Treatment of phimosis in men. Development and treatment of phimosis in men Phimosis of the foreskin treatment

The main problem of patients with phimosis remains pain when trying to expose the head in the erectile state of the penis. In some cases, it is completely impossible to open it, regardless of whether an erection is present or not. In addition, there may be problems with urination, as well as the accumulation of sperm in the pouch and the classic hygienic inconvenience associated with limiting the possibility of cleaning the head. When the condition is neglected, doctors also detect inflammation of the extreme epithelium and urethra. The above symptoms are typical for both men and women.

Species and types

Doctors distinguish 4 degrees of severity of phimosis:

• 1st degree. Problematic and painful exposure of the head of the penis in an excited state.
• 2nd degree. During an erection, the head does not open at all, there are difficulties in its withdrawal in the normal state.
• 3rd degree. The head can be partially exposed only in the non-erect state of the penis.
• 4th degree. The head is absolutely not exposed, in the process of urination the stream does not flow freely, but inflates the preputial sac, and then, in rare drops or a very thin stream, flows out of the scarlet slit of the end of the penis. As a rule, in this case, there is chronic inflammation due to the impossibility of removing the secret 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 problem, the vast majority occurs in children under three years of age. In fact, this phenomenon is an underdevelopment of the foreskin after the period of infancy: in the first year of life, in all male babies, the epithelium is practically closed and fits snugly against the head of the penis. After some time, it “opens”, therefore, until the age of three or four years, physiological phimosis can be considered a variation of the age norm, of course, if it does not cause severe inflammation, as well as pain during urination. By the age of five or six, this type of phimosis resolves 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 is significantly thinned and even completely atrophied.
• Cicatricial. Here, along with the classic phimosis, there is the formation of scars of various sizes on the edges of the foreskin.

Thus, physiological phimosis IS NOT a pathology in children under 5-6 years old and there is no need to treat him.

Causes

There are no absolutely clear and clear causes of phimosis in the stronger sex. The most likely include:

1. Congenital genetic problems, which are the initial factor of systemic insufficiency of the elastic element of the connective tissue in the human body.
2. Inflammatory processes like balanoposthitis, which often lead to cicatricial phimosis.
3. Physical injury to the penis, head or epithelium.
4. Diseases of the circulatory system.
5. Age-related changes (aging and "sclerosis" of the skin).

Complications of phimosis

Phimosis 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 backflow into the urinary canal.

The most dangerous consequence of phimosis is paraphimosis - a sharp infringement of the head of the penis, flesh. Paraphimosis usually occurs due to attempts to expose the head during intercourse or onanism. The foreskin at the same time blocks the blood flow of the end of the penis, which in turn leads to swelling of the organ, its blueness and other negative condition. If it is impossible to return the epithelium to its original state on its own, then an emergency surgical intervention will be required in the form of a longitudinal section of the epithelium or excision of its “leaves”.

Treatment of phimosis without surgery

In the vast majority of cases, it is rational to eliminate phimosis in an operative way, however, there are also non-operative methods, although they do not act immediately and in some cases do not have the proper effect.

Stretching of the foreskin

The main and fairly good method of non-operative disposal of phimosis. It consists in a periodic phased stretching of the foreskin. The easiest way is masturbation with the strongest retraction of the epithelium and the corresponding exposure of the head of the penis.

Gradual stretching must be done before the onset of a moderate pain syndrome and repeated in several approaches two to three times a day (10-15 minutes). In the process of expanding the passage, it is possible to increase the amplitude of translational movements, up to 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 an act of masturbation with maximum amplitude.

An alternative way to stretch is to insert two little fingers into the preputial sac and periodically spread them apart to stretch. This procedure is less traumatic than classical masturbation, but is less effective.

Medical treatment

The basis of drug therapy for phimosis is the application of corticosteroids in the form of ointments to the head of the penis - this type of drug gives elasticity to the epithelium, and also relieves inflammation and swelling.

The most effective ointment preparations for this task are considered to be clobetasol and betamethasone. They must be applied daily and once on the head of the penis, for two months. In this case, the method can be combined with the above-described stretching of the epithelium.

