Phimosis is a condition in which it is impossible to remove completely the head of the foreskin of their contractions. It is found in 90% of children before the start of puberty and is a sign of the maturation of physiological of the penis. Phimosis in men is a pathological condition. Develops in 2-3% of adults and leads to a number of serious complications, reduces the sensation of sexual intercourse. In the early stages of phimosis can be successfully treated with conservative methods, therefore, it is important to note the disease and seek medical attention.
The mechanism of development
The penis is the external sexual organ of men, the main function of which is to Deposit sperm inside a woman's vagina. The most sensitive part is the head, which concentrates the largest number of nerve endings. It is covered with a delicate epithelium, which is similar in structure to the network edge of the lips. At the top of the head, opens the urethra. The lower part is fused with the cavernous bodies of the penis, which form the trunk. In this place the penis is a thickening of the coronary sulcus, which can be felt immediately below the head.
Protects the delicate skin of the head of the fault a fold of the skin of the foreskin. It consists of 2 sheets:
- The outside – in the structure identical to the skin of the epidermis, has a high cornified layer;
- The internal is covered with a thin epithelium that is similar to that of the mucous membranes.
The foreskin starts from hair groove and tightly covers the whole head, forming prepucialis of the cavity. She opens the front opening which easily expands and releases the head out. In normal adult men, the foreskin moves easily, fully exposing the top of the penis. In the back of the head of the interior leaf of the cavity well fused fabrics in the form of a horseshoe. In the thickness of the horseshoe is a large amount of nerve endings and capillaries, to stimulate it during sex gives a man pleasure.
The foreskin performs the following functions:
- Protects the urethra against the penetration of pathogenic agents, which covers a hole;
- Avoid mechanical irritation and damage of the thin epithelium on the surface of the head, keeping the sensitivity;
- Facilitates slide into sexual relations, production of smegma and a smooth inner layer;
- Increases the pleasure received during intercourse, due to the stimulation of the nerve endings of the glans and the frenulum. This is an important factor in the evolutionary history plan: without strong positive emotions of people refuse sex and were less likely to procreate.
Phimosis as a pathological condition develops after inflammation or injury to the foreskin. The resulting impact destroyed tissue and start an inflammatory process. That passes through certain stages and always ends with the restoration of the integrity of the authority. Deep damage is replaced, with the formation of thick connective tissue, which significantly reduces the elasticity of the foreskin. The high activity of reduction processes leads to the formation of connective tissue septa between the leaf interior of the cavity and the head of the penis. It firmly keep them together and prevent the denudation of the upper part of the penis.
You need to understand that phimosis is not a disease, but specific condition that is associated with the physiological characteristics of the organism (age), heredity and the damage to the fabric of the foreskin. In this sense, there are the following forms of phimosis:
- Physiological – occurs in most children before puberty, is associated with the maturation of functional prepucialis of the cavity. It is not a disease, and if it is solved after 7 years.
- Pathological – occurs as a result of inflammation, trauma, metabolic diseases and require treatment:
- Hypertrophic cardiomyopathy (proboscis);
- The scar.
The frequency of occurrence of a particular form of phimosis depends on the age. The children in the majority of cases are physiological in nature, but in men is caused by the healing.
According to the seriousness of the process, there are 4 degrees of phimosis:
- In the relaxed state the mind is released completely, during the erection, its excretion is limited, and painful;
- At rest, the penis is removed in the work, during the erection is completely covered by the prepuce and is not released;
- The head can be partially withdrawn only in rest;
- Head constantly hidden by the foreskin, is not shown. During urination urine out drop by drop.
The genitals of the child begin to form after 11-12 weeks of development intrauterine. The head of the penis and prepuce are formed from a common rudiment in the third trimester of pregnancy, their separation occurs where the hair groove. The cells of the foreskin began to share, well ahead of its growth the tissues of the penis. In the end, that surround the head in the form of a Cup and to close the cavity. Anatomic proximity and common tissue lead to the formation of the delicate epithelial walls between the inner leaf of the foreskin and the skin of the head.
A baby child prepucialis cavity is completely closed from the environment of these axes, which eliminates the entry of pathogens. For 3-4 months of the life of the beginning of functioning sebaceous glands of the foreskin. Produce smegma that accumulates in a small amount in the cavity. The infection and the development of inflammation, inhibit epithelial septum in the region of the hole of the foreskin. Gradually these subtle threads are destroyed, smegma is shifted to the output and released through the format of free space. It can be seen in the form of small wax flakes white clothing of the child.
At the time of puberty partitions fully or partially, are limited and the mobility of the foreskin increases. During the Masturbation or after the beginning of sexual life, the head begins to be fully released, although the first time, the process can be painful. Therefore, physiological phimosis self-resolves in puberty and does not require treatment.
Treatment in case of inflammation
Despite the naturalness of phimosis in some cases, there is a need of medical attention. With little care of the boy or the non-observation of personal hygiene in prepucialis bag with skin pathogenic microflora and inflammation develops. Clinically it is manifested by redness around the edge of the hole foreskin, local pain and an unpleasant odor of the penis. In the subsequent inflammation leads to the formation of cicatricial phimosis that will require surgical treatment.
After the detection of these symptoms of the child, parents should consult a pediatric urologist. The previously widely practiced method of simultaneously open prepuce sharp movement. This procedure is very painful for the child and can cause psychological trauma. In addition, simultaneously with the opening of the damage the foreskin and can cause cicatricial phimosis in the future.
