The diagnosis of phimosis in boys: Komarovsky advises
Depending on the severity of clinical manifestations, urologists distinguish four degrees of phimosis in boys:
- The head is freely exposed in a calm state and with little effort - during an erection,
- The head in the resting state is exposed with some effort. Exposing the head during an erection is not possible,
- The head in the resting state is not exposed or exposed with considerable effort. Exposing the head during an erection is not possible. Urination is not difficult
- Partial exposure of the head is impossible. Urination is difficult. Urine is drip or thin stream.
Suspecting phimosis in the baby, you can talk with the pediatrician, he will examine the baby and say if there is any reason to worry. It is absolutely impossible to push the foreskin on your own, gross interference can cause harm.
The question of how to determine whether a boy has phimosis or not worries many parents. Note that the symptomatology of this deviation varies depending on the age of the crumbs and the complexity of the course. If phimosis is diagnosed in boys, the signs and treatment of the disease are determined in accordance with external manifestations, the presence of complaints and acute conditions.
There are a number of symptoms showing that it is necessary to consult a doctor in a condition resembling phimosis. These symptoms include:
- Difficulties in trying to open the glans penis, inability to do this is the main symptom, but not always an indication for urgent intervention,
- Violations, difficulty urinating. It becomes painful, in some cases almost impossible. In young children, this is sometimes accompanied by increased nervousness and sleep disturbances,
- Pain during erection in older children. This symptom may go unnoticed if the relationship between children and parents is not sufficiently trusting.
Such symptomatic indicators may occur individually, or may appear together. In any case, when the first suspicious signs appear, a doctor's consultation is necessary.
The main sign of phimosis is the inability to completely expose the head or difficulties arising from the shift of the foreskin.
When the disease reaches the fourth stage, the child begins to complain about problems with urination: worried, tense, crying. The prepuce cavity is inflated due to the urine in it, and the latter is released from the hole in small drops.
If the child is a teenager, he may experience pain during an erection. It is important that parents maintain a trusting relationship with the teenager: only in this case will he be able to tell adults about his problem.
It is worth noting that unpleasant sensations occur only at stages 1-2 of the disease, when the preputial ring squeezes the trunk of the penis or part of the head. At stages 3 and 4, the foreskin closes the head completely, and the feeling of constriction disappears.
As for diagnostics, it, as a rule, does not cause difficulties. It is enough for the doctor to examine the genitals to make a diagnosis without using additional research methods.
Phimosis in boys begins to be pathological in nature when such signs occur:
- it is not possible to release the head of the penis due to a too narrow hole,
- the appearance of problems with urine excretion, the child experiences severe pain, a burning sensation at the time of urination,
- inflammatory processes under the foreskin,
- discharge with pus
- swollen lymph nodes.
If such symptoms appear, you should contact a specialist who will prescribe the necessary therapy. Treatment of phimosis without surgery in children is advisable up to 12 years, but subject to the absence of complications.
Features of the disease
The formation of the penis in the boy begins in the mother’s womb, and in the very first weeks of pregnancy. However, in a newborn baby, it is not fully developed. The process of final ripening ends in the puberty. According to medical statistics, 90% of male infants are diagnosed with phimosis, and in 50% this phenomenon does not pass up to a year.
In a newly born baby, the foreskin slightly sags. The mucous membrane is always motionless and serves as a kind of shield. It protects the head of the penis from the effects of urine and contamination with feces. This is the first sign of phimosis. Violation is not a symptom of pathology and is considered a normal condition. During this period, the full opening of the head is not possible, since it does not pass through a narrow hole. The situation independently normalizes by about 5 years. In rare cases, the process drags on to adolescence.
Phimosis can be pathological. In this case, a pronounced narrowing of the foreskin is observed. The child begins to experience difficulties during urination, discomfort is often accompanied by an inflammatory process. Pathological phimosis in boys Komarovsky advises treatment with medication. If conservative therapy is ineffective, the pediatrician recommends surgery.
The etiology of the disorder is not fully understood. However, physiological phimosis has a clear genetic trace. At the same time, there is a lack of certain components in the body that are responsible for the elasticity of connective tissue.
The causes of the disease should be considered only in the case of its pathological form. The foreskin can narrow against the background of inflammatory processes, the appearance of scars in the genital area. Inappropriate actions of parents during bathing or rubbing clothes - these factors contribute to traumatic damage to the head of the penis. Therefore, when choosing linen, preference should be given to natural fabrics and the absence of rough seams.
An allergic reaction can also provoke phimosis in boys. Komarovsky symptoms of the pathological process suggests evaluating in the first place. According to the clinical picture, you can try to independently determine the cause of the disease. For example, in the case of an allergy, the genital organ swells, and the skin changes its color towards cyanotic. A similar reaction of the body may appear on powder for washing underwear, personal hygiene products for bathing.
The degrees and symptoms of pathology
Dr. Komarovsky phimosis in boys is classified into 4 stages. Its initial stage in adolescents is manifested by the inability to completely expose the head of the penis during erection. In a calm state, all manipulations end in a positive result. The second stage is characterized by a difficult process of exposing the head of the penis even in the absence of an erection. In the future, this becomes impossible. Then the pathological process is complicated even more. For example, pain appears during urination. This sign indicates the final stage of development of phimosis.
Komarovsky names the following symptoms of the pathological form of the disease, which parents should pay attention to:
- difficulty urinating
- pain, discomfort in the genital area,
- incomplete head closure,
- inflammation, pronounced drooping foreskin,
- discoloration of the head.
How to identify physiological phimosis in boys? Komarovsky clarifies that in newborns this disorder manifests itself in a slightly different way.First of all, the child becomes overly restless, he can constantly cry and refuse to eat. Another symptom is a change in the appearance of the genital organ (cyanotic shade, swelling, swelling). Older children usually constantly correct their underwear, since the onset of inflammation brings discomfort.
Parents should pay due attention to any changes in the behavior of the boy. If suspicious symptoms appear, you should immediately consult a doctor who can give useful recommendations.
Many parents, having learned about the diagnosis of phimosis, decide on their own to cope with the problem. They are trying to forcibly expose the head. However, the inept actions of mothers and fathers often lead to a complication of pathology - paraphimosis.
In this condition, the head of the penis quickly swells as a result of being pinched by the foreskin ring. Lack of urgent surgical care can lead to tissue necrosis and even amputation. Before the arrival of the medical team, you can try to correct the situation yourself. To do this, gently squeeze the head of the penis with your fingers and apply something cold to it. Due to the physical effect, the edema should decrease, but it still costs to see a doctor.
Another common complication of untreated phimosis is a violation of urination. The disorder, in turn, is often accompanied by inflammatory processes and infectious diseases of the kidneys. Difficult urination can also result in damage to the foreskin. Over time, such an inflammatory process takes on a chronic form.
We must not forget that phimosis can lead to psychological problems. When the boy’s genital organ differs from the genitalia of peers in appearance, the child often closes. At an older age, this problem can lead to difficulties with erection and sexual intercourse.
Types and degrees of phimosis
There are phimosis of four degrees. The first degree implies an almost complete opening of the head, and in the latter the head is completely covered with foreskin, which is narrowed at the end.
Narrowing the foreskin can be both an innate feature, and acquired with age. Congenital form (physiological phimosis), as a rule, is found in almost all newborn male babies. This type of phimosis usually goes away with age.
The acquired form of this disease is a pathological change that can occur for various reasons. A complication of acquired phimosis is the so-called paraphimosis, which means infringement of the head of the penis with the foreskin.
The acquired form of the disease can be cicatricial and hypertrophic.
The cicatricial form of acquired phimosis appears due to any mechanical trauma and damage to the foreskin, as well as a consequence of genital infections.
Hypertrophic phimosis is excessively elongated foreskin, due to which with age, such unpleasant symptoms appear as pain during urination, infection of the penis and others.
What is the norm and when should treatment begin?
Judging by the statistics and the results of medical research, then in half of all boys who have been diagnosed with congenital phimosis, at the age of 12-18 months, the head is completely exposed. By reaching 4-5 years of age, about 90% of male children have a normal structure of the genital organ.
Unfortunately, the luminaries of medicine until today have not come to general conclusions and opinions about the critical age for the presence of phimosis in a boy. Indications for specialist intervention may be obvious problems with the genitourinary system , various genital infections, pain, the onset of sexual activity and others.
On average, the mobility of the foreskin can be observed in older preschool and primary school age, but often this process is delayed until puberty. If until this time the narrowing of the foreskin did not give the child any discomfort, then to seek help from a urologist does not make sense.
As a rule, the peak of puberty occurs at the age of 13-14 years. If by this time the head still does not open, it is worth consulting a doctor.
Treatment of phimosis in boys
The main rule of treatment is a preliminary consultation with a specialist, since the genitals of young children and in particular the head of the penis are very sensitive, there is a huge risk of breaking functionality or cause any other harm without the advice of an experienced doctor.
The treatment of phimosis is prescribed depending on the stage of the disease diagnosed by the doctor. In the easy stages conservative treatment is prescribed , but with a severe form of the disease, the doctor can prescribe surgery.
What does Komarovsky say about phimosis?
Quite well-known pediatrician and TV presenter Yevgeny Olegovich Komarovsky believes that the concepts of "phimosis" and "boy" are synonymous words. That is, phimosis is physiological characteristics of male children testifying to their innocence.
Evgeny Olegovich insisted that it is absolutely normal when a boy is diagnosed with phimosis up to full puberty or first sexual contact.
But at the same time, the child should completely have no complaints about the genitourinary system. If there are any, then in this case without the intervention of a pediatrician and urologist can not do.
Komarovsky insisted that in the absence of complaints from the child, there was no need for any intervention in the development of his penis, so he advised all impatient and curious mothers to be patient and wait for everything to fall into place by itself.
According to him, phimosis is a normal condition of boys penis and will pass without outside interference until a certain age. If phimosis was detected immediately before the onset of sexual activity or there are other medical indications, then in such cases the doctor should prescribe treatment.
The practitioner should decide on the appropriateness of treatment. But if the boy does not bother anything, he does not feel discomfort and pain when urinating, does not live a sexual life, it is not worth resorting to various treatment methods. This is a temporary phenomenon, which not dangerous to the health of the child and his life as a whole and is simply a physiological feature of its development.
But at the slightest suspicion of inflammatory processes, infections, a violation of the function of the urethra, pain, you must immediately consult a doctor. Untimely treatment can be useless, and a running illness can lead to irreparable consequences.
Almost every boy is born with physiological phimosis. Not all parents know how to behave in this case. The famous pediatrician E. Komarovsky advises not to worry ahead of time. Before taking any measures, you need to understand the causes of the violation. In addition, pathological and physiological phimosis in boys should be distinguished. Komarovsky believes that medical treatment is not always required for this diagnosis. In what cases it is really necessary, let's try to understand today's article.
In what situations is the disease physiological?
Phimosis in children is not always physiological, therefore, pathology should be differentiated from the normal variant. First of all, the criterion for determining is age. However, doctors do not agree on how long congenital phimosis does not require medical intervention.In various clinical bases, very small numbers can be found, for example, 2 years , and some experts believe that phimosis can remain physiological throughout life.
Due to the fact that doctors are not determined with the time of the transition of physiology into a disease, the clinical picture is important. The appearance of any complaints in the child indicates that it is time to go to the doctor and be treated.
If the child had a history of physiological phimosis, which resolved on its own, but for some reason arose again, then we are talking about a secondary pathological process. Such a child will have a pronounced clinical picture of the disease, as well as another mechanism for the development of phimosis. However, in any case, you need to conduct a survey, for more accurate differentiation.
Physiological phimosis is rarely accompanied by any complications, and therefore does not require any therapeutic measures. However, parents should carefully monitor their child’s condition and note the slightest change . The most common factors leading to complications:
- Non-observance of the rules of intimate hygiene,
- Tendency to allergic reactions,
- Attempts to forcibly expose the head,
Parents, even if diagnosed with physiological phimosis that does not require treatment, should immediately show the child a doctor if such symptoms appear,
- and him
- Local signs of the inflammatory process (swelling, hyperemia, pain),
- Severe itching
- General violation of the condition of the child.