Treatment of phimosis with surgery

Surgery is still considered the most effective method of getting rid of phimosis. Surgical intervention usually consists in the formation of three zigzag-longitudinal incisions of the foreskin with their subsequent stitching.

When a more gentle method is used, based on the neutralization of adhesions at the head, using a special metal probe. However, if the foreskin is scarred, then a safer and more effective method would be to completely circumcise the epithelium in a circle. In rare cases, to preserve aesthetics, they use more expensive plastic surgery with preservation of the foreskin, however, in some cases, after this event, a recurrence of the problem may occur.

The effectiveness of surgical intervention for the treatment of phimosis approaches one hundred percent.

Postoperative period

Despite the high efficiency of surgical intervention, some doctors note the regular appearance of various complications in operated patients. Most often, these are small bleeding caused by not too accurate suturing, as well as meatitis and meatostenosis - the former are inflammation of the outer part of the urethra, while the latter are due to the narrowing of the canal of this component of the genitourinary system.

In order to avoid such problems in the first ten days, you must regularly take baths with potassium permanganate, use antibacterial creams approved by your doctor. In some cases, repeated surgery may be necessary, most often to eliminate defects in the appearance of the foreskin (plastic) or to restore the meatus - the correct contours of the urethra.

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Phimosis is a rather serious pathology characterized by a violation of the normal physiological structure of the male genital organ.

general information

Phimosis in men is a pathological condition in which it is not possible to fully expose the head of the penis. The disease is usually extremely painful.

This pathology necessarily requires treatment. Otherwise, the likelihood of developing an inflammatory process in the preputial sac and urinary retention in it increases. Phimosis in men adds a lot of problems to everyday and even intimate life. The inability to fully expose the head of the penis leads to loss of sexual desire, erectile dysfunction and the development of various kinds of infections.

What happens if phimosis is not treated?

Such a pathology can provoke many negative consequences. First of all, patients begin to develop inflammatory processes under the foreskin, provoked by stagnation of the secret. In addition, due to improper excretion of urine and its return to the urinary canal, infection of the urethra occurs.

The most dangerous complication of this condition is the so-called paraphimosis. This is a sharp infringement of the head of the organ. Such a pathology usually occurs as a result of repeated attempts to expose the head during direct sexual intercourse. In this case, the foreskin itself blocks the blood flow to the penis, which leads to its swelling and blueness. Independent attempts to return it to its normal state, as a rule, end in failure. In this kind of situation, emergency surgery is indispensable.

Why does phimosis develop in men?

The causes of this pathological condition are varied. These include the following:

• genetic predisposition. In the body of a man, there is a deficiency of the elastic element of the connective tissue.
• Mechanical damage to the penis.
• Inflammatory processes (balanoposthitis, syphilis).

Despite the fact that the causes of phimosis are very commonplace and, if they are eliminated in a timely manner, it is possible to avoid the development of the disease, specialists are still forced to diagnose it. The thing is that men do not tend to closely monitor their health, consult doctors as necessary.

Clinical manifestations

Disease classification

Depending on the degree of opening of the head, the following stages of the disease are distinguished:

• The first stage is characterized by slight difficulties in releasing the head of the penis during erection; in a calm state, such problems are not observed.
• The second stage is the inability to open the head in an excited state, even with effort.
• Third stage. Each attempt to pull back the foreskin results in bleeding and severe pain.
• The fourth stage is characterized by painful urination, as the head of the penis is completely covered by the skin.

There are also several subspecies of this pathology:

• Physiological. It occurs in children under three years of age. In fact, the disease implies the incomplete development of the foreskin. After some time (by 5-6 years) the head opens. If this does not happen, you should consult a specialist.
• Hypertrophic. In this case, there is a thickening of the epithelium of the foreskin and its protrusion beyond the head.
• atrophic. The foreskin initially thins out, and then completely atrophies.
• Cicatricial. On the edges of the foreskin, scars of various sizes are formed.

