Phimosis (from the Greek. phimosis - tightening of the compression) – this is a narrowing of the foreskin, preventing the removal of the glans of the penis. This state is the norm for the young representatives of the stronger sex, however, becomes a pathology, pausing after the time had finished. We will try to understand where the border between these States.
Clearly imagine the problem of phimosis, remember the peculiarities of the structure of the anatomical of the prepuce "male dignity."
The penis (the penis) consists of body, head, and root. The head of the penis hidden behind the skin of the foreskin (prepuce), which in an adult male is easy to move, exposing the head. The foreskin consists of two leaves: the outer, which is not different from most of the rest of the areas of the skin of the body and the interior, soft and smooth, looks like membrane mucous. Between the head and the inside of the leaf of the foreskin has preputial space (sometimes called the preputial SAC). In this cavity stands out the secret of the glands under the foreskin and a special lubricant (smegma), which facilitates the sliding of the header. At the bottom of the surface of the foreskin of the penis is connected to head by the frenulum of the prepuce is a fold of the skin, in which the blood vessels and nerves. The head is the external opening of the urethra.
Babies of the knights of the glans penis is the prepuce adherent to a kind of spikes that don't allow you to withdraw freely any. This physiological function - a kind of protective mechanism to reduce the probability of infection in the preputial space and the development of inflammation - called physiological phimosis. For boys 3-7 years with physiological phimosis is perfectly normal condition! Statistics show that at the age of 1 year, the head of the penis is open to a 50 % of boys for 3 years - is now at 89 %. The frequency of phimosis in 6-7 years is 8 %, and 16-18 years in boys - only 1 %.
The growth of the head member gradually pushes the foreskin, the physiological sinehii destroyed. Thus, at puberty, from 12-14 years old when aktiviziruyutsya male sex hormones, causing the tissue of the foreskin more elastic and elastic head opens fully.
Physiological phimosis does not require any type of treatment, but requires that parents pay close attention to the condition of the external genitalia of the child. The condition of the glans penis, the prepuce and preputial SAC (the space) is easier to control during the daily cleaning, and then, when the baby urinates. If the foreskin is swollen and reddened, and the child, and then spreads the hand of a causal site (and even more so in the case of difficult urination), it is urgent to consult with children's services, and if such a specialist does not have a surgeon paediatric or urologist.
About phimosis as a medical diagnosis (i.e., pathological narrowing of the foreskin) begin to speak in the case of that to bring the head of the penis not the guy after 6-7 years.
Phimosis, depending on the state of the foreskin may be atrophic and hypertrophic. In atrophic phimosis skin of the foreskin is very thin and very susceptible to microtrauma, resulting in the formation of scars. In hypertrophic cardiomyopathy, the foreskin, although the opposite, rather thick, and in the form of "proboscis" speaks far beyond the borders of the glans of the penis.
In addition, phimosis, to distinguish between different degrees. Depending on the severity of the reduction of the foreskin, there are 4 degrees of phimosis:
The main causes of phimosis are:
It should also be noted that the phimosis is a factor of the further narrowing of the foreskin. The fact that the presence of even a slight contraction is a constant lesion of the sheets of the foreskin when the exposure head. This situation is especially common in puberty and the onset of erections. During erection increases the size of the header and the body of the penis, which causes the tension of the foreskin and the formation of micro-holes. In the process of healing in the field of the micro-holes are formed in scar tissue are not able to tension, which leads to the progression of phimosis.
Since the phimosis is a bit difficult for the hygiene, if not careful care of the baby possible stagnation of smegma. Unfortunately, it is the perfect breeding ground for bacteria, which in turn can cause the development of inflammatory processes. In addition, long-term stagnation it is even possible the training of formations, dense - smegmatis (literally "stones of smegma").
Especially dangerous is phimosis 4-degree, in which there are barriers to the exit of the urine. Increase of pressure in the preputial sac at the end of urination, when the reduction of the pressure in the bladder, leading to a backflow of urine and dissolved smegma urethra. This leads to the development of complications infectious in the urethra.
In general, the main danger is not the phimosis and its complications. The most formidable of these is paraphimosis infringement glans narrowed foreskin to force it open. This can happen when the family or the child that will says "got game" - exposed the head, and return the foreskin in place is not. Paraphimosis can also occur at a later age, during sexual intercourse or Masturbation. Infringement leads to the inflammation of the penis head to a certain stage does the reverse reduction is impossible. As a result of violations of blood circulation head turns blue, and becomes sharply painful. And if you don't provide emergency assistance, there may be a necrosis (necrosis) of the head, leading to its amputation.
As you know, to help you in this case can only be a specialist. Immediately call an ambulance. Procrastination as an attempt to deal with this problem by itself, it is filled with the loss of precious time and serious consequences.