The main complications that can occur with physiological phimosis:
- Allergic reactions
- The inflammatory process (or fasting, as well as their combination),
- Urinary retention (acute or chronic),
Types and Types
Doctors distinguish 4 degrees of severity of the phimotic state:
- 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
- 2nd degree. With an erection, the head does not open at all, there are difficulties in removing it in the normal state.
- 3rd degree. The head can only partially be exposed 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 prepuce sac, and then with rare drops or a very thin stream flows from the scarlet cut of the end of the penis. As a rule, in this case there is chronic inflammation due to the inability to remove secretions from the head, and in some cases smegmolites 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 problems, overwhelmingly found in children under three years old . In fact, this phenomenon represents the underdevelopment of the foreskin after a period of infancy: in the first year of life in all male babies, the epithelium is almost closed and fits tightly to the head of the penis. After some time, it “opens”, therefore, up to the age of three to 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 urination. By five or 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 epithelium of the foreskin, its protrusion beyond the head in the form of a "trunk". If there is no proper treatment, this phimosis flows into hypogonadism.
- Atrophic. In this case, the foreskin significantly thins and even completely atrophies.
- Cicatricial.Here, along with classical phimosis, the formation of scars of various sizes on the edges of the foreskin is observed.
Thus, physiological phimosis is NOT a pathology in children under 5-6 years old and there is NO NECESSITY to treat it.
Treatment and prevention of complications
Uncomplicated physiological phimosis does not require any treatment, and the doctor prescribes a wait-and-see tactic. With the appearance of mild symptoms of inflammation associated with non-observance of intimate hygiene, you can cope with the consequence yourself. For this, special washing with furacilin is used. This technique is carried out as follows:
- Furatsilin is collected in a 10 ml syringe (the solution must be warm),
- The skin of the foreskin is pulled a little
- The syringe, from which the needle is previously removed, is inserted into the hole formed,
- The solution is injected into the cavity and thereby the space between the head and the foreskin is washed.
This method can be repeated several times, completing it by introducing special solutions of oils into the washed space. The presence of an allergic reaction can be associated both with the external effect of the allergen on the body, and with the use and further elimination of the aggressor from the body. Events that are carried out with an allergic reaction:
- Identification and elimination of the allergen (this can be external chemicals, clothing and other external irritants, as well as food or medicine),
- To minimize the penetration of household chemicals on the skin of the foreskin,
- Increase fluid intake to flush irritants from the body.
If the above measures do not have the desired effect or if the condition of the child worsens, and the symptoms increase, then you can not self-medicate. Parents should quickly show the child to a specialist. When complications occur, special treatment measures are required:
- Balanoposthitis is treated with antibacterial and anti-inflammatory drugs, as well as local washings,
- Paraphimosis (i.e., infringement of the glans penis) is treated only in a hospital and under general anesthesia,
- Any difficulty in urinating, even if phimosis is considered physiological, requires surgical intervention.
Uncomplicated phimosis after reaching adolescence, if it has no tendency to self-elimination, is treated conservatively and not medically.
For therapy, a special technique developed relatively recently is used. The treatment consists in daily exercises, taking only a quarter of an hour, when a man tries to bare his head through masturbation.
This method requires prior medical advice and accuracy. A man should not expose the head by force, but simply try to stretch the foreskin as much as possible. The method is highly effective, since phimosis is gradually cured in approximately 75% of patients .
To improve the stretching of the foreskin, medication can also be used, which involves the use of corticosteroid ointments. These drugs are used topically and only in the absence of contraindications, which include inflammatory processes. Corticosteroid ointments should be prescribed only by a doctor, since their use leads to a variety of side effects.
As an auxiliary treatment, alternative therapies can be used, which include local washing of the affected area with herbal decoctions. The most effective herbs for phimosis are: chamomile, calendula or a series of. With uncomplicated physiological phimosis, these agents can be used as a prophylaxis of complications.
Phimosis - a condition characterized by the narrowness of the foreskin, which leads to a limitation of its mobility.Thus, the first, and often the only, sign of phimosis is the inability to expose the glans penis at rest and / or during an erection.
The foreskin or prepuce in men is called the skin fold covering the glans penis. The prepuce is a specialized tissue, the structure of which is much like the structure of the eyelids of the eyes and labia in women.
The foreskin consists of two sheets that are attached to coronal sulcus located at the base of the glans penis. The outer leaf is lined with thin skin epithelium, and the surface of the inner leaf is the mucous membrane.
Additional fixation of the prepuce provides bridle located on the underside of the head and limiting the displacement of the foreskin towards the base of the penis. The structure of the frenum of the foreskin is much like the structure of the frenum of the tongue.
As a rule, with an erection, the foreskin shifts toward the base of the penis and exposes the glans penis. In the usual state, the prepuce completely covers the head, so that the inner surface of the foreskin forms a prepuce cavity (prepuce bag) - a narrow gap between the head and foreskin.
Thus, the foreskin performs a protective function, protecting the mucous membrane of the glans penis from drying out and adverse external influences. For this reason, in the treatment of phimosis, doctors try to maintain this anatomical formation and resort to circumcision (removal of the foreskin) only in extreme cases.
How common is phimosis?
It should be noted right away that phimosis is a very common occurrence and in many cases does not cause patients much concern.
This is due to the fact that the head and foreskin during the period of intrauterine development are formed from the same tissue. The development of the external genitalia continues until the end of puberty; therefore, more than 95% of male newborns have congenital physiological phimosis.
By the beginning of the second year of life, the head of the penis opens only in 20% of infants, and by the beginning of the third - in 50%. As a rule, spontaneous elimination of physiological phimosis occurs in preschool age (3-6 years).
However, the cases when the head of the penis first opens already during the period of sexual development are far from unique, due to the increase in the level of sex hormones, which help soften and stretch the skin of the foreskin.
Many nations of the world have a common predisposition gene to preserve physiological childhood phimosis at puberty. So, for example, in some countries of Southeast Asia, phimosis in adult men is considered the norm, except in cases where narrowing of the foreskin leads to the appearance of painful symptoms.
And in the culture of Ancient Greece, the long and narrow foreskin was not only not considered a pathology, but was also perceived as a sign of beauty and masculinity. The bare head of the penis was considered obscene because it resembled circumcision. The ancient frescoes depict the custom of artificially gradually lengthening the foreskin.
For this, the ancient Greek youths used a special leather ribbon - a film desma, one end of which was attached to the foreskin, and the other was tied around the waist. Wearing a film desma was seen as a manifestation of particular modesty and decency.
There are no absolutely clear reasons for the occurrence of phimosis in representatives of the stronger sex. The most likely include:
- Congenital genetic problems, which are the initial factor in 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 injuries of the penis, head, or epithelium.
- Diseases of the circulatory system.
- Age-related changes (aging and sclerosis of the skin).
Phimoses can cause a number of negative consequences, some of which require urgent surgical intervention.
The consequence of the problem is regular inflammation under the foreskin, caused by stagnation of the secret. In addition, the above condition often leads to infection of the urethra due to improper excretion of urine and its return to the urinary canal.
The most dangerous consequence of phimosis is paraphimosis - a sharp infringement of the head of the penis, the flesh. Paraphimosis usually occurs due to attempts to expose the head during intercourse or masturbation. The foreskin at the same time blocks the bloodstream of the end of the penis, which in turn leads to edema of the organ, its blueness and other negative state. If it is impossible to return the epithelium to its original state on its own, then emergency surgical intervention in the form of a longitudinal section of the epithelium or excision of its “leaves” will be required.
According to the development mechanism, hypertrophic and atrophic phimosis are distinguished.
Hypertrophic phimosis characterized by a significant lengthening of the foreskin (due to its very characteristic appearance it is also called proboscis phimosis).
Statistically hypertrophic phimosis is more common in obese boys, which is associated with metabolic disorders and the accumulation of fatty tissue in the pubic area.
About atrophic form of phimosis They say in cases where the foreskin, on the contrary, is reduced in volume and tightly fits the glans penis. In this case, the preputial opening is narrowed and does not pass the head.
Degrees of pathological phimosis
With phimosis first degree possible free excretion of the glans penis in a calm state, during an erection, exposure of the glans is difficult or painful.
ABOUT second degree phimosis is said to be when difficulties in exposing the head arise at rest. During an erection, the head is either completely hidden under the foreskin, or only its small part is exposed, often swelling in the form of a ball.
At third degree phimosis of the glans penis is no longer possible outside the prepuce ring.
Fourth degree phimosis is characterized by such a sharp narrowing of the foreskin, which causes difficulty in urinating.
It should be noted that it is customary to talk about the first or third degrees of pathological phimosis when patients are adults or adolescents. As for the fourth degree, then normally in children with physiological phimosis, the preputial cavity has an opening sufficient for free discharge of urine.
Therefore, such signs as filling the prepuce bag during urination and / or narrowing of the trickle of urine, even if they occur in early infancy, clearly indicate pathology and require emergency medical intervention.
The main and rather good method of non-operative disposal of phimosis. It consists in a periodic phased extension of the foreskin. The easiest way is masturbation with the most powerful retraction of the epithelium and the corresponding exposure of the penis head.
Stage-by-stage stretching must be performed 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, you can increase the amplitude of the translational movements, up to the 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 way to stretch is to insert two little fingers into the prepuce bag and periodically spread them apart to stretch. This procedure is less traumatic than classical masturbation, but it is less effective.
What is the danger of asymptomatic phimosis in adults
Unfortunately, phimosis poses a significant risk to the health of an adult male. The fact is that cells of the mucous membrane of the inner leaf of the prepuce secrete a special secret that has a rather complex composition (fats, bactericidal substances, pheromones (excitatory substances), etc.). This secret is the main part of smegma (translated from Greek as “sebum”), which also includes dead epithelial cells and microorganisms.
The activity of the cells of the glandular epithelium of the foreskin increases by puberty (maximum smegmosis occurs at the age of 17-25 years) and progressively decreases in older men.
Normally smegma protects the mucous membranes of the glans penis and the inner surface of the foreskin from drying out, and also acts as a natural lubricant during intercourse.
However, the secretion of the glands of the mucous membrane of the inner leaf of the foreskin is an excellent living environment for many pathogens. Therefore, stagnation of smegma in the preputial sac can cause the development of infectious and inflammatory diseases, such as balanitis (inflammation of the mucous membrane of the glans penis) and balanoposthitis (combined inflammation of the mucous membranes of the glans penis and inner sheet of the foreskin).
In addition, according to many studies, with prolonged stagnation of smegma, carcinogenic substances are formed and accumulate in it, which contributes to the development of oncological diseases in men (papillomas of the glans penis, penile cancer) and their sexual partners (cervical cancer).
In childhood, the purification of the preputial sac occurs independently, since the amount of smegma secreted is small. For adult men, to prevent the development of complications, it is necessary to observe the rules of hygiene, that is, to make a toilet every day, which consists in washing the foreskin and head of the penis with warm water and soap.
With phimosis, this procedure is usually difficult. Thus, the narrowing of the foreskin in adults contributes to the accumulation of smegma in the preputial sac.
Even in cases where phimosis does not manifest any unpleasant symptoms, doctors advise taking care to eliminate the pathology, since, in addition to the danger of developing infectious and inflammatory diseases and oncological diseases, the possibility of developing such a serious complication as paraphimosis .
Paraphimosis as a serious complication of phimosis in adults
Caught in a tight ring of narrowed foreskin, the head swells, while the pressure of the ring increases. Thus, a vicious circle is created: a circulatory disturbance caused by strong compression increases head edema, and edema increases pressure on the head of the foreskin ring.
In adult men and adolescents, paraphimosis most often occurs during intercourse or masturbation. It should be noted that such a complication is characteristic only for phimosis of the first or second degree, since the more severe forms of phimosis simply do not allow the exposure of the glans penis.
Clinically, paraphimosis is manifested by acute pain, the head of the penis swells and acquires a bluish tinge. Over time, the intensity of the pain syndrome decreases due to gross circulatory disorders. In advanced cases, the restrained head acquires a purple or black color.
Severe and prolonged circulatory disorders can lead to deep necrosis (necrosis) of the tissues of the foreskin and glans penis.Therefore, paraphimosis is an extremely dangerous complication requiring immediate assistance.
First aid for paraphimosis in men is to immediately seek specialized medical care. In the early stages of development of paraphimosis, doctors can perform a manual reduction of the glans penis (this manipulation is very painful, therefore it is performed after the administration of narcotic analgesics). In more severe cases, they resort to dissection of the foreskin ring.