Establishing diagnosis

First of all, at the appointment, the doctor collects a complete medical history of the patient, listens to complaints. In addition, the specialist can ask a number of clarifying questions (when problems with urination appeared, were the symptoms preceded by mechanical damage, etc.).

Diagnosis of this pathology, as a rule, does not cause difficulties and is based on an external examination of the genital organ. The doctor also evaluates the degree of exposure of the head, the presence of pus under the foreskin. In some cases, an additional consultation with a surgeon may be required.

How to treat phimosis in men?

In most cases, this pathology can be eliminated only through surgical intervention. However, there are also conservative methods. One such treatment option is gradual stretching of the foreskin.

Consistent stretching is recommended until the onset of moderate pain and repeated several times a day for 10 minutes. In the process of direct expansion of the passage, it is possible to gradually increase the amplitude of translational movements until the head is completely exposed. For greater effectiveness, it is recommended to take a hot bath before the procedure.

Phimosis in men is sometimes treatable through drug therapy. It involves the application of ointments with corticosteroids to the head of the organ. Such drugs are aimed at improving the elasticity of the epithelium, reducing inflammation and swelling. Among these funds, the drugs "Betamethasone" and "Clobetasol" have proven themselves to be excellent. They should be rubbed into the head of the organ daily for two months.

Surgery

How else can you overcome phimosis in men? Treatment through surgery is considered the most effective option for getting rid of such a pathology. The operation usually involves the formation of three zigzag incisions of the foreskin with their subsequent stitching. According to experts, such treatment in almost 100 percent of cases allows you to achieve the desired results.

Postoperative period

Despite the rather high efficiency of surgical treatment, many doctors note the occurrence of various complications in individual patients. Most often, there are minor bleeding caused by inaccurate suturing, as well as meatitis (inflammatory processes in the outer part of the urethra).

How to prevent the development of such complications in patients diagnosed with phimosis? In men after surgery, such problems can be avoided if all recommendations from the doctor are strictly followed. It is necessary to take baths with potassium permanganate, use special antibacterial creams. In some cases, additional surgery may be required to correct defects in the appearance of the foreskin and restore the correct contours of the urethra.

Conclusion

In this article, we talked about what constitutes such a pathology as phimosis in men. The operation, the price of which can vary from 15 to 25 thousand rubles, is the most effective method of treatment. When primary symptoms appear, a visit to the doctor should not be postponed. It is better to cure this disease at an early stage and not think about its consequences. Be healthy!

Diagnosis - phimosis, what to do? Diagnosed - phimosis of the penis, how this disease manifests itself, it is worth talking about and understanding. Men have a system in the body that may not be laid correctly - this is the genitourinary system, namely, violations of the external genital organs. So phimosis is a kind of defect according to some signs. Phimosis is the narrowing of the ring of the foreskin, which, in turn, contributes to untimely or difficult removal of the head of the penis beyond the so-called "skin" of the penis. The foreskin in the medical literature is also called the preputial sac. In pathology - phimosis - inside the preputial sac, a sexual glandular secret (smegma) accumulates, this secret should not be confused with sperm, since the purpose of these secrets is completely different. On the head of the penis, men have glands that produce a whitish fluid that cannot be fully excreted with phimosis. With the accumulation of a secret in the sinuses of the foreskin, the smegma thickens and encrusts with salts, and if a urinary tract infection joins this condition, which happens quite often, in such cases an extensive inflammatory process occurs.

Phimosis of the penis appeared - this indicates that this manifestation of the disease can have a different character: both congenital and acquired. Phimosis with which a boy is born manifests itself - narrowing the opening of the foreskin, or it is also called physiological phimosis (phimosis of the year) or another literary name - congenital phimosis. Acquired phimosis may develop over the years. As practice shows, it is formed as a result of chronic diseases of the hollow organ, extensive swelling of the head or infiltration of the penis, the presence of penis injuries, and do not forget that cicatricial changes help to reduce the ring of the foreskin and prevent the head of the male penis from being exposed in full. Incomplete phimosis of the foreskin is a condition that is manifested by a tight narrowing of the skin around the glans penis, but it can be moved, with great difficulty and severe discomfort. This course of the disease is characterized by several initial stages:

1st stage. The skin flap can be freely moved from the tip of the penis, but only in an unexcited state, during an erection it is impossible to do this because of the sharp pain.