Today, doctors recommend gradual opening of the head of 1-2 mm., It is done after a hot bath, preferably with the addition of an antiseptic: a decoction of chamomile, calendula, sage. Do it should be 2 times a week for 10-15 minutes. After the water treatment the foreskin is treated with healing ointment or baby cream to increase their elasticity and avoid tearing. The skin push not more than 2 mm in a single procedure. This method can cure phimosis at home for several months.
The ineffectiveness of the above-described method, the surgeon or urologist dissects the adhesions formed by the probe. Performs the procedure in an outpatient setting without anesthesia or with local anesthesia. The doctor inserts prepucialis bag thin metal rod with a rounded end and directs them around the circumference of the glans of the penis. Later should daily wash the penis of the child with the use of solutions antiseptic.
Causes of pathological phimosis are:
- A genetic defect of the connective tissue;
- The metabolic disorders;
- Inflammatory diseases of the foreskin and the penis head;
- The Trauma of the penis;
- Infection transmit sexually transmitted diseases;
- Age-related changes.
Hypertrophic phimosis is an excessive development of the prepuce, which is a long proboscis hanging from the penis. At the end of the "proboscis" is narrow and opens with a dense ring, removal of the head through which is not always possible.
A long proboscis lengthens the path for the excretion of urine and smegma, resulting in favourable conditions for the growth of pathogenic microorganisms. The increase of the moisture in prepucialis the bag and the accumulation of fat is a perfect breeding ground for bacteria. The damage in the epithelium of the glans and the inner layer of the foreskin with the development of reactions of inflammation. In children with diabetes in prepucialis bag often multiply yeasts fungi that it seems intolerable itching in the genitals and a thick white discharge. Balanoposthitis often ends with the formation of the scar in the form of phimosis.
Another reason pathology – hypoplasia of penis normal size of the foreskin. Is detected in the process of puberty boy and usually is associated with insufficient secretion of testosterone in the testicles. In this case phimosis, combined with low growth, lack of muscle mass, excessive hair growth, lack of growth of facial hair, high voice, and depression.
Cicatricial phimosis is the most common form of the disease among the adult men. The reason is, any condition that leads to swelling of the foreskin or head. Between genital infections are the most common cause of balanoposthitis in the result is Treponema pallidum. The virus of genital herpes, human papillomavirus and Candida also often due to the inflammation of the glans penis. In children with cicatricial phimosis is rare and approximately one-third of the cases could not determine the cause of the disease.
The disease progresses slowly. In the first weeks after the inflammation is formed by a thin connective tissue bridges, which somewhat restrict movement of the foreskin. Only a few months they considerably thicken, become dense and tough. The mobility of the foreskin is small, the head is maintained in the closed state, even during the erection, and tries to discover them accompanied by severe pain. The forced exposure of the head leads to a small tear, bleeding and the formation of new scars.
The last degree of phimosis violate the self-cleaning of the cavity and the process of urination. In the end, the patient developed a urinary tract infection: urethritis, cystitis, pyelonephritis. In addition, cicatricial phimosis interferes with the normal flow of sexual intercourse. There is a need for additional lubrication, a man is not getting enough stimulation and feels pain when stretching the foreskin.
Treatment of the forms of pathological
Diagnosis and treatment of phimosis ducts, urologist, surgeon. If the cause of the disease was a sexually transmitted disease, the patient is, in addition, seeing the dermatologist who prescribes antibiotic therapy. The treatment in this case, has two partners.
Treatment conservative treatment is carried out in the first two grades of phimosis, adhesions, although it was not more than a month ago. In these cases, the patient is recommended a gradual stretching of the foreskin after a hot bath. In the glans apply anti-inflammatory ointment containing glucocorticoids and absorbable ointment. Open the head carefully, avoiding injury of the foreskin. After surgery show healing of the drug.
Surgical method of treatment is a circumcision. The operation involves the complete removal of the foreskin, the glans after it is constantly open. The operation is performed under General anaesthesia in children and under local anaesthesia in adults. First, the surgeon makes an incision and is folded back towards the outside of the leaf of the foreskin, then carefully cut adhesions. After two sheets selected, cut them into the hair groove. The result wound, the surgeon sews the suture material, which later dissolves, that is to say, the removal of points after the surgery is not necessary. In the postoperative period perform 1-2 bandages and discharged the patient to home. Complete tissue healing occurs in 2-3 weeks and after this period you can resume sexual activity.
Complications and prevention
Among the complications of phimosis can be found with most frequency:
- Infringement of the head – that develops in the attempt to force bring the head of the penis of the cavity. Tight ring in foreskin compresses the tissue of the head, it swells and increases in size. As a result of the inverse reduction becomes impossible, disturbed blood supply to the tissues and without medical emergency situation ends with a necrosis – necrosis of the strangulated part of the head.
- Inflammation of the foreskin and the penis head.
- Urethritis, cystitis, pyelonephritis – developed with 4 degrees of phimosis because of a violation of a stream of urine.
- The increase of the foreskin of the glans – the most damaged areas due to the tight junction to the other in order to heal a single scar, cut, which is not always possible.
As preventive measures the most important are:
- A careful hygiene genital, daily washing away of the child and timely, the change of diapers or diapers;
- Use barrier methods of contraception (condom) during sex with a casual partner;
- Treatment of major disease (diabetes).