What to do with physiological phimosis?
This question arises with most parents. Komarovsky does not recommend treating physiological phimosis in boys, but advises him to wait for puberty. Otherwise, irreparable harm can be caused to the newborn. Inaccurate exposure to the foreskin often results in the appearance of microcracks. When they heal, a more pronounced narrowing may form.
If physiological phimosis has not passed by the age of 14, you need to consult a doctor for advice. Based on a physical examination, he will be able to prescribe medication. In rare cases, surgical intervention is required. According to statistics, only one boy out of 2 thousand children needs surgery.
Treatment of the pathological form of the disease
When the pathological process is supplemented by problems with urination, the doctor prescribes a conservative treatment. First of all, they try to use non-drug therapy methods, namely special massage exercises. What it is? This is a gradual extension of the foreskin, aimed at exposing the head of the penis. Such exercises are recommended to be performed daily. Only a constant effect on the problem area can cure pathological phimosis in boys. Komarovsky recommends following these rules:
- sharp movements during procedures should not be allowed,
- all manipulations should be carried out with clean hands,
- it is important to pay attention to the reaction of the child (if the baby cries or feels discomfort, the stretching must be stopped),
- it is better to start procedures after swimming.
With competent and constant physical impact, the first positive results can be observed after 4-8 weeks.
A good effect is given by drug therapy with a diagnosis of phimosis in boys. Komarovsky treatment advises starting with corticosteroid drugs. Most often, children are prescribed “Prednitop” ointment. It contributes to the rapid healing of microcracks on the skin, increases its elasticity and significantly reduces puffiness.
What other treatment methods are mentioned in the diagnosis of phimosis in Komarovsky boys? The operation, according to the pediatrician, is indicated in extreme cases. We are talking about the cicatricial form of the disease and the ineffectiveness of previous conservative therapy.
Surgery involves a circumcision procedure. The operation lasts no more than 20 minutes. However, it provides for the use of general anesthesia. If the disease is not in a neglected form, the solution of the problem is reduced exclusively to the separation of adhesions. This minimally invasive intervention is performed under local anesthesia.
Proper hygiene is the basis of prevention
Can phimosis be prevented in boys? Komarovsky sees the causes of this disorder in poor-quality genital hygiene. It is worth noting that we are talking about a pathological form of the disease. Physiological phimosis does not provide for treatment and prevention.
What does a pediatrician mean by good hygiene? Komarovsky advises daily to wash the child with warm water. You should also use special wet wipes when changing the diaper. Bathing foam is not recommended. It contains a large number of chemicals that can cause irritation. It is better to replace it with baby soap.In no case should you try to expose the glans penis or pour foam under the foreskin for better cleansing. Such manipulations often end with an inflammatory process.
It is important to change the baby’s underwear daily. For washing, it is better to use powders and non-allergenic products. Breasts need to change their diapers as often as possible. This is necessary to prevent prolonged contact of the penis with urine and feces.
Do not be afraid of the diagnosis of phimosis in boys. Komarovsky, whose photo is presented at the beginning of the article, considers this violation a variant of the norm. So the body of a small person is arranged. The pathological form of the disease is also not dangerous. It can be cured by strictly following the doctor's recommendations. If the child is prescribed an operation, you should not refuse it. Surgical intervention is rarely accompanied by complications and practically does not affect future sexual activity.
Physiological phimosis in children
At such a tender age, in most boys, the inner leaf of the foreskin is soldered to the glans penis. For this reason, in no case should you try to forcibly expose the head - this will lead to erosion of the inner surface of the prepuce cavity, the development of the inflammatory process and the emergence of secondary pathological phimosis.
The well-known children's doctor Komarovsky unjustifiably claims that in 99 cases out of 100 complications of physiological phimosis in babies are associated with gross and illiterate intervention carried out by the parents themselves on the advice of relatives, neighbors and even, sadly, doctors.
If nothing bothers the boy (there are no problems with urination, pain, itching, etc.), no additional measures should be taken to correct phimosis. It is only necessary to make a regular toilet every day, washing the perineum and genitals with water. Soap is best used no more than once every three to four days, preventing it from falling into the preputial bag.
The separation of the mucous membranes of the glans penis and the inner leaf of the foreskin occurs due to the gradual desquamation of epithelial cells. This is a fairly slow process that should not be artificially stimulated.
Desquamated epithelial cells form the basis of the so-called baby smegma, which, accumulating, slowly moves to the exit and is excreted in the form of grains with urine. Unlike adult smegma, child smegma is not dangerous in relation to the development of infections and cancer.
Physiological phimosis in itself has an important protective function, it protects the tender, not yet formed epithelium of the glans penis and inner sheet of the foreskin from external aggressive agents.
How old is the boy's phimosis can be considered a physiological phenomenon
Based on clinical data, the probability of self-elimination of physiological phimosis in a five-year-old boy is 90%, at the age of 10 years - 83%, and by the age of thirteen decreases to 33%.
Many pediatricians advise parents to take a wait and see attitude before puberty: if there are no alarming symptoms, it is best to wait, since phimosis can also be treated at an older age.
It should be noted that the persistence of phimosis by 11-13 years of age can be associated with a low level in the blood of male sex hormones that have a beneficial effect on the process of softening and stretching the foreskin.
In addition, it is necessary to distinguish between congenital physiological phimosis and secondary phimosis resulting from any infectious and inflammatory diseases.
Of course, only a specialist can make such a diagnosis.But in those cases when the child has already observed the opening of the glans penis, and then there was a narrowing of the foreskin, we are most likely talking about pathological phimosis.
The technique of stretching the foreskin
Treatment of phimosis can be carried out at home using non-pharmacological methods. Among them, special emphasis is placed on massage, which is based on translational movements leading to stretching of the foreskin. Before the procedure, the patient is recommended to seek help from a specialist.
To achieve maximum effect, it is necessary to use local medicines during massage. They will reduce discomfort, as well as reduce adverse reactions. They should be based on a vasoconstrictor component, which will prevent the development of edema. The procedure should be carried out after a hot bath is taken, which will allow the stretched skin to stretch better. The main methods of stretching the foreskin using massage include:
- The introduction of fingers into the area of the prepuce sac with subsequent stretching of the skin in different directions. The range of motion in the first attempts should be small, as the patient may experience severe discomfort or pain, which is associated with varying degrees of severity of the traumatic effect on the tissue. In some cases, it may be minor cracks in the foreskin, but there are cases of its complete rupture as a result of rapid sharp movements. To achieve a positive effect, the procedure should be performed daily for several months. Faster foreskin is stretched in children and adolescents, for men, massage may take six months. This method of stretching the foreskin must be carried out using sterile gloves or thoroughly washed hands, since there is a high probability of infection
- Stretching of the foreskin after it is thoroughly steamed. The patient needs to tighten the foreskin as much as possible until he feels pain or other unpleasant sensations. In this position, it must be left for a minute. The procedure is repeated daily for 10-15 times. After just a few lessons, men with minor phimosis will be able to expose the glans penis independently without additional effort. To perform stretching in a similar way, corticosteroid ointments are used for phimosis in adults of the first degree. They will enhance the therapeutic effect and quickly eliminate the pathological condition,
- Stretching with medical instruments. Stretching the foreskin is similar to the first method. At the same time, experts believe that such a technique is the most effective. It can only be performed by a medical professional who owns the method and will not cause injury to the patient. Corticosteroid ointments for the treatment of phimosis by stretching not only eliminate microtraumas, but also increase tissue elasticity. A massage course is required to achieve the desired effect. If necessary, it is recommended to be repeated.
Dangerous complication of phimosis: paraphimosis
A serious complication of phimosis is paraphimosis. In children, pathology is usually formed as a result of a violent attempt to open the head of the penis. This is a disease in which the head of the penis that extends beyond the foreskin is impaired. Being in a tight ring, the head swells, respectively, the pressure of the ring increases.
Symptoms of paraphimosis are cyanotic and swelling of the penis, severe pain. After a while, the pain syndrome becomes less intense due to a serious circulatory disorder. Without specialized help, the impaired head becomes black or purple.
Also, complications that need the help of a specialist include:
The best ointments for phimosis
The listed properties of drugs have a positive effect on the treatment of phimosis at home, so hormonal ointments are considered effective for the disease. Characteristics of drugs:
- Betamethasone. This medication contains the eponymous topical steroid in an amount of 0.05%. To achieve a sustainable result, you need to apply the ointment after hygienic procedures for 1 month, but the more accurate instructions for use will be indicated by the attending physician. Before going to bed, after you apply the cream, you need to put a gauze bandage on the penis. You can not be treated with the drug if in the anamnesis there are: tuberculosis, stomach ulcer, diabetes mellitus, mental disorders, varicose veins,
- Diprosalik. The drug contains 2 active ingredients: betamethasone (helps soften scars) and salicylic acid (softens the skin). You can not use the medicine for lesions of fungal origin and the occurrence of allergic reactions,
- Hydrocortisone ointment. It has all the properties inherent in corticosteroids, and in addition, applying it to prepuce helps restore microflora. In most cases, a two-week use is enough to give a satisfactory result. But if the patient notices such side effects as infections of fungal origin, atrophy of the skin, hemorrhages, you must stop the course immediately,
- Prednisone. This drug has properties similar to the previous one, but it is more effective. The ointment is applied to the head of the penis covered with foreskin and rubbed into the skin with massage movements. The duration of therapy is from 10 to 14 days, but the frequency of procedures is gradually reduced, otherwise a drug withdrawal syndrome may occur.
Sometimes, instead of corticosteroids, doctors prescribe ointments that contain an antibacterial substance. These are such drugs:
- Syntomycin ointment. It contains an antibiotic that inhibits the reproduction of pathogens, that is, it is an antiseptic. The drug is active in the treatment of pathology associated with the presence of gram-positive and other bacteria. Disinfects and stops inflammatory processes,
- Tetracycline ointment. This is a bacteriostatic drug with a wide spectrum of action. It also has an antiseptic effect and eliminates skin inflammation. Duration of use - up to 2-3 weeks, but more precisely the doctor will indicate.
In clinical practice, glucocorticoid ointments are most widely used. They are highly effective, but due to the risk of side effects, the use is possible only under the supervision of a specialist with the possible cancellation of the drug.
In pharmacies, a huge amount of drugs based on glucocorticosteroids is sold, which allows you to choose the most effective medicine for each patient in accordance with his age, degree of disease, and individual characteristics of the body.
Fimozin cream, a natural product that does not include synthetic and chemical components, has established itself well. According to the manufacturer of the drug, phimosin helps to cure phimosis, not only the first and second stages, but the third.
The basis of drug therapy for phimosis is the application of corticosteroids to the head of a member in the form of ointments - this type of drug gives elasticity to the epithelium, and also relieves inflammation and swelling.
The most effective ointments-drugs for this task are considered to be clobetasol and betamethasone. 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 surgery
The most effective method of getting rid of phimosis is still considered surgery.Surgical intervention usually consists in the formation of three zigzag-longitudinal sections of the foreskin with their subsequent stitching.
When using a more gentle method, based on the neutralization of adhesions at the head, using a special metal probe. However, if the foreskin is covered with scars, then a safer and more effective method will be complete circumcision of the epithelium in a circle. In rare cases, to preserve aesthetics, use more expensive plastic with preservation of the foreskin, however, in some cases, after this event, a relapse of the problem may occur.
The effectiveness of surgery to treat phimosis is approaching one hundred percent.
Despite the high effectiveness of surgical intervention, some doctors note a regular appearance in the operated patients of various complications. Most often these are small bleeding caused by not too careful suturing, as well as meatitis and meatostenosis - the former are inflammations of the external part of the urethra, the latter are due to 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 that are allowed by your doctor. In some cases, a second surgical intervention 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.
Can physiological phimosis cause problems in boys and what to do in such cases
In cases where the severity of unpleasant symptoms is insignificant (itching, slight redness, anxiety of a child), you can try to fix the problem yourself. Many pediatricians recommend washing the prepuce with a warm solution of furatsilin with a standard ten-millimeter syringe.
The procedure is as follows:
- Put in a syringe a warm solution of furatsilina or ekteritsida,
- Pull the skin up without exposing the head,
- Insert the syringe without a needle into the formed gap (it is more convenient to carry out this manipulation together so that one person pulls the foreskin and the other performs actions with the syringe),
- Release the solution from the syringe under pressure, washing out the accumulated discharge.