2nd stage. At rest (i.e., in a relaxed state), it is quite difficult and uncomfortable to open the head, and during a period of excitement or a rush of blood it is completely impossible.

With phimosis, the glans penis is not completely removed from the skin flap, which makes it difficult to release the sexual secretion beyond the foreskin and can subsequently lead to an unpleasant odor, itching, discomfort, and an inflammatory reaction. In boys, incomplete phimosis is considered the age norm up to three years of life, if by these years the disease does not resolve itself, then pediatricians recommend contacting a specialist to determine further tactics for managing such patients. Physiologically, the opening of the glans begins at two months of age, and by the age of seven, the head of the penis is completely removed. And why does incomplete phimosis develop at an older age? from a medical point of view, the prerequisites for phimosis in adult men can occur as early as childhood; Genetic predisposition plays an important role. Infection of the genital tract leads to scarring of the tissue, which can subsequently cause cicatricial phimosis. Incomplete phimosis of the foreskin is not a fatal disease, but it significantly reduces the standard of living of a man, because of discomfort, sexual life can be disturbed, which will lead to psychological disorders and complexes, due to the structural features of the organ.

Phimosis disease ICD-10. There is a classification recognized throughout the world, which has been revised several times and is constantly being supplemented - this is ICD 10. This classification contains all epidemic diseases, constitutional and general in their anatomical location, all injuries, diseases that develop with intrauterine development and its defects . Diseases are described in detail and systematized. To study the pathology, you need to know which system this disease belongs to and what nomenclature number it has. Phimosis refers and is encrypted in a large group - diseases of the genitourinary system, diseases of the male genital organs. In the classification, it is under the number N47 - excess foreskin, phimosis and paraphimosis (tightly fitting foreskin).

Code phimosis growing member. With the onset of puberty and age-related changes in a man, the disease takes on a different character and can be complicated by a number of unpleasant diseases. Depending on the classification code, ICD-10 contains complete information about the possible aggravation of the situation and the severity of the course.

How to remove phimosis of the glans penis? Depending on the age and severity, it is possible to determine the treatment technique in different ways.

It should be noted that phimosis can be treated without surgical methods of treatment. The easiest way is the conservative method. It is simple enough for any man: gradual manual stretching of the foreskin is recommended, using soap or ointments, gels. It is possible to use special devices and tools that help stretch the tissues on the head.

Drug treatment is often used with the use of steroid ointments. If the severity is high and the disease itself is running, it is possible to resort to more radical methods of treatment - surgery, laser excision.

In addition, we apply the method of tension, exposing the glans penis with the help of masturbation, however, it is worth considering that it is not worth bringing to pain, this manipulation must be done daily and gradually increase the procedure time to 15 minutes. Stretching, as a method of eliminating the problem, is used in the shower while bathing, with this method it can be brought to slight pain. You can also resort to more radical methods through surgical manipulations.

What does phimosis look like, video?

Disease - phimosis, reviews. On the Internet, you can find a lot of information on this topic and, as life practice shows, many men have had or have this problem. However, it is surprising that the topic of the urological profile is also relevant today, although medicine has stepped far ahead. If you carefully approach this issue, you can see the following pattern: the problem concerns not only men, but also women, since many have sons. The problem of phimosis is a problem of any age, more often, of course, children get sick before puberty. One of the main questions that women ask is whether phimosis interferes with the forum and the majority believe that this disease reduces the standard of living in couples due to lack of sexual intimacy or, in other words, reduces the level of self-esteem in a man, which will subsequently lead to the formation of complexes and psycho-emotional disorders. As for childhood, it brings discomfort and pain.

The reasons for the development of phimosis as a separate disease can be quite diverse. If the disease did not develop in infancy, it does not mean at all that the disease cannot occur in adulthood. This pathology is observed in men in all age categories. Most often, congenital phimosis is manifested in men, such a process will not be eliminated by itself. Pathological phimosis can be formed as a result of self-intervention in order to correct physiological phimosis. If you act on the pathology mechanically, then the mucous membranes of the penis and the sac fuse and adhesions form, which will ultimately lead to a narrowing of the cavity and the development of secondary phimosis.

