of relapse.
- Increased cases of infection of the head of the genital organ and foreskin (balanitis and balanoposthitis).
All these phenomena inevitably lead to a deterioration in the condition of a man and a high risk of paraphimosis.
To fix the problem, use one of the methods:
- Surgical intervention using a classic scalpel. The advantage of the operation is its low cost. Disadvantages - long recovery time.
- Removal of the foreskin with a radio wave scalpel. The advantage of the method is low trauma and a short rehabilitation period. Disadvantages - the relatively high cost of the procedure.
- Elimination of phimosis with a laser. The advantages of the method are low trauma and almost zero risk of infection, a short rehabilitation period. The disadvantage is the high cost of the procedure.
About circumcision for religious reasons, as well as what nationalities it is accepted and what the Bible interprets, read in this publication.
A contraindication to circumcision of the foreskin by any of these methods is an inflammatory process in the exacerbation stage.
First-degree progression of phimosis
In the absence of adequate measures to eliminate 1st degree phimosis, there is a likelihood of pathology progress. At the same time, the man has more and more pronounced discomfort due to the progressive narrowing of the prepuce. Against this background, the patient may experience:
- Difficulty urinating due to squeezing of the penis
- inflammatory processes;
- pain in the head of the penis in the absence of an erection;
- accumulation of large volumes of urine under the foreskin.
These situations require immediate response and serious therapy, including surgery or even amputation of the penis.
The video below will tell you how to track phimosis of the 1st degree in boys so that it does not result in a critical form of the disease as they grow up.
Conclusion
Phimosis is in vain considered a condition that needs to be hidden from others, and even more so from doctors. This problem can be solved relatively painlessly if you seek help at the initial stage of the development of the disease.
Otherwise, the pathology threatens with rapid progression and the emergence of life-threatening complications. Independent attempts to eliminate the narrowing of the foreskin can end in failure, therefore, it is better to treat phimosis under the guidance of a doctor.
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I have half of my relatives - Muslims, it is customary for them to do circumcision. Initially, our boys do not have these problems - phimosis, other diseases, this is also hygienic - any dirt does not collect, which then leads to inflammation and other unpleasant diseases, and prolongs the time of intercourse for obvious reasons. The penis is such a delicate and important organ that it is better for boys in early childhood to try to prevent possible problems.
I had a genetic disposition to this disease and decided to treat it after the first signs of the disease appeared, without waiting for it to get worse. I chose the operation with a radio wave scalpel. Yes, it is much more expensive than a regular scalpel, but it heals faster and soon it was possible to start having sex again. I see no reason to save on my own health.
It seems to me that phimosis is sometimes just a product of poor personal hygiene. In general, if the foreskin is narrow from birth, then this problem must be surgically solved once and for all. Moreover, at the present time it is not difficult and painless. And there is nothing to be ashamed of. And it is imperative to observe personal hygiene in the future.
In addition to personal hygiene, if the foreskin is narrow, you need to pull back the flesh with each shower or bath and try to open it more. My child had phimosis, the doctor recommended doing such procedures every day, and after a while everything opened by itself. Although all the relatives insisted that we did not waste time and corrected the situation surgically.
Phimosis: norm and pathology, manifestations, when and how to treat
Phimosis (from the Greek. "To tighten") is a condition in which it is impossible to completely remove the head from the foreskin due to its narrowing. It occurs in 90% of boys before puberty and is a manifestation of the physiological maturation of the penis. Phimosis in men is a pathological condition. It develops in 2-3% of adults and leads to a number of serious complications, impoverishes the sensation of intercourse. In the early stages, phimosis can be successfully treated with conservative methods, so it is important to notice the pathology in time and consult a doctor.