With an increased tendency of the child to allergic reactions (exudative diathesis, atopic dermatitis, etc.), unpleasant symptoms can be associated with exposure to allergens excreted in the urine or with their contact effect on the skin.
- if possible, eliminate the intended agent (review the menu, medications, antibiotics, vitamins, diapers used, household chemicals, etc.),
- eliminate exposure to chemicals on the skin,
- increase the amount of fluid used for the quickest “leaching” of allergens from the body.
Even in cases where the boy's phimosis was unconditionally recognized as physiological, you should immediately consult a doctor if the following alarming symptoms appear:
- there are problems with urination (difficulty urinating, soreness, etc.),
- There are pronounced signs of inflammation (swelling and redness in the foreskin, pain).
Elena Malysheva in the program "Live great!" about men's problems
Dr. Komarovsky about what will happen if phimosis in a child is not treated
Phimosis is a disease that is characterized by the narrowness of the foreskin, which leads to a restriction of its mobility, so the glans penis cannot be completely exposed. This disease is relevant for children and adults, which is almost always due to the lack of adequate treatment in childhood. Phimosis is physiological, which is associated with features of the development of the glans penis and foreskin, and pathological.
Physiological phimosis in boys
In infants, the lack of mobility of the foreskin is not associated with the narrowness of its opening. Physiological phimosis itself performs an important protective function, it protects the glans penis from external factors. In 99 cases out of 100, complications of physiological phimosis in infants are associated with gross and illiterate parental intervention. If the baby does not bother, there are no problems with urination, pain, itching, then no additional measures should be taken to correct phimosis. It is only necessary to wash the perineum and genitals daily with water, it is better to use soap every 3-4 days, preventing it from falling into the prepuce bag.
Cicatricial phimosis in boys can be congenital and acquired. Acquired pathology occurs due to inflammatory diseases of the external genital organs and urinary tract. With inflammation, the foreskin swells, and the removal of the head to the outside is not possible, the opening of the foreskin is small in diameter, and in inflammatory processes it narrows. In this case, it is impossible to carry out normal hygiene of the penis.
In this video, the doctor tells what phimosis is, about its causes, types and appropriate treatment.
Treatment of phimosis at home
Since the foreskin is quite elastic, it can be stretched with some daily exercises, and you can also use special devices that stretch the foreskin.
- Head exposure method. It includes daily exercises to expose the head of the penis, which must be done at least 10-15 minutes a day.
- The method of stretching the foreskin. During the morning shower, as well as after urination, it is necessary to pull the foreskin daily on the head of the penis until pain occurs.
- Finger Stretch Method.
- In order to fix the foreskin in the right position, use special rings that are worn on the penis.
Drug treatment of phimosis is a combination of the above-described stretching methods using ointments containing corticosteroids. Ointments soften and increase the elasticity of the foreskin, reduce inflammatory reactions. Ointments with corticosteroids can be used only after consulting a specialist, since prolonged use of drugs can cause unpleasant side effects.
Surgical treatment of phimosis is most effective. To date, a large number of methods have been developed for the surgical correction of pathological phimosis. The choice of technique depends on the age of the patient and the type of phimosis. The bloodless method is most often used in children, as it is a minimal intervention and preserves the functions of the foreskin.
In medicine, circumcision is a circular excision of the foreskin, circumcision. This is the most common operation to eliminate pathological phimosis, with its help you can quickly eliminate all unpleasant symptoms and eliminate relapses. The only drawback of circumcision is the complete elimination of the foreskin and the loss of all its functions. With cicatricial phimosis, circumcision is a non-alternative treatment method.
You should understand the structure and functioning of the penis in men in order to better understand the mechanism of development and the consequences of this disease. The penis consists of three parts: the head, root, and also the body.
The development of phimosis is associated with the anatomical features of the head. Normally, it is hidden by the foreskin, that is, the skin, which consists of two leaves. In a man, the foreskin should be mobile, able to quickly expose the head. The sheets of the foreskin are slightly different.
The outer is a regular skin that is characteristic of the whole body, and the inner is more like a mucous membrane. The inner penis of the penis and its head are separated using the special space of the prepuce sac. In this cavity, the ducts of the glands open, and there is an accumulation of (natural lubrication).
Normally, the foreskin has connections with the frenulum along the lower part of the penis, where the main vessels and nerves pass.
Phimosis is a condition of the penis in which the foreskin is significantly narrowed, because of which it is impossible or difficult to bring the head of the penis out. Phimosis can be both pathological and physiological, that is, it is a variant of the norm. Physiological phimosis is characteristic of newborn babies and children of primary and secondary school age.
It is a protective reaction of the body, when a system for protecting the baby from various infections has not yet been formed. An important feature of physiological phimosis is its origin.
The essence of this phenomenon is not that the foreskin is narrowed, but that it grows together with the head with the help of synechia. Therefore, any attempts by parents or a doctor to expose the head end with the appearance of erosion on the inner sheet of the foreskin, into which the infection easily penetrates. Due to attempts to expose the head during physiological phimosis, the process can be brought to a pathological state when the inflammation of the foreskin ends with a narrowing.
Also, the exposure process is very painful for the child. With physiological phimosis occurs gradual opening of the head . Statistics show that phimosis goes away at age:
- One year - in half of the children,
- Three years - in 90% of boys,
- Seven years - 92%,
- Adolescent - 99%.
In children, the absorption of synechia gradually occurs, which is manifested by the gradual opening of the head. The mechanism of extinction of synechia consists in the gradual desquamation of epithelial cells. And with active sexual development in adolescents, the hormones produced increase the elasticity of the leaves of the foreskin, which contributes to the normal exposure of the head.
Why does phimosis occur?
Phimosis can occur naturally or it may be the result of scarring of the foreskin.
Phimosis most often can occur naturally. It is not clear why this happens in some boys, but at the same time in others everything is in order. Phimosis can also occur if the foreskin was forcibly withdrawn before it is ready for it. This can harm the skin and lead to scarring, which will be the second cause of phimosis. For this reason, doctors categorically do not recommend forcibly exposing the glans penis in young boys. At the age of 4-6 years, they will do it on their own and without negative consequences.
Inflammation or infection of the foreskin or glans penis can cause scarring and phimosis in boys or men.
As we said above, phimosis is divided into 2 main types - physiological (primary) and pathological (secondary, acquired).
Balanitis, post and balanoposthitis in children
Balanoposthitis - combined infectious and inflammatory lesions of the glans penis and foreskin.
These diseases in boys are several times more common than in adult men. The latter circumstance is connected precisely with the physiological features of the structure of the children's male genital organ.
In addition to physiological phimosis, important predisposing factors for the development of inflammatory processes in the area of the glans penis in children are:
- diabetes mellitus (high sugar in the urine contributes to the development of infection in the prepuce cavity),
- obesity (metabolic disorders, worsening conditions for personal hygiene),
- vitamin deficiency (decreased overall body resistance).
- trauma resulting from a gross attempt to expose the glans penis,
- acute allergic reaction (allocation of food or drug allergens with urine or direct contact with the allergen (diapers, cosmetics, soap, laundry detergent, etc.)),
- severe hypothermia, which can cause a sharp decrease in immunity,
- external injury, including uncomfortable clothing (too narrow panties with a seam in the middle, injury by a snake, etc.).
Symptoms of the disease are quite characteristic:
- redness and swelling in the foreskin (post),
- through the hole you can see the hyperemic portion of the head (balanitis),
- pain aggravated by urination (irritating effect of urine on the inflamed tissue of the head and foreskin),
- itching and discomfort
- serous or serous-purulent discharge.
If you suspect an infectious inflammation of the glans penis and / or foreskin, you should immediately consult a doctor who will prescribe the necessary treatment.
With relapses of the disease, as well as in the case of the formation of secondary phimosis, the question of surgical treatment may arise.
Primary, or physiological phimosis.
With physiological phimosis, we are talking about congenital narrowing of the foreskin, which occurs in 96% of all newborn boys.
It occurs as a result of gluing the foreskin with the glans penis. In most cases, phimosis disappears on its own within the first 5 years of life.
Remember - physiological phimosis is NOT a pathology in children under 5-6 years of age and there is NO NEED to treat it.
At the age of 3 years, this problem is solved in 80-90% of babies, and in the seventh year of life phimosis can occur in 10-18% of boys.
In the age group of young people 16-18 years of age, narrowing of the foreskin occurs in 1% of people.
Physiological phimosis, which was not resolved during the first 7 years of life, takes on a pathological character. In connection with this boy, under 3-5 years old, circumcision is not recommended, since the head is difficult to bare, with the exception of medical indications.
The transition of primary phimosis to secondary is possible if during the first years of life gross attempts were made to move the foreskin, which provoked an increase in scars as a result of cracks in the mucous membrane.
With physiological phimosis, which, we recall, occurs in the vast majority of young boys and gradually disappears with age, no treatment or special precautions are required. For the foreskin in infancy, special care is not required.In the first few years of life, you can very carefully expose the foreskin for hygiene during a diaper change. But usually a simple bath is enough for hygiene. When the child is older and the foreskin is completely exposed, he will learn the rules for caring for her during hygiene procedures. After exposure, the foreskin should be pulled over the glans penis and returned to its normal position. This will prevent inflammation and scarring - that is, acquired phimosis.
Paraphimosis in children
The clinic and the complications of phimosis in boys are the same as in adult men. A very severe pain syndrome, redness and rapidly progressive swelling of the glans penis are characteristic. Untimely or inadequate medical care can lead to irreparable consequences in the form of necrosis of the foreskin and penis.
First aid for paraphimosis in children . There are many tips on the network to adjust the head on its own (applying cold to reduce swelling, using oil, etc.). Of course, much depends on the severity of paraphimosis (the severity of edema and pain) and the state of the child's psyche.
But it is prudent not to follow such advice. Repositioning the glans penis during paraphimosis is a very painful procedure that is performed under anesthesia in medical institutions (in pediatric practice, intravenous anesthesia is used, which implies a short-term, but complete loss of consciousness).
So it’s best not to waste precious time and mock the child, but to seek medical help as soon as possible. Transportation of patients in such cases is carried out in a supine position with legs apart.
Secondary, acquired or pathological phimosis.
Pathological phimosis is diagnosed in adult men. It is acquired throughout life and is often the result of post-fasting (inflammation of the foreskin) and (inflammation of the glans penis). Basically, these 2 states complement each other and it is difficult to say what is the cause and what is the consequence. Therefore, they are combined in one name -. The inflammatory process leads to the formation of scars and at the same time to the narrowing of the foreskin.
In addition to inflammatory processes, the following causes can lead to phimosis:
Violent injuries and fissures of the glans penis (cicatricial phimosis in the photo below),
A number of diseases, for example, sclerotic lichen . This is a skin condition that can be caused by an abnormal immune response or hormonal imbalance. Symptoms may include white spots or spots on the foreskin. Skin can become itchy and easily vulnerable. The impetus for the occurrence of phimosis can be eczema - a prolonged condition in which the skin becomes itchy, red, dry and cracked, and psoriasis - a skin condition that causes red, flaky, crusty skin patches coated with silver scales.
Genetic predisposition, expressed in insufficient elasticity of connective tissue,
Uneven development of the foreskin and puberty during puberty. Thickening of the foreskin, due to which it is impossible to expose the head of the penis.
Also phimosis can be complete and incomplete.
Incomplete phimosis is said to be when it is impossible to move the foreskin with an erect penis, while full phimosis, the foreskin does not move as well when it is completely calm.
In addition, in such cases, children often complain of pain and discomfort during the passage of urine. They begin to avoid going to the toilet, which leads to the development of secondary enuresis (day and night).
Difficulty urinating in infants is manifested by anxiety, screaming and severe straining when urinating.
This pathology leads to an increase in pressure in the urinary tract, which is fraught with serious complications. Therefore, difficulties with urination are an indication for emergency elimination of phimosis.
What is phimosis?
Doctors distinguish 4 degrees of narrowing of the foreskin:
1 degree - opening the glans penis is only possible in a calm state, while pain may occur, during an erection a small effort is required.