Phimosis - causes. Probably the main reason for the onset of the disease, both in infancy and in adulthood, is insufficient care for the organs of the male reproductive system, the consequences of poor-quality hygiene measures and, as a result, fusion of the foreskin. With insufficient hygiene measures in the foreskin, inflammatory processes (balanitis, balanoposthitis) can occur and lead to a decrease in the skin ring.

The next important reason is genetic predisposition factors: the skin flap in men can be malelastic, which subsequently leads to a mechanical narrowing of the preputial sac. It should be borne in mind that trauma to the penis also increases the risk of developing phimosis.

Phimosis is the cause of diseases of various etiologies, such as balanoposthitis, thrush and other sexually transmitted diseases. Also, pathology manifests itself as a congenital defect with associated problems in general.

Can phimosis cause infertility? Today, medicine does not stand still, and scientists have long proven that phimosis and male reproductive health are not at all related. But complications of phimosis can still cause problems with reproductive function in men.

If the problem is not eliminated in a timely manner, the disease can provoke a number of side effects:

• Erectile disfunction;
• Balanoposthitis or balanitis;
• paraphimosis;

Infertility in phimosis is most often psychosomatic in nature. Men with this condition avoid sexual contact due to discomfort, pain and unaesthetic appearance.

Treatment of phimosis directly depends on the causes. In most cases, phimosis is treated surgically, but there are also conservative methods of treatment. The narrowing of the cavity of the preputial sac can be stretched using mechanical action, this method consists in the gradual stretching of the foreskin, masturbation with the maximum retraction of the epithelium. Inflammatory processes that lead to phimosis can be treated with medical therapy, with the use of corticosteroid ointments to reduce edematous and inflammatory symptoms. Protracted forms of phimosis are treated with the help of surgery.

Symptoms

Phimosis symptoms treatment. The clinical picture with phimosis is not as bright and extensive as with other diseases of the genitourinary system, but signs of phimosis can be seen visually. In solving the actual question “how to know if phimosis is or not?” complaints and the first external changes in the head of the penis are important. Parents and adult men should pay more attention to hygiene procedures of the genital organs (this disease is manifested in part due to improper care and insufficient hygiene), paying attention to their external changes. It is worth telling the child about the correct removal and care of the organ. Depending on the severity of the fusion of the foreskin or the narrowing of the prepuntal sac, different variations of phimosis (congenital or acquired) can be distinguished. Many experts are sure that physiological (congenital) phimosis occurs in boys under the age of seven, but so far urologists have not come to a consensus on this matter, while doctors recommend that mothers begin to remove the head of the penis on their own at the age of three. To date, scientists believe that closer to the age of 7, the glans penis should be completely removed, if this does not happen, it is worth contacting a urologist for quality medical care. If you understand the etiology of phimosis in adulthood, then phimosis can persist from childhood, and do not bother until puberty, develop slowly, in accordance with age and sexual function. During puberty, the organs are characterized by intensive growth: an increase in size, often during this period of time there is an uneven development of the penis and foreskin, which fits snugly against the head of the penis. In such situations, the problem lies in the fact that the foreskin is much smaller than the head itself, due to this, difficulties occur in its further rolling out. As for adolescents who have reached puberty, phimosis can manifest itself much more often, this is determined by more frequent erections, masturbation and violent sex life. With a physiological erection, the head increases, and the foreskin is stretched, and due to this, microcracks can occur on the skin, which subsequently leads to scarring of the tissue and an extensive adhesive process. One of the first manifestations of the problem at any age is pain when the glans penis is removed from the foreskin during intercourse (in the erectile state of the penis). In the future, with a deterioration in the condition, the foreskin may not open at all, and then difficulties arise with its removal at rest. The next feature of the lesion is difficulty urinating, urine is excreted in small portions with concomitant pains in the urinary canal, and its remnants accumulate in the foreskin sac, the urine stream can be very small, and sometimes it comes to excretion in drops. Due to the fact that the secret and the remains of urine are collected in the cavity of the penis, a serious inflammatory process may soon mature. Another striking manifestation of the disease is severe pain with phimosis in the foreskin and glans penis. The very head of the penis becomes edematous, hyperemic and very hot, these are manifestations of the inflammatory process. The pain component intensifies with the excitation of the penis and increases sensitivity when the penis increases in size, and the foreskin is pulled over the head.