Development mechanism
The penis is a man's external genital organ, the main function of which is to insert sperm into a woman's vagina. The most sensitive part of it is called the head, it contains the largest number of nerve endings. It is covered with a thin delicate epithelium, which is similar in structure to the red border of the lips. At the top of the head, a slit-like opening opens the urethra - the male sperm and urinary tract. With its lower part, it grows together with the cavernous bodies of the penis, which form its trunk. In this place, the penis has a thickening - a coronal groove, it can be felt right under the head.
Protects the delicate skin of the head from damage to the skin fold - the foreskin (prepuce). It consists of 2 sheets:
- External - in structure it is identical to the epidermis of the skin, has an upper stratum corneum;
- Internal - covered with thin epithelium, similar to mucous membranes. It has a large number of modified sebaceous glands that produce a waxy substance - smegma. Their secret is to moisturize the glans and facilitate sliding during intercourse.
The foreskin starts from the coronary groove and tightly covers the entire head, forming a slit preputial cavity. At the front, it opens with a hole that easily stretches and releases the head outward. Normally, in a sexually mature man, the foreskin is easily displaced, completely exposing the upper part of the penis. In the back of the head, the inner layer of the prepuce is tightly fused with its tissues in the form of a bridle. In the thickness of the bridle lies a huge number of nerve endings and capillaries, so stimulating it during intercourse gives a man pleasure.
The foreskin performs the following functions:
- Protects the urethra from the penetration of pathogens, covering its opening;
- Prevents mechanical irritation and damage to the thin epithelium on the surface of the head, while maintaining its sensitivity;
- Facilitates sliding during intercourse due to the development of smegma and a smooth inner leaf;
- Increases the pleasure obtained during coitus by stimulating the nerve endings of the head and frenum. This is an important factor in evolutionary terms: without strong positive emotions, people would refuse sex and have less chance of procreation.
Phimosis, as a pathological condition, develops after inflammation or injury to the foreskin. As a result of exposure, tissues are destroyed and an inflammatory process is triggered. It goes through certain stages and necessarily ends with an organization - the restoration of the integrity of the organ. Deep lesions are replaced with the formation of coarse connective tissue, which significantly reduces the elasticity of the foreskin. The high activity of recovery processes leads to the formation of synechia - connective tissue septa between the inner prepuce and the glans penis. They hold them firmly together and prevent exposure of the upper part of the penis.
Classification
It should be understood that phimosis is not a disease, but a special condition that is associated with the physiological characteristics of the body (age), heredity and damage to the tissue of the foreskin. In this regard, the following forms of phimosis are distinguished:
- Physiological - occurs in most boys before puberty, associated with functional maturation of the preputial cavity. It is not a pathology and resolves on its own after 7 years.
- Pathological - occurs as a result of inflammation, trauma, metabolic disorders and requires treatment:
- Hypertrophic (proboscis);
- Atrophic;
- Cicatricial.
The incidence of this or that form of phimosis directly depends on age. In children, in the overwhelming majority of cases, it is physiological, and in men it is caused by cicatricial changes.
According to the severity of the process, 4 degrees of phimosis are distinguished:
- In a calm state, the head is completely released, with an erection, its removal is difficult and painful;
- At rest, the head of the penis is removed with difficulty; during an erection, it is completely covered with the foreskin and is not released;
- The head can be partially removed only at rest;
- The head is constantly hidden by the foreskin, it is not displayed. In this case, during urination, urine first fills the preputial sac and only after that it is released outward drop by drop.
Physiological phimosis
The boy's genitals begin to form after a week of intrauterine development. The head of the penis and the foreskin are formed from a common rudiment in the third trimester of pregnancy, their separation occurs at the site of the coronal groove. The prepuce cells begin to actively divide, significantly outstripping the tissue of the penis in their growth. As a result, they surround the cup-shaped head and close it with a cavity. Anatomical proximity and tissue commonality lead to the formation of delicate epithelial septa between the inner layer of the foreskin and the skin of the head.