This problem bothers the man, as it is quite difficult for him to have a sex life due to discomfort and pain during sex. At the same time, nothing threatens the man - only the intimate side of his life suffers. However, it is still advisable to consult a doctor. After all, once, having exposed the foreskin, it may not be possible to return everything back. And this is already really dangerous.
2 degree - opening the head in a calm state is somewhat difficult, but in an erect state is completely impossible.
3 degree-head of the penis in a calm state does not open completely or opens with considerable effort, during an erection it does not open, urination is not impaired.
You can not independently release the head, as this can lead to negative consequences.
4 degree-head does not open in either of two states, urination is difficult. Urine is excreted in drops or a weak stream.
The foreskin does not move at all, which does not allow a man to even conduct hygiene of the genitals. As a result, smegma accumulates under the foreskin, which is a favorable environment for many pathogenic organisms. This can lead to the development of infection and various inflammatory processes. Naturally, at the same time, a man absolutely cannot have sex, because even with the slightest attempt to move the flesh, he feels pain and discomfort. As the disease progresses, urination is impaired and acute pain appears. Burning and itching may also bother the patient.
Medical tactics in the treatment of pathological phimosis
This neglect was greatly facilitated by the fact that many patients self-medicate without consulting with professionals and often make gross errors that lead to serious complications (paraphimosis, infectious and inflammatory diseases of the foreskin).
In addition, it is often not taken into account that scar forms of phimosis are an absolute contraindication to the use of conservative methods. The fact is that scar tissue does not stretch, so all attempts to achieve the elimination of phimosis are doomed to failure in advance.
Meanwhile, there is evidence of the effectiveness of conservative methods in many patients, even with the second or third degree of congenital phimosis.
An important positive aspect of all non-surgical methods for the treatment of phimosis is the “naturalness” of their effect, since they actually repeat the mechanism of physiological self-elimination of age-related phimosis.
In addition, conservative methods of treating phimosis can fully preserve the unconditionally important functions of the foreskin and avoid unpleasant side effects and complications.
Thus, in the absence of contraindications, conservative methods may well be used as a useful alternative. Of course, treatment should be carried out after consultation with a specialist and under the supervision of a doctor.
However, in those cases when it is necessary to achieve a quick and radical elimination of phimosis for medical reasons (for example, with phimosis of the fourth degree) or for personal indications, it is better to give preference to surgical intervention.
What does a man with phimosis feel?
A characteristic symptom of phimosis is that it is impossible to move the narrowed foreskin completely.Since hygiene is difficult in this case, secretions secreted by the glands, residues of urine and sperm, and skin cells accumulate under the foreskin. All this forms whitish deposits, the so-called smegma, in which bacteria accumulate and which can cause inflammation of the glans penis and foreskin.
Also, with narrowing of the foreskin, the following symptoms may occur:
Violation of urination due to obstruction to the outflow of urine. It is expressed in most cases by a weakened, thin and strongly deflected stream of urine, as well as bloating of the foreskin in the form of a “balloon” during urination. Violation of the outflow of urine can lead subsequently to infectious and inflammatory processes of the genitals and urinary tract.
Pain during erection and sexual intercourse, sometimes it is completely impossible. With an erection, a sensation of tension of the foreskin, as well as its crack, may occur.
A painful, tightened ring around the glans penis (paraphimosis, or Spanish collar), arising from a violent attempt to move the foreskin. Untimely provision of medical care in this case can lead to necrosis (death) of the glans penis.
With the development of the inflammatory process, pain occurs in the foreskin and the glans penis, fever, in a neglected case, purulent discharge.
Diagnosis of phimosis.
Diagnosis of narrowing of the foreskin occurs mainly through physical examination and questioning of the patient. As a rule, patient complaints are typical and we wrote about them above.
During a physical examination, the doctor cannot move the foreskin and withdraw the glans penis or it is partially excreted. This suggests that there is a mismatch between the width of the foreskin and the diameter of the glans penis, i.e. phimosis. Also, the head and foreskin can be inflamed, painful to the touch, have purulent discharge. In the case of paraphimosis, the head may be bluish in color, swollen, sharply painful.
If phimosis occurs in an adult male, it is advisable to do a blood test for blood sugar: diabetes often causes narrowing of the foreskin.
Non-drug conservative treatment of phimosis. Tension methods.
As a result, a hypothesis was put forward on the possibility of eliminating congenital phimosis by the method of gradual extension of the foreskin and special methods have been developed for conservative elimination of pathology.
The general rules of these techniques are:
- mandatory prior consultation with a professional and subsequent medical supervision,
- gradual stretching (in no case should pain be avoided),
- regularity of manipulations.
There is evidence that elimination of phimosis of the first or second degree with the help of exercises to expose the head can be done within three to four weeks.
Method sprains of the foreskin consists in daily tension of the foreskin on the head of the penis during the morning shower, as well as after urination until pain occurs.
This method is often used to delay the elimination of phimosis in childhood. In such cases, it is quite effective, but the duration of the course of treatment largely depends on the type of phimosis and can reach 3-4 months with hypertrophic (proboscis) phimosis.
Method finger sprain consists in the careful introduction into the prepuce cavity of the fingers and their gradual dilution.
According to some reports, the effectiveness of the methods described above for congenital phimosis reaches 75%.
What complications threaten you as a result of phimosis?
Like any disease, narrowing of the foreskin has its own complications, ignoring which can lead to serious consequences for a man. So, the most famous complications of phimosis:
Paraphimosis, or the “Spanish collar”. It occurs, as a rule, with phimosis of 3-4 degrees and is the result of an independent attempt to open the glans penis. May occur during masturbation or during sexual intercourse. The foreskin at the same time infringes on the glans penis and forms a painfully tightened ring that disrupts the blood supply to the head. This leads to swelling of the glans penis, it becomes cyanotic, sharply painful.
Gradually, while ignoring medical care, necrosis (death) of the glans penis develops. Help consists in setting the head, and if it doesn’t work, in the longitudinal section of the foreskin.
- fusion of the glans penis with foreskin. It occurs at 3-4 degrees of phimosis, when low mobility leads to the formation of synechia (fusion sites) between the glans penis and foreskin, which gradually grow, which leads to a complete increase. All attempts to push back are sharply painful with the appearance of bleeding. Treatment only by surgery.
- balanoposthitis - inflammation of the glans penis and foreskin. As we wrote above, the reason is the difficulty in carrying out hygiene measures, which leads to an inflammatory process.
Treatment of phimosis with ointments (drug treatment of phimosis)
Drug therapy is especially indicated for children and adolescents (recommended by the American Association of Pediatricians), since at this age it is most likely to achieve the elimination of congenital phimosis by conservative methods.
However, it should be borne in mind that such ointments are not shown to everyone. So, for example, a contraindication to the local use of corticosteroid drugs is the presence of a bacterial, viral or fungal infection - both acute and chronic.
Long-term use of drugs can cause unpleasant side effects (thinning of the skin, hyperpigmentation, violation of the structure of the superficial vessels), and with uncontrolled use, a systemic effect of corticosteroids is possible, which is fraught with dangerous complications.
Therefore, the use of ointments with corticosteroids is possible only after a thorough examination and consultation with a specialist who has sufficient experience in treating congenital phimosis with this method.
Of course, you need an individual selection of the drug and the dose of the drug, as well as constant medical monitoring of the results of therapy.
How to avoid pathological phimosis?
It is important to regularly conduct hygiene procedures with the genitals in order to avoid problems with acquired phimosis.
You should do the following:
- gently wash your dick with warm water every day while taking a bath or shower
- carefully expose the foreskin (if any) and wash under it, do not pull the foreskin of a child or boy, because it can be painful and cause harm
- if you do not wash correctly under the foreskin, a substance called smegma may begin to collect there. And this not only threatens you with complications due to poor hygiene,
- use a mild or non-aromatic soap (if you decide to use soap) to reduce the risk of skin irritation,
- do not use talcum powder and deodorants on your penis, as they can cause irritation, accumulated under the foreskin,
- circumcised men should also regularly wash their penis with warm water and soap (if you decide to use soap).
Each newborn boy has an inborn feature of the genital organ associated with the full coverage of the head of the penis with a skin fold. Doctors call it physiological phimosis. Young mothers are often not familiar with this diagnosis, so they try to learn more about phimosis in infants (forum) and medical sites. In fact, physiological phimosis is not dangerous for the baby and disappears as the boy grows up. There are other situations when the physiological phimosis characteristic of newborn male children is converted into pathological at an older age. The problem develops in children aged 6-7 years. But here, for proper diagnosis, you need to take into account the individual characteristics of the development of the child's body. In medicine, cases have been recorded when congenital phimosis disappeared on its own only in the teenage period.
What does the physiological and pathological phimosis of boys look like in the photo: before and after elimination, how is it classified in the international classification of diseases, what features does the pathology have in different periods of the boy’s life? This article will tell.
ICD code: Phimosis in children (photo), general characteristics
According to medical statistics, in 95-96% of newborn boys, the head of the penis cannot be fully exposed. This feature in medicine is called physiological phimosis. Phimosis in a child per year does not require medical intervention and is considered a normal condition. However, if the baby has difficulty urinating, is naughty when emptying the bladder, parents should take him to a consultation with a pediatric urologist, pediatrician or surgeon.
In the international classification of diseases, childhood phimosis is assigned the code N47. The disease is included in the category “Diseases of the genitourinary system” and the subcategory “Diseases of the male genital organs”, together with pathologies of the excess foreskin and paraphimosis.
Alternative methods of treating phimosis
However, some of the favorite remedies of traditional healers are widely used as an adjuvant. We are talking about decoctions of herbs that have anti-inflammatory, bactericidal and softening effects, such as:
- a series of.
Steaming the skin of the foreskin in a bath with a decoction of collecting herbs for 15-20 minutes contributes to effective, painless and safe stretching.
This kind of preliminary procedure is especially recommended for children and adolescents.
During the treatment of phimosis, you can alternate decoctions of various medicinal herbs or use collection of medicinal plants for decoction.
The only contraindication to the use of alternative medicine as an aid in the treatment of phimosis may be individual intolerance or allergies (extremely rare).
Phimosis at 1 year and pathological features in newborn boys
Congenital phimosis is characterized by complete immobility of the foreskin, which physiologically fuses with the surface of the head. Most boys are born with physiological phimosis. Only 4-5% of male babies have a movable foreskin, which can be easily lifted and exposed to the head of the penis. Pediatricians and andrology call phimosis of the first year of life a normal physiological phenomenon. This feature of the child’s body passes independently after several years of life. At the same time, with the appearance of inflammation of the head of the penis or foreskin, as well as in the case of development of problems with urination, a child of any age undergoes surgery for medical reasons or use medication.
Elimination of phimosis by the bloodless method
First, a special probe is inserted into the preputial cavity, with which synechiae (adhesions) are formed, which are formed between the glans penis and the inner sheet of the foreskin. To do this, the probe is carefully advanced inward to the coronary sulcus and perform slow clockwise movements.
Then expand the opening of the foreskin with the help of a Pean's clamp: the ends of the clamp are inserted into the hole and the branches are opened.
Often, two or three such manipulations are enough to completely eliminate phimosis. In cases where positive dynamics are not observed, a more invasive surgical intervention is indicated.
After sessions of bloodless elimination of phimosis, it is necessary to follow all the recommendations of the surgeon in order to prevent the fusion of the mucous membranes of the foreskin and the glans penis.
Anti-relapse measures are indicated during the month: daily manual opening of the foreskin and washing of the prepuce cavity with a weak solution of potassium permanganate. If this manipulation is too painful or unpleasant for the child, you can perform it once every two to three days, but at least.
Surgical interventions for phimosis are most often performed under local anesthesia, an indication for the use of general anesthesia can be:
- too young a patient’s age
- increased emotional lability
- individual intolerance to the means used for local anesthesia,
- personal desire of the patient.
After the operation, unpleasant sensations in the area of the surgical wound are possible for several days, however, as a rule, it is possible to do without additional painkillers.
In those cases when there is a need to remove the stitches, this manipulation is performed 7-10 days after surgery. Before removing the sutures, it is necessary to make dressings every other day and make sure that urine does not get on the postoperative wound.
As a rule, within two weeks after the operation, the patient can have sex. Before this period, it is advisable to wear tight underwear that provides additional support for the penis.