The temperature during phimosis can manifest itself as a result of an inflammatory reaction in the body, this is a normal reaction of the body to the ingress of foreign microflora, in which case the disease has a protracted stormy character, which will subsequently cause complications from the urinary system: cystitis, pyelonephritis and other, not the most pleasant diseases . Also, temperature can be one of the first symptoms of swollen lymph nodes due to inflammation.

Phimosis, the patient complains after some time, when the process is strongly launched. As with all diseases and pathologies, the intensity of the entire symptomatic picture will increase and increase not immediately, but gradually. Patients will complain of sharp severe pain that increases when touching the head, pain and discomfort when walking or mechanical pressure. The patient notes a change in the appearance of the penis (resembles a proboscis), the foreskin swells and thereby squeezes the head of the penis, soreness manifests itself even at rest.

Phimosis differs from paraphimosis very slightly. Paraphimosis is a greater infringement of the head by the ring of the foreskin. The whole point lies in the severity of the flow, in paraphimosis, in frequent cases, tissue necrosis may occur due to mechanical compression of the tissues due to dense edema.

The macropicture of phimosis manifests itself quite extensively and well, so the disease is difficult to confuse with another pathology, sometimes the manifestation of the disease can be observed only in certain cases and under certain circumstances. In these cases, there is a decrease in erectile function in a man due to discomfort and pain. All these factors affect the subconscious reactions of a man in the course of the disease.

The psychosomatics of phimosis in adult men to a greater extent lies in the fact that they focus on the problem, which is definitely not worth doing, since this can lead to psychological problems.

If we talk about young men, in this situation the child's behavior model depends on the mother, who helps her boy cope with the disease or, on the contrary, makes fun of his problems. It is much more difficult for doctors to cope with the psychological problems of sick people than with physical ones.

How to open phimosis without consequences for a man's health? All manipulations should be carried out in a relaxed manner, there are a sufficient number of methods for opening spliced ​​tissues, but this will be discussed below.

Diagnostics

Diagnosis of phimosis is carried out according to the standard scheme, as well as other diseases of the urinary system, but it should also be borne in mind that it would be useful to check the reproductive function of the body during the disease itself. As you know, the disease does not proceed in a latent form, when the process is considered to be running, experts recommend conducting both instrumental and laboratory research methods.

Phimosis diagnosis is carried out in a set of measures aimed at identifying and eliminating the problem. To begin with, the diagnosis of the disease is best done with a survey of the patient, collecting a detailed history will allow the doctor not only to establish the cause, but also to determine at what age this problem is disturbing. It is also worth establishing at what stage (namely, at what age period) this situation worsened. Do not forget that there is a congenital form, which, until a certain age, men almost do not manifest themselves and most often do not pay attention to it. Genetic predisposition to the disease plays an important role in the further course of the pathological process. Talking with the patient, the doctor has the opportunity to fully ask about the clinical picture of the disease, to collect a complete list of complaints that bother the patient. A visual examination of the problematic organ is carried out exclusively by a narrow specialist who can objectively assess the nature of the pathology and correctly indicate the diagnosis with further prescription of treatment regimens. An examination of the genital organs is more necessary to detail the neglect of the process, if the head of the penis is not removed from the foreskin at all, then it is worth thinking about the correct treatment tactics. But there are cases when it is possible to withdraw, but there is no way to enter back, then it should be said that the process was complicated by another pathology, which will be discussed below. But one examination is not enough to make a final diagnosis, it is necessary to conduct a full range of laboratory examinations.