The development of the penis as the child grows. Before
10 years old fused head and foreskin are the norm
In a newborn child, the preputial cavity is completely delimited from the environment by similar strands, which excludes the entry of pathogenic microflora into it. By 3-4 months of life, the sebaceous glands of the foreskin begin to function. They produce smegma, which accumulates in small amounts in the preputial cavity. Its infection and the development of the inflammatory process are prevented by epithelial septa in the area of the foreskin opening. Gradually, these thin strands are destroyed, smegma shifts to the exit and is released through the resulting free spaces. It can be seen as small white waxy flakes on the baby's underwear.
By the time of puberty, the septa are completely or partially reduced and the mobility of the foreskin increases. During masturbation or after the onset of sexual activity, the head begins to be completely released, although at first the process can be painful. Thus, physiological phimosis resolves on its own in puberty and does not require treatment.
Treatment in case of inflammation
Despite the naturalness of phimosis, in some cases there is a need for medical attention. With insufficient care for the boy or non-observance of personal hygiene, pathogenic microflora gets into the preputial bag from the skin and an inflammatory process develops. Clinically, this is manifested by redness along the edge of the prepuce opening, local soreness and an unpleasant odor from the penis. Subsequently, inflammation leads to the formation of cicatricial phimosis, which will require surgical treatment.
If such symptoms are found in a child, parents should contact a pediatric urologist or pediatric andrologist. Previously, the technique of simultaneous opening of the foreskin with a sharp jerk movement was widely practiced. This procedure is extremely painful for the boy and can cause psychological trauma. In addition, a one-stage opening damages the foreskin and can cause cicatricial phimosis in the future.
Today, doctors recommend a gradual opening of the head by 1-2 mm. It is carried out after a warm bath, preferably with the addition of antiseptic agents: a weak solution of potassium permanganate, decoction of chamomile, calendula, sage. It should be taken 2 times a week for a minute. After the water procedure, the foreskin is treated with a healing ointment (bepanten, solcoseryl) or baby cream to increase its elasticity and prevent rupture. The skin is pushed back no more than 2 mm in one procedure. This method can be used to treat phimosis at home for several months.
If the method described above is ineffective, the surgeon or urologist dissects the formed adhesions with a probe. He performs the procedure on an outpatient basis without anesthesia or under local anesthesia. The doctor inserts a thin metal rod with a rounded end into the preputial sac and guides it around the circumference of the glans penis. Subsequently, the boy's penis should be washed daily using antiseptic solutions.
Video: phimosis - norm and pathology, doctor Komarovsky
Pathological phimosis
The causes of pathological phimosis are:
- Genetic defect in connective tissue;
- Metabolic disease;
- Inflammatory diseases of the foreskin and head of the penis;
- Penile trauma;
- Sexually transmitted infections;
- Age-related changes.
Hypertrophic
Hypertrophic phimosis in terms of frequency of occurrence in children is the next place after physiological. It is an overdevelopment of the foreskin, which hangs down from the penis with a long proboscis. At its end, the "proboscis" narrows and opens with a dense ring, the removal of the head through which is not always possible. As a rule, this condition is due to the obesity of the child - overdeveloped subcutaneous fatty tissue pulls back the foreskin and reduces its elasticity.
The long proboscis lengthens the path for the excretion of urine and smegma, as a result of which favorable conditions are created for the growth of pathogenic microflora. The increased moisture in the preputial sac and the accumulated secretion of the sebaceous glands is an ideal breeding ground for bacteria. They damage the epithelium of the head and inner layer of the foreskin with the development of an inflammatory reaction - balanoposthitis. In children with diabetes mellitus, yeast often multiplies in the preputial sac, which is manifested by unbearable itching of the genitals and white cheesy discharge. Balanoposthitis often ends with the formation of a cicatricial form of phimosis.
Another reason for the pathology is the underdevelopment of the penis against the background of the normal size of the foreskin. It is detected during the boy's puberty and is usually associated with insufficient testosterone production by the testes (hypogonadism). In this case, phimosis is combined with short stature, lack of muscle mass, female-pattern hair growth, lack of facial hair growth, high-pitched voice, and depression. Treatment of such a condition is carried out jointly by a urologist and an endocrinologist or andrologist.