Phimosis in 2 years
In young boys under the age of 2 years, problems and pathologies of the foreskin do not arise, since it completely covers the head of the penis and is closed tightly enough. Pathogenic microorganisms simply can not penetrate under it, and, therefore, the inflammatory process in the genital organ does not threaten the baby. But there are exceptions in which the physiological state of the foreskin turns into a pathological process. Phimosis at the age of 2 in boys is formed if the parents forcefully try to open the head of the penis in the crumbs. It is impossible to stretch the foreskin in infancy, because such manipulations lead to the appearance of tears, bruises and microcracks in the delicate tissues. If adults neglect this requirement, the child already at the age of 2 develops pathological phimosis. It happens:
- atrophic (in a boy, the foreskin ring is critically compressed, the pathological development of tissues becomes clearly distinguishable, the skin becomes thinner, its vulnerability to mechanical stresses increases),
- hypertrophic (the problem is associated with the pathological lengthening of the prepuce sac, more often observed in overweight boys, with the accumulation of a large amount of subcutaneous fat in the pubic area),
- cicatricial (appears as a result of mechanical injuries of the delicate tissues of the foreskin, provokes its edema, as well as the rapid accumulation and stagnation of urine under it, due to adverse processes, connective tissue scar adhesions are formed between the inner part of the head and prepuce).
Phimosis in a 2-year-old boy does not always require surgery. Surgical intervention is recommended by a doctor only if there are risks to the child’s health.
Circular excision of the foreskin
Circular excision of the foreskin, which in medicine is more often called circumcision, and "in the world" - circumcision, is the most common operation to eliminate pathological phimosis.
Important positive aspects of this surgical intervention are the speed of elimination of all unpleasant symptoms and the absence of relapse (this is the only surgical procedure for phimosis that provides 100% effectiveness).
The only, but significant drawback of the method is the complete elimination of the foreskin, and, consequently, the irretrievable loss of all the functions it performs. However, it should be borne in mind that millions of men in the world annually perform circumcision for religious reasons and do not suffer at all.
Circumcision is a non-alternative method for cicatricial phimosis, as well as for the fourth degree of phimosis, paraphimosis and recurrent balanoposthitis (the operation is performed after the acute process is eliminated).
Phimosis at 4 years old
The inability to move the foreskin from the head of the penis in boys at 4 years of age can also be considered a normal physiological phenomenon. If the child does not have pain during urination, he is not capricious and does not show anxiety, treatment of phimosis or surgery is not required. Parents should contact a pediatric urologist only if the child has phimosis and complications have developed (the head of the penis has become inflamed and there are problems with urination). Medical statistics indicate that at the age of 4-7 years, many boys disappear manifestations of congenital phimosis. The head begins to freely come out from under the foreskin. If this does not happen, you can consult a specialist and, if necessary, undergo a course of drug treatment.
Phimosis in adolescents 16 years old
Preservation of congenital phimosis at 5 years and at an older age (up to 16 years, when the adolescent period begins), may be a sign of physiological processes or pathological deviations. To understand what kind of phimosis the boy suffers, parents should carefully look at the symptoms. Redness of the skin on the penis, the inability to remove the penis’s head from under the epithelial folds on the skin, swelling and soreness of the sac of the foreskin, impaired urine diversion and its accumulation under the prepuce sac, malaise, weakness, headaches - all these manifestations are the reason for immediate medical intervention .
Doctors begin to classify phimosis as a disease and pathological deviation of sexual development in a child when the boy is 7 years old. The doctor in the process of diagnosis looks at the state of prepuce, the degree of narrowing of its outer edges and on the basis of this information determines the degree of pathology and the causes of its occurrence.
Plastic surgery of the foreskin with pathological phimosis
So with prepuceoplasty, in contrast to the circular excision of the foreskin, the foreskin is not completely removed, since they make a significantly smaller incision.
Another common method of foreskin plastic surgery is called the Schlöffer method. During the operation, the surgeon does not make a straight, but a zigzag incision, and then sutures the edges in such a way as to significantly expand the hole, preserving the foreskin.
In addition, the methods of plastic surgery of the foreskin according to Roser, spiral plastic of the foreskin, etc. are quite widely used.
The common disadvantages of such operations include a longer recovery period, the possibility of relapses and a relatively short list of indications. So, for example, operations with partial preservation of the foreskin cannot be performed in patients with severe cicatricial forms of phimosis.
The pathological causes of phimosis in boys are as follows:
- insufficient, poor hygiene of the external genital organs in boys, due to which the infection falls under prepuce and provokes the development of inflammation,
- wounds, injuries, microscopic ruptures of the skin on the head or foreskin,
- past diseases and inflammatory processes in the genitourinary organs (balanitis, balanoposthitis).
Laser phimosis treatment
Using a laser, it is possible to perform both circular excision of the foreskin (laser circumcision) and plastic surgery that preserves the foreskin.
Laser surgery has a high accuracy of incisions, so that damage to surrounding tissue is minimal.
In addition, laser beams cut tissue while cauterizing blood vessels, and have a bactericidal effect.
Thus, laser surgery has the following advantages:
- safety (there is no risk of bleeding and infection of the surgical wound),
- less severe pain
- short recovery period.
Compared with conventional surgery, the postoperative period with laser correction of phimosis is more comfortable (there is practically no swelling of the tissues, there is no need for dressings, removal of sutures, etc.) and lasts only three to four days. However, doctors do not advise starting a sexual life earlier than two weeks after the operation.
One of the serious and significant problems with the parents of young gentlemen is the question. Serious controversy erupts about the hygiene and nuances of caring for the penis of boys: does the child have phimosis, is it a pathology, or are these features of age-related anatomy?
You will find answers to all these questions in this article.
Phimosis: causes in children
Phimosis in boys of different ages can also occur due to the action of such factors:
- connective tissue deficiency in the child’s body,
- too uncomfortable clothes that squeeze and rub the genitals of the boy,
- penile injuries associated with inept actions of parents in the process of bathing a newborn baby.
Often in young boys, the penis and skin fold around it grow unevenly. The foreskin develops more slowly and therefore clings too tight to the head of the penis, does not make it possible to expose it and perform the necessary hygiene procedures. The initial stages of childhood pathological phimosis are accompanied by a progressive narrowing of the foreskin, injuries and scarring of its internal part. The situation is exacerbated by a further narrowing of the skin fold. An acute state of infringement of the head may develop, requiring immediate intervention by surgeons.
The symptoms of phimosis always help the doctor determine the causes of pathology. The severity of signs, their number and features contribute to the detection of the causative agent of the disease and the development of an effective treatment regimen.
Pathological phimosis: symptoms in children
When it comes to a medical diagnosis that requires treatment, doctors talk about pathological phimosis . Most often it is diagnosed in boys after 7 years, and sometimes, if there are no additional symptoms in children , and at a later age.
Two types of pathological phimosis are distinguished:
- Atrophic. Too thin skin of the foreskin, which often tears and is prone to scarring, which leads to a loss of elasticity.
- Hypertrophic. Too thick foreskin, protrudes far beyond the head of the penis and resembles a proboscis.
Parents should consult a doctor if the boy has noticed:
- Painful urination.
- Inadequate urination - urine goes in drops or a thin stream.
- Scars on the foreskin.
- Swelling and redness.
All this can cause development. pathological phimosis or other childhood diseases of an infectious nature, leading to pathologies. Pay attention to the condition of the boy's penis if he suffered an injury or there was a strong inflammatory process.
Children's diseases: phimosis complications
Phimosis in itself is not dangerous, complications manifest themselves much worse:
- Paraphimosis The result of retraction of the foreskin during physiological phimosis. It occurs when the head has been exposed, but the foreskin cannot be returned back. Paraphimosis It is dangerous because necrosis can develop without proper medical assistance and the head will have to be removed.
- Balanoposthitis. If hygiene is not observed, inflammation of the foreskin and head develops. Sometimes balanoposthitis occurs against the background of other infectious childhood diseases or with reduced immunity. It threatens the degeneration of the tissues of the foreskin, scarring and the development of pathological phimosis.
Almost all newborn male babies have such a disorder as phimosis. Before you take any action, you need to understand what nature phimosis in boys is and what it threatens with.
Physiological phimosis is the age norm in male babies of the first years of life and does not require special treatment. It is enough to observe basic hygiene rules, regularly change underwear, do not use detergents and hygiene products that can cause allergic reactions.
The fight against pathological phimosis
Pathological phimosis requires a completely different approach, here you can not do only with herbs and clean linen. There are two main methods of getting rid of the disease: conservative (medication) and surgical.
In the case of hypertrophic forms of phimosis, the method of gradual extension of the foreskin is used. It is possible to carry out manipulations at home, special skills are not required. Three times in seven days the child should be bathed in decoctions of chamomile and string, which have anti-inflammatory and disinfectant properties. Then the flesh moves away, opening the head, until the pain in the child appears. After that, in the open space you need to spray a few drops of petroleum jelly. It must be sterile! The duration of such treatment is several months. The procedure must be done very carefully so as not to harm the baby.
Modern medicine offers a large number of hormonal ointments intended for the treatment of phimosis. They are also placed in the opened preputial space. Such therapy should be under strict medical supervision.
The result of non-surgical methods of therapy depends on the responsibility of the parents, the regularity of the procedure and the degree of the disease.
In the case of diagnosing cicatricial phimosis, this method of combating an ailment will not work, it will not give a result. In case of scarring, surgical methods are used. The operation is prescribed only if the baby is in full health, colds and other diseases must first be cured.
Surgery is indicated only in cases where other methods do not give a result, or bring temporary relief (inflammatory processes occur again and again) and are carried out in the order established by the plan.
The work of surgeons takes place under general anesthesia and lasts about 15 minutes. The essence of the operation is circumcision of the foreskin, but with the preservation of the frenum, the head always remains open as a result. Rehabilitation takes some time and requires compliance with certain hygiene standards, but after a few hours the boy is allowed to move and go to the toilet on his own.
Complications after surgery are extremely rare and make up less than 0.3% of the total. More often they are associated with the fact that the head of the penis is deprived of natural protection and is exposed to all kinds of infections.As a result, inflammation appears, their chronic form is called meatitis.
In the future, the treatment method does not affect the intimate life and its male viability.
Is phimosis dangerous if left untreated
Like any disease, phimosis should be treated. If you let the development of the disease take its course, then as the boy grows, it will lead to serious and sad consequences. Among them are complications such as the presence of persistent inflammation, male failure, cancer, problems of a psychological nature, the development of complexes, sepsis, etc.
Prevention of phimosis in boys
Despite the seriousness of the consequences, prevention of this problem is quite simple.
There are no measures to prevent the occurrence of physiological phimosis. A person is not able to influence his appearance. Enough basic hygiene that prevents the occurrence of inflammation, infection of the foreskin.
There is nothing complicated in the prevention of hypertrophic phimosis. Boys who have reached the age of three must be shown to a surgeon or urologist.
If a child shows you in words or gestures that it hurts to write, be sure to visit a doctor.
Personal hygiene is the most effective way to prevent problems. To wash a member with the foreskin should be every time the boy went to the toilet. The “frivolous" procedure at first glance will prevent the accumulation of bacteria and prevent inflammation from developing.
During bathing, boys should avoid special means for intimate care. The components of such gels disrupt the natural microflora and reduce the natural level of protection.
It is very important to regularly change underwear, giving preference to shorts from natural fabrics. The material does not cause irritation.
Phimosis is an unpleasant problem, but it is completely removable. No need to give up if your son is given this diagnosis. According to experts, physiological forms are not dangerous and are permissible. These are just structural features of the boy’s intimate organs.
Hypertrophic phimosis is more dangerous, but with correctly and timely treatment, it completely disappears and leaves no traces.
It is important to understand: it is extremely difficult to independently diagnose phimosis and its appearance. If you have any doubts, it is better to consult a doctor. Remember, the foreskin in children is a very delicate and vulnerable area of the skin. Any impact on it should be monitored by experts, so as not to harm. Improper treatment or extraneous physical intervention can lead to injury, deformation and death of the head.
Do not disregard your child’s complaints about discomfort in the intimate area, make sure that the foreskin is natural in color and has no swelling, consult a specialist on time.
Each parent must be aware: the male strength and viability of their child in the future is completely dependent on the state of health in childhood.