Dangerous complication of phimosis can be balanoposthitis - inflammation of the foreskin and the glans of the penis. Develops when poor cleanliness of the genital organs and the infection of the preputial space. The opportunity to develop balanoposthitis increases in children with reduced immunity or against other infectious diseases. Inflammation of the foreskin is characterized by swelling, redness (hyperemia), pain, purulent secretions from preputial space. The result of the inflammation may become cicatricial degeneration of the skin of the foreskin and, as a consequence, the development of phimosis. Balanoposthitis is a disease that requires medical assistance urgent. The doctor inserts a special probe between the glans penis and the skin of the foreskin, which is perfectly divided available sinehii, thus creating the conditions for the exit of the accumulation of pus.
Another complication of phimosis that requires immediate treatment to the doctor with acute retention urinary. This condition is more common in children and is reflected in the nature, in reaction to the pain. The child for a long time could not urinate, becomes restless, complains of pain in the stomach and above the vagina, where palpable enlarged bladder. In the process of treatment, the baby is given pain medication, do an enema cleaning (in the intestine full of faeces, not more pressured, and not to obstruct the flow of urine), and then make a warm bath with potassium permanganate, during which the child tries to urinate. If that doesn't work, the urine passes through the catheter.
The complication of phimosis grade 3 and 4 may be also the increase of the foreskin of the head. Usually first grows in this small area, then the area of the seam widens and, finally, the foreskin adheres to the glans penis in its entirety. In this case, attempts to open the head accompanied by sharp pain and bleeding. This condition is not an emergency, but to start it should not be. When the increase of the foreskin is only possible surgical treatment. But, as with a large plot of fusion of the intervention can be difficult, as soon as the problem is discovered, the easier it is to resolve.
In the treatment of phimosis can apply both conservative and surgical methods.
In hypertrophic phimosis, if there are no complications, possible conservative treatment, which consists in the gradual stretching of the foreskin. The manipulation can be performed by parents at home. Three times a week, while bathing with decoctions of herbs (succession, daisies) is the displacement of the foreskin until the child's pain, and then in the preputial space is introduced a few drops of paraffin sterile oil. The duration of treatment is several months. The procedure must be performed with great care to avoid paraphimosis. The success depends on the perseverance of the parents and the severity of phimosis.
In recent years, is used in the correction of phimosis hormonal ointments that was in the preputial space. Facilitate the stretch of the fabric. The treatment is carried out by parents under the mandatory supervision of a physician.
In atrophic (scar) phimosis, conservative treatment is not effective. In this case, surgical methods are used.
Indications of surgery are the paraphimosis expressed cicatricial changes prepuce, repeating the recurrence of balanoposthitis, a violation of urination.
The most rapid and effective treatment of phimosis - an operation called circumcision, or the circumcision. In this procedure, the foreskin is removed, which eliminates any exposure of the glans of the penis. This operation takes 10-15 minutes and is usually performed under General anesthesia. The foreskin is cut circularly (circles), with preservation of the frenulum. The interior and the exterior sheets of the foreskin are sewn together with catgut (suture materials, which do not require the removal of the sutures, as self-absorbed). After the surgery, a bandage with vaseline oil. After a few hours of the surgery, the child can walk, restored self urination. Circumcision is indicated for any degree of phimosis.
Contraindications for circumcision are balanoposthitis and paraphimosis.
Longitudinal cut of the foreskin
This operation is used when a full circumcision may not be possible. As a general rule, for its treatment with two types of complications of phimosis with acute balanoposthitis, and paraphimosis. In the first case, the longitudinal cut of the foreskin is to appeal due to the fact that the opening of the inflamed glans of penis can be circumcised, as the infection can lead to insolvency seams. Well, paraphimosis, when the circulatory failure acute does not allow a complete circumcision, a longitudinal incision of the foreskin is the only way to "break" the ring squeezing the glans of the penis.
By the way, in any case, after the acute period (that is to say, the worst is behind us), the doctor may recommend to perform a circumcision, which would have been not medicinal, and cosmetic value.
Development of phimosis is, in large part because of genetic predisposition, so drastic measures of prevention of this disease and medicine can offer. But we can speak of the prevention of complications of phimosis. Here, the first and main role is played by hygiene.
Children proper hygiene care limited daily bathing of child and washing once baby's dirty diaper or diapers. While bathing under the foreskin enters the water, which naturally flushes out your secret. At least once a week you should wash the penis and scrotum with soap and water. It is better to use baby soap or special baby bath facilities. We do not recommend daily use of antibacterial Soaps or gels. With frequent use that can disturb the balance of normal microbial environment necessary for a healthy skin.