Cicatricial
Cicatricial phimosis is the most common form of the disease in adult men. Its causes are any conditions leading to inflammation in the foreskin or head. Among genital infections, the most common cause of balanoposthitis with cicatricial phimosis in the outcome is treponema pale - the causative agent of syphilis and Trichomonas. Genital herpes virus, human papillomavirus and candida also often cause inflammation of the head. In children, cicatricial phimosis is rare and in about a third of cases it is not possible to find out the cause of the disease.
The disease progresses gradually. In the first weeks after inflammation, thin connective tissue bridges are formed, which slightly limit the mobility of the foreskin. In just a few months, they thicken significantly, become dense and rough. The mobility of the foreskin is reduced, the head remains closed even with an erection, and attempts to bring it out are accompanied by severe pain. Forcible exposure of the head leads to small tears, bleeding and the formation of new scars.
The last degrees of phimosis disrupt the self-cleaning of the preputial cavity and the process of urination. The urine washes over the head, mixes with the infected smegma, and flows back into the urethra after the man stops urinating. As a result, the patient develops urinary tract infections: urethritis, cystitis, pyelonephritis. In addition, cicatricial phimosis interferes with the normal course of intercourse. There is a need for additional lubrication, the man receives insufficient stimulation and feels pain when the foreskin is stretched.
Treatment of pathological forms
Phimosis is diagnosed and treated by a urologist, surgeon or andrologist. If the cause of the disease is a genital infection, then the patient is additionally monitored by a dermatovenerologist, who prescribes antibiotic therapy. In this case, both partners must undergo treatment.
Treatment with a conservative method is carried out at the first two degrees of phimosis, if the adhesions are thin and arose no more than a month ago. In such cases, the patient is advised to gradually stretch the foreskin after a hot bath. An anti-inflammatory ointment containing glucocorticoids (locoid, hydrocortisone) and a resorbable kontratubex ointment is applied to the head of the penis. The head should be opened carefully, avoiding injury to the foreskin. After the procedure, healing drugs are shown locally (solcoseryl, bepanten, panthenol).
The surgical method of treatment is circumcision or circumcision. The operation implies the complete removal of the foreskin, the head after it remains constantly open. The intervention is performed under general anesthesia in children and under local anesthesia in adults. The surgeon first cuts and folds the outer layer of the foreskin, then gently excises the adhesions in the preputial sac. After both leaves are selected, he cuts them off along the coronal groove. The surgeon sutures the resulting wound with absorbable suture material, that is, removing the sutures after the operation is not required. In the postoperative period, 1-2 dressings are performed and the patient is discharged home. Complete healing of tissues occurs within 2-3 weeks and after this period you can resume sexual activity.
phimosis surgery
Complications and prevention
Among the complications of phimosis, the most common are:
- Infringement of the head (paraphimosis) - develops when trying to forcefully remove the head of the penis from the preputial cavity. A dense ring of foreskin compresses the head tissue, it swells and increases in size. As a result, its reverse reduction becomes impossible, the blood supply to the tissue is disrupted and, without urgent medical care, the situation ends in necrosis - necrosis of the restrained part of the head.
- Balanoposthitis is an inflammation of the foreskin and head of the penis.
- Urethritis, cystitis, pyelonephritis - develop at 4 degrees of phimosis due to impaired urine flow.
- The accretion of the foreskin to the head - the most damaged areas, due to tight adhesion to each other, heal with a single scar, which is not always possible to excise.
As preventive measures, the most important are:
- Thorough hygiene of the genitals, daily washing of the baby and timely change of diapers or diapers;
- The use of barrier methods of contraception (condom) during casual sexual intercourse;
- Treatment of major diseases (diabetes mellitus).
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