Types of disease and its causes
Phimosis in a child is a pathology in which the head of the penis cannot open at all or opens with difficulties accompanied by pain. The ailment is of two types and appears for various reasons.
The first group of boys has physiological phimosis of the foreskin. It arises as a result of processes laid down by nature. Babies in the foreskin have adhesions that have a protective function. They prevent infection and infection of the genitals. This type of pathology does not require any intervention, passes on its own as the child grows. Adhesions weaken and disappear, and the foreskin moves freely.
The other half of male infants has pathological phimosis, it requires more serious therapy and does not allow any initiative. This phimosis is divided into two subspecies:
Cicatricial phimosis is characterized by the appearance on the penis of keloids and scars that make it difficult to remove the head.
A characteristic sign of hypertrophic phimosis is excess skin that does not allow the glans penis to open freely.
Pathological phimosis is characterized by several stages, it seems possible to determine them only after puberty. On average, 13-15 years. There are only four stages and they are classified as follows:
- Phimosis manifests itself only at moments of sexual arousal; in a calm state, the foreskin opens almost completely, exposing the head.
- There are certain problems with opening the glans penis in an excited state and slight difficulties with exposure in a calm.
- The glans penis does not open in any state, but urination is painless and does not cause any discomfort.
- The head of the penis remains closed with the foreskin in any condition, urination is accompanied by painful sensations. Before going outside, a peculiar bubble forms from the urine. Further urine comes out in a thin stream.
Diagnosis of the disease, symptoms
A surgeon can diagnose the disease. As a rule, this diagnosis is made on the basis of external examination, complaints of the crumbs and parents, the presence of concomitant symptoms. In most cases, additional medical or instrumental examinations are not required. They are addressed only in cases where there are prerequisites or suspicions of more serious pathologies.
Quite often, people go to the doctor when the ailment is quite neglected. To avoid unpleasant consequences, you should pay attention to the appearance of symptoms characteristic of phimosis. There are not very many of them; it will not be difficult to trace the appearance of signs.
The main and most significant symptom is difficulty opening the glans penis. Children often become restless, constantly touching their reproductive organs (due to discomfort, itching and other things). When the baby is peeing, it is very tense, urine is excreted in a small amount, sometimes in the form of drops. Also, phimosis is sometimes accompanied by an increase in body temperature, an increase in lymph nodes, the release of a certain amount of pus from the penis.
If you notice one or more signs of an illness in your little man, immediately consult a doctor. He is able to refute suspicions or confirm them and prescribe adequate treatment.
Primary phimosis, in which it is impossible to free the head of the genital organ in a child of 4-7 years old, is the norm. It does not require treatment or surgery . Attempts to forcibly displace the epithelium can cause the formation of cracks and tears, and subsequently provoke necrotization of the tissue.
Seeking medical help is necessary only with, that is, the inflammatory process of the glans penis, and impaired urination.
By 4-7 years, in 92-95% of boys, the symptoms of primary phimosis disappear, and the head is freely removed from under the foreskin. Otherwise, the child needs a urologist consultation and appropriate treatment.
Symptoms of pathological phimosis in children 5 years of age and older :
- The epithelium completely hides the surface of the penis, it is difficult to remove the head from under the skin.
- Hyperemia, soreness and swelling in the area of the preputial sac. In a certain percentage of patients due to the development of the inflammatory process, purulent discharge is noted.
- Disorders of urination. It is difficult for a child to urinate: urine first accumulates under the skin, after which it is excreted in a thin, interrupted stream.
- Pain syndrome when trying to release the head of the penis in a calm state or in case of spontaneous erection.
ATTENTION ! Hyperthermia, weakness, malaise, headache and other symptoms of general intoxication, developed against the background of delayed urine outflow, indicate the development of infectious processes in the child's body and require urgent medical intervention.
There may be several reasons for the development of pathologies of phimosis in boys of 5 years :
- Scleroderma of the penis, deficiency of elastic tissue in the patient's body.
- Infectious and bacterial diseases of the genitourinary system.
- Penis injuries and burns, as a result of which epithelial tissue is replaced by connective tissue, forming scars.
- Non-observance of personal hygiene, which can lead to the development of inflammatory phenomena and the development of balanitis.
- Genetic predisposition to the development of pathology.
The answer to the question: "Phimosis in a boy of 7 years old, what to do?", There can only be one - take him to a doctor.
Types of disease
The physiological deficiency in the development of epithelial tissue of the genital organ is caused by synechia, that is, embryonic adhesions preserved between the epithelium of the head of the penis and the inner sheet of the prepuce. As the penis grows, the head extends the synechia, and its release occurs without difficulty .
Physiological phimosis at 5 years old may be the norm, it usually goes away by 6-7 years, but in some cases it can persist up to 9-10 years. It does not require treatment, however, it requires the observance of particularly thorough penile hygiene and observation by a urologist to exclude the development of secondary, that is, pathological, phimosis.
When should treatment begin?
If a child under 6-7 years of age continues to experience phimosis that does not cause the boy any inconvenience, you should seek the advice of a urologist. He will monitor the condition of the child and will be able to notice signs of pathology in time.
In addition, the doctor may recommend that the mother conduct a special gymnastics with the boy, aimed at stretching the foreskin by hand. In some cases, the use of corticosteroid ointments and gels that increase the elasticity of the skin is also prescribed. With a review of the various ointments prescribed for a child with phimosis, you can familiarize yourself.
If phimosis persists even after 12-14 years or goes into the 3-4 stage, then the patient requires surgical treatment. In this case, circumcision is performed - an operation to remove the foreskin. It takes an average of 10-15 minutes and has minimal risks of complications. 3-4 hours after circumcision, the boy begins to urinate independently.
With development, circumcision is impossible. Therefore, the intervention takes place in 2 stages: during the first operation, a longitudinal dissection of the prepuce is performed, and during the second, its removal.
What to do during an exacerbation?
If the child has pain while trying to urinate, purulent discharge from the urethra or sediment in urine, consult a specialist. All these symptoms indicate a genitourinary infection. .
This condition requires medical supervision, antimicrobial therapy and careful hygiene of the genitals of the child. A urologist is involved in the treatment of the disease.
The surgeon should be consulted if the child complains of pain, cracks in the prepuce area, the need to strain during urination. This symptomatology indicates the development of secondary, pathological phimosis and is an indication for a disease or surgery.
And adolescents up to 13-14 years old - a physiological condition that does not require, as a rule, medical or surgical treatment. However, a child with a similar diagnosis should be registered with a urologist to prevent the development of pathologies and, if necessary, start therapy on time.
Pathological phimosis in boys
Usually, in the absence of any action to open the head, problems with the penis do not arise, but accumulations of smegma in the foreskin can form, which are poorly eliminated due to abundant synechia. In such cases, a kind of tumor forms on the tip of the penis. In these cases, they resort to the help of surgeons or urologists, who, with a special instrument such as a wand probe, carefully separate the synechiae under local anesthesia and remove the accumulated secret.Then, for several days, it will be necessary to produce hygienic baths for the penis with solutions of antiseptics for proper healing.
If we talk about the fact that pathological phimosis develops directly with impairment or a sharp difficulty in removing the penis head, it will be characterized by a number of features. Usually, such phimosis occurs in the case of injuries or violent actions to remove the head, when mucosal injuries, microcracks occur and an inflammatory process forms.
Phimosis in newborn boys: symptoms and characteristics of the disease
Parents who want to learn how to determine phimosis in boys (photos), just born, should know the physiological features of the structure of the penis in infants. In most boys, immediately after birth, the penis has one anatomical feature. Its foreskin fuses with the head of the penis, so you can not expose the latter. This form of phimosis is not considered a problem, with it the baby feels good, discomfort does not annoy him.
The situation with pathological phimosis of newborns is quite different. The disease is formed already in the process of a baby’s life and can take various degrees and types. Signs of phimosis in a child under the age of 1 year, associated with pathological changes in the foreskin, are represented by such manifestations:
- nudity of the head of the penis is difficult (a symptom of cicatricial phimosis),
- hypertrophy of the foreskin, which is characterized by its excessive thickening and elongation (the skin protrudes beyond the boundaries of the genital organ, hangs from it like a proboscis, the head of the penis does not open because of this, some children experience minor problems with urination),
- thinning of the foreskin, accompanied by the maximum manifestations of phimosis of newborns (it is not possible to release the head of the penis, the baby has difficulty emptying the bladder, urine comes out in droplets or a weak stream, its remnants accumulate under the skin fold and provoke infection),
- blueness and swelling of the tip of the penis is a dangerous complication of phimosis (paraphimosis), in which the head of the penis is infringed by a narrowed skin fold,
- an increase in temperature (a symptom of an inflammatory process, balanitis, balanoposthitis or diseases of the urinary system that arose as a result of infection from the foreskin entering the urethra, ureters, bladder).
All the symptoms listed above require medical attention.
Phimosis: symptoms in adolescents
The degree of phimosis in boys, the symptoms and treatment of the disease are interconnected. When doctors diagnose “phimosis”, adolescent boys already call the inflammatory process a disease and pathology, which must be eliminated by medication. Often in such situations, you can not do without surgery.
Phimosis in adolescents is often associated with the onset of puberty. The external genitalia develop intensively, as a result of which the dimensions of the foreskin may not correspond to the parameters of the penis. The skin fold in this period does not have time to grow behind the head of the penis, strongly tightens it and injures. Phimosis and symptoms in children manifest themselves in the form of such deviations:
- the head of the penis does not open well at rest, sometimes it is not exposed at all,
- an inflammatory process develops, the foreskin swells, turns red,
- a teenager has difficulty urinating,
- sex drive is reduced,
- the size of the genital organ changes, its swelling is observed,
- pus accumulates under the foreskin, which can go out through a narrowed hole,
- pain and discomfort when trying to expose the head of the penis or while urinating,
- drooping of the foreskin from the penis, pinching the head with it.
Symptomatic manifestations of pathological phimosis in adolescents can manifest themselves in a complex or each individually. In any case, if there are alarming signs, it is necessary to consult an andrologist.
Symptoms of pathological phimosis in boys
- In the first stage of phimosis, the head of the penis can be removed completely in a calm state, without an erection. In the stage of erection, its conclusion is difficult.
- In the second stage of phimosis, the head of the penis cannot be removed in any state, but it is clearly visible through the hole.
- In the third stage, the head cannot be removed at all, it is visible in the hole only a couple of millimeters.
- In the extreme, fourth stage, the narrowing is so pronounced that the process of urination occurs with bloating of the foreskin and straining, soreness and discomfort, which leads to cries and crying of the child.
What does Komarovsky say about phimosis (signs in children of inflammation of the foreskin)
Dr. Komarovsky identifies such signs of phimosis in boys (photo):
- difficulties in exposing the head of the organ,
- pain during urination
- the head of the penis does not close completely,
- the color of the head changes
- the foreskin becomes so inflamed that the pathological process becomes clearly visible,
- the fold of the skin hypertrophies and hangs from the penis.
Komarovsky draws the attention of parents to the fact that the symptoms of physiological phimosis in newborns look somewhat different. A small child cannot yet say that it hurts. However, parents will be able to understand that something is wrong with the baby’s health, because he is constantly acting up, crying and refuses to eat. The list of pathological symptoms is supplemented by external signs in the penis. The intimate organ swells, becomes edematous, acquires a bluish tint. Older boys, due to the discomfort in the penis, constantly correct their underwear, trying to scratch the area near the pubis.
Evgeny Komarovsky gives parents of babies useful tips to help reduce the severity of symptoms of phimosis, as well as implement the correct prevention of this deviation.
- Signs of phimosis can always be prevented. Parents of the boy just have to carefully monitor the hygiene of his external genital organs.
- You need to bathe your child every day, especially carefully watching the cleansing of the genitals. In the evenings, the genitals should be washed with clean warm water without using soap.
- In no case can you forcibly expose the head of a member. Some parents make a big mistake when trying to pour soap foam under the foreskin of a child to better clean the internal cavity of the “sac”. This can not be done, because the chemical components that make up the soap can provoke irritation, and the water remaining inside will become a favorable environment for the life of pathological bacteria. As a result of such improper actions, an inflammatory process develops under the foreskin, suppuration can occur.
- A newborn boy often needs to change diapers. This will help to avoid prolonged contact of the head and foreskin with excrement (feces and urine).