Tests for phimosis can determine the presence of an infection or assess the degree of the inflammatory process. Perhaps the most informative method for diagnosing phimosis is a urinalysis. In a clinical analysis of urine, the doctor can see an increase in total protein, an increase in leukocytes and the detection of a small amount of mucus, which will indicate a general inflammatory process. Urine with phimosis will not change much, no pathological impurities will be found in it. It is also recommended to take a blood test to determine inflammatory processes, and discharge from the penis for further diagnosis of the picture of the disease and the type of infectious process. In extreme cases, it is recommended to conduct an ultrasound examination of the urinary organs in order to determine pathological changes.

Bacteria in phimosis in infants indicate that the process is complicated by an infectious component, but this process can be considered physiological due to the anatomical structure of the genital organs in newborns. Up to seven years, this disease is not treatable and is considered a normal process, this condition should only be observed by a specialist, to monitor the dynamics of the process. Do not panic and run to the doctors, asking the question: "What to do and how to treat?".

Phimosis and blood in the urine, forum. Mothers are increasingly asking the question of whether red blood cells can be detected in a urine test. According to observations, scientists came to the conclusion that blood appears in the urine only in cases where the upper urinary system is involved in pathologies such as cystitis, glomerulonephritis, in rare cases - with pyelonephritis, and never - with phimosis.

How to determine phimosis in boys? Often, parents are faced with this problem at an early age of the child, but not everyone knows what to do and how to behave. All newborns have physiological phimosis of the penis. The head of the penis is tightly closed by the foreskin, in order to protect it from external damage, an attempt to open it will cause discomfort and a painful reaction in the child. The duplication of the skin tightly adheres to the structure, which makes it impossible to remove the head ahead of time. This process is considered physiological and occurs in most boys before puberty. This condition will resolve itself before the age of seven, the task of parents is to carry out a hygienic toilet of the genital organs every day, wash the perineum and genitals with soap and water. Stratification of the mucous membrane and the inner layer of the skin occurs slowly and gradually, mechanical damage can form scars and adhesions.

Phimosis, differential diagnosis of the disease is carried out to exclude adverse effects. With prolonged stagnation of the secretion, carcinogenic substances can accumulate in the skin cavity, which can provoke oncological diseases in men. Phimosis can be complicated by a number of diseases, even in cases where it is not manifested by any unpleasant symptoms. Doctors recommend diagnosing paraphimosis, balanoposthitis, malignant tumors and other infectious and inflammatory diseases.

Balanoposthitis and phimosis, differential diagnosis in a child. These two diseases, which can be combined with each other, since physiological phimosis is inherent in all young boys. And, as you know, the disease itself is manifested by the inability to remove the head from the cavity of the foreskin, which subsequently leads to infection and inflammation of the prepuntal sac (balanoposthitis). Even with good hygiene of the external genitalia, microorganisms still get on the foreskin and head and cause inflammation.

stages

How to determine the stage of phimosis? The staging of the process is determined by the symptom complex of the clinical picture of the disease, by the appearance of the organ, laboratory tests are also important, which the patient is recommended to do during the illness. With the progression of the phimosis process, this is often associated with the ingress and development of an infectious process on the genitals. To date, only four stages of the development of the disease have been described in the literature, each stage is a specific type of phimosis. All four stages directly depend on each other, one follows from the other, taking into account the severity of the clinical picture and the neglect of the process itself.

The first stage of phimosis is an asymptomatic course of the disease, no manifestations can be seen, there will also be no external changes in the organ. A man can only experience discomfort during sexual intercourse, when the head of the penis increases in size, and the foreskin remains unchanged, as a result of which the tight removal of the head brings discomfort. Physiological phimosis, which did not resolve itself in childhood, can also be attributed here, to the first stage. Phimosis from one year to seven is considered physiological.

Stage I phimosis does not need correction, or any treatment method. As evidenced by the medical literature, it will pass on its own.

The next stage is characterized by visible changes that can alert a man. During sexual arousal, the foreskin almost does not allow the head to be exposed, which leads to slight pain, but when the patient is at rest, the narrowed foreskin also does not let the head go up. At this stage, conservative treatment will be sufficient.

Stage III is the most difficult, since at