Adults should pay due attention to suspicious symptoms, so as not to miss the moment and show the baby a highly specialized doctor in time. The specialist will not only detect the symptoms and causes of pathological phimosis, but also prescribe an effective course of treatment.
How is phimosis treated in boys? The main methods and techniques
Therapy of pathological phimosis in boys is carried out using a variety of methods. The choice of treatment depends on the following factors:
- the severity of the disease
- degree of disease
- age of boy
- the presence of complications
- diagnosis of concomitant diseases.
After detecting phimosis in boys (photo), treatment is carried out by 2 methods:
If the child is not yet 6-7 years old, his phimosis most often has a physiological nature. It is not worth eliminating it by surgical methods. Pediatricians recommend parents to observe the dynamics of phimosis, to prevent its complications by conservative methods at home.
Phimosis in boys, treatment
In the first two stages of phimosis, only dynamic active observation by parents is required without any action on their part, in the third stage, strict monitoring of the urination process and strict hygiene of the genitals are necessary in order to prevent inflammation and pain.
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Any violent actions against the baby’s penis, excretion of the head with force and pressure are prohibited, which will only increase trauma to the foreskin.
Pathological phimoses require the intervention of a doctor, and often these are operations under anesthesia, especially with cicatricial or atrophic form of phimosis. With an atrophic penis, there is too much excess skin, and it prevents the head from being removed, but cicatricial phimosis is the result of the actions of the parents.
The causes of cicatricial phimosis are obvious:
- violent manipulations with the penis (stretching or sharp simultaneous removal of the head)
- inflammation in the foreskin (balanoposthitis), resulting in adhesions.
Once again, repeat!
With physiological phimosis, there is no problem with urinating the child, and then nothing needs to be done. If the child cannot urinate himself, when urinating, the foreskin swells and the urine is excreted in drops or a weak stream - you need the help of a doctor. such a problem can lead to acute urinary retention, an emergency condition of the child, which is formed due to pain or pinching of head tissue. At the same time, the baby does not urinate for a long time, cries, bangs its legs, and a bloated bladder is felt over the pubis. This requires an immediate ambulance and catheterization of the bladder and elimination of problems with the penis with adequate pain relief.
The second danger is the infringement of the head of the penis by the tissues of the foreskin - paraphimosis, with the forced removal of the head. This condition is extremely painful and dangerous, if you do not provide assistance in the next 30-90 minutes, you can get the death of the head of the penis. If the head is pinched to the tissues of the foreskin, and in a minute it has not pulled out, immediately call an ambulance in the hospital. If the infringement is not strong and swelling of the tissues has just begun, doctors under pain relief can return the head to its place with his hands. If the swelling is severe and the tissues are severely injured, surgical dissection of the skin compressing the head will be required.
In pathological phimoses, the main method of treatment will be circumcision (circumcision) surgery, with it removed the foreskin tissue from the head along with their pathological changes that interfere with normal head excretion.
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Special thanks to the doctor for preparing this material. to the pediatrician, Alena Paretskaya.
Phimosis is a disease that is characterized by the narrowness of the foreskin, which leads to a restriction of its mobility, so the glans penis cannot be completely exposed. This disease is relevant for children and adults, which is almost always due to the lack of adequate treatment in childhood. Phimosis is physiological, which is associated with features of the development of the glans penis and foreskin, and pathological.
How to cure a child's phimosis with conservative methods?
Caring parents often ask pediatricians the question of what to do if the child has phimosis. Experts, responding to it, take into account the stage of the disease.If the pathology has just begun to develop, there is every chance of getting rid of it without surgery. In general, doctors in many cases try to avoid surgery for phimosis in boys. Radical manipulations are fraught with risks, therefore, preference is given to conservative methods of eliminating defects of the foreskin.
The main non-surgical methods of combating phimosis in children:
- careful foreskin movement by hand,
- the use of hormonal ointments, the basis of which is the component cortisone (Betamethasone, Clobetasol),
- use of the finger or instrumental method of stretching the foreskin.
Conservative treatment options for childhood phimosis are used to eliminate the 1st and 2nd stages of the disease. In more severe cases, they are not effective and are replaced by surgical intervention.
Treatment of phimosis in children with surgery
Surgical removal of phimosis in children is a radical method of pathology correction, which is used in case of ineffective conservative treatment. The surgical method of eliminating phimosis is considered the most effective, because it is guaranteed to help eliminate the problem and prevent relapse.
Surgical treatment of phimosis in children is mandatory if the disease is complicated by impairment of the head of the penis (paraphimosis). Without surgery, the tissues of the head of the penis will quickly die, and eventually gangrene will develop. The genitals must be amputated in this situation.
Surgical treatment of the foreskin involves complete or partial excision of it. Surgeons use various surgical techniques, but in most cases circumcision is used (circumcision). Circumcision of the foreskin is associated with partial or complete excision of the skin fold above the head of the penis. Sometimes a specialist, under local anesthesia, makes a small incision in the foreskin to perform surgical stretching. This method includes the following techniques:
- dorsal incision (a notch on the skin of the foreskin, including transverse locks, running along the back of the inflamed ring of the posterior flesh, then the surgeon sews it using transverse sutures),
- triple dissection of the skin fold (the method helps to expand the foreskin and is based on the surgeon creating 3 longitudinal sections of small length, expanding the foreskin to the desired parameters and suturing the created notches, the operation is performed using general anesthesia, adolescents can be given local anesthesia),
- lateral incision (an analogue of dorsal dissection, but with a small addition in the form of 2 longitudinal incisions on the sides, subsequently stitched with transverse sutures).
The above techniques belong to surgical manipulation called prepuceoplasty (plastic of the foreskin) and are used to treat phimosis in adolescents. Sometimes, to expand the foreskin, the surgeon makes a zigzag incision on its surface, and then it is sutured. The effectiveness of this method is quite high. In 99% of cases, surgery is successful and does not cause any complications.
If surgical treatment was ineffective, the boy has complications in the form of prolonged chronic processes. Against this background, the risks of the appearance of infectious diseases or cancer of the head of the penis increase. With cicatricial phimosis, conservative treatment methods are ineffective, therefore, with such a diagnosis in boys, the doctor advises the operation. Treatment of phimosis after surgery should be effective and correct - this will help to avoid complications.
Phimosis in boys: treatment after surgery
Postoperative phimosis therapy in boys of different ages is aimed at eliminating the infection, removing edema and inflammation.The task of the parents is to provide the baby with quality care after the surgical procedure. If the baby complains of pain during urination in the postoperative period, his penis can be lowered for several minutes in warm water. This method helps relieve tension in damaged muscles. After applying it, the boy will not be so hurt. The surgeon who performed the removal of phimosis must prescribe an antibacterial ointment for dressing. The need for dressings persists for 1 week, then they are canceled. Relapses of phimosis are possible only if the foreskin is not completely excised. With the complete removal of the skin fold, the likelihood of complications during the rehabilitation period is minimal.
How to treat phimosis in a child at home
It is possible to treat childhood phimosis at home if the pathology has a hypertrophic form. The therapeutic course takes a lot of time (up to several months without a break), and treatment procedures are recommended to be performed at least 3 times a week.
The essence of home treatment is to perform certain manipulations when bathing a boy. Parents should carefully move the foreskin up until the child begins to complain of pain. Also, inside the preputial sac, you need to fill in a little Vaseline oil (3-4 drops). But it is worth remembering that therapeutic procedures performed at home will not help to eliminate cicatricial phimosis.
To make the skin with hypertrophic phimosis more flexible and supple, hormonal ointments (for example, hydrocortisone or prednisone) should be applied to it. They will soften the foreskin, give it elasticity and facilitate the stretching procedure. Ointments are applied inside the preputial cavity regularly, until the onset of recovery. Parents of the boy must coordinate with the doctor the use of hormonal ointments for home treatment of pathological phimosis.
So to summarize. Children's phimosis, which is physiological in nature and does not cause discomfort to the child, is considered the norm. He is not treated until complications occur. If any, the boy should be shown to a urologist or andrologist. A visit to a specialist should be done if the head of the penis does not open by 13-16 years. If a child undergoes an operation to eliminate phimosis, parents need to know the details of the postoperative period from the surgeon.
What is dangerous phimosis
Since phimosis somewhat complicates hygiene procedures, with insufficient care for the baby, stagnation of smegma is possible. Unfortunately, it serves as an excellent breeding ground for bacteria, which, in turn, can cause the development of inflammatory processes. Moreover: with prolonged stagnation, the formation of dense formations — smegmolites (literally “smegma stones”) is even possible.
Phimosis of the 4th degree is especially dangerous, in which there are obstacles to the outflow of urine. Increased pressure in the prepuce bag at the end of the urination act, when the pressure in the bladder decreases, leads to a reverse flow of urine and dissolved smegma through the urethra. This leads to the development of infectious complications in the urethra.
Conservative treatments for phimosis
With hypertrophic phimosis, if there are no complications, a conservative treatment is possible, which consists in the gradual extension of the foreskin. Manipulation can be performed by parents at home. Three times a week while bathing with decoctions of herbs (a string, chamomile), the foreskin is displaced until the child experiences pain, after which several drops of sterile paraffin oil are injected into the prepuce space. The duration of treatment is several months. The procedure should be performed very carefully to avoid paraphimosis.Success depends on the persistence of parents and the severity of phimosis.
In recent years, correction of phimosis by hormonal ointments, which are laid in the preputial space, has been used. They facilitate tissue stretching. Treatment is carried out by parents with the obligatory supervision of a doctor.
With atrophic (cicatricial) phimosis, conservative treatment is not very effective. In this case, surgical methods are used.
Surgical treatments for phimosis
Indications for surgery are paraphimosis, pronounced cicatricial changes in prepuce, repeated repetitions of balanoposthitis, and urination impairment.
The fastest and most effective way to treat phimosis is an operation called circumcision, or circumcision. With this intervention, the foreskin is removed, which completely eliminates any problems with exposure of the glans penis. This operation lasts 10-15 minutes, and is usually performed under general anesthesia. The foreskin is cut off circularly (in a circle), while maintaining the bridle. The inner and outer sheets of the foreskin are sutured with catgut (suture material, which in the future does not require removal of sutures, since it dissolves on its own). After the operation, a bandage with petroleum jelly is applied. A few hours after this surgical intervention, the child can walk, independent urination is restored. Circumcision is indicated for any degree of phimosis.
Contraindications for circumcision are balanoposthitis and paraphimosis.
Longitudinal dissection of the foreskin
This operation is used when a complete cutoff is not possible. As a rule, her help is addressed in two types of complications of phimosis - with acute balanoposthitis and with paraphimosis. In the first case, a longitudinal dissection of the foreskin is resorted to because circumcision cannot be performed to open the inflamed head of the penis, since infection can lead to failure of the sutures. Well, with paraphimosis, when acute circulatory failure does not allow for complete circumcision, longitudinal dissection of the foreskin remains the only way to “open” the ring that compresses the glans penis.
By the way, in both cases, at the end of the acute period (that is, when the worst is over), doctors can recommend circumcision, which will have not medical, but cosmetic value.
The development of phimosis is largely due to a genetic predisposition, so medicine can not offer radical measures to prevent this ailment. But we can talk about the prevention of complications of phimosis. Here, the first and main role is played by hygiene.
During infancy, proper hygiene is limited to bathing the baby daily and washing after the baby has soiled diapers or diapers. During bathing, water gets under the foreskin, which naturally flushes out the accumulated secret. At least once a week, you should wash your penis and scrotum with soap. To do this, it is better to use baby soap or special children's bathing products. The daily use of bactericidal soaps or gels is not recommended. With frequent use, they can upset the balance of the normal microbial environment necessary for healthy skin.
In order to avoid urinary tract infections, children should be washed from front to back. The boys are washed with a penis without shifting the foreskin. If you still try (on the advice of some doctors) to gradually shift the skin of the penis and expose the head, then this procedure should be performed very carefully, without causing the slightest pain to the child. It should be remembered that the area of the glans penis contains a large number of nerve pain endings, and gross manipulations on the penis can lead to mental trauma and fear.Immediately after the toilet of the head, the foreskin should be returned to its place in order to avoid the development of paraphimosis.
Genital hygiene should be a daily habit for a boy, like washing or brushing his teeth. Later, and especially at the beginning of puberty, the future man needs regular regular check-ups. Take care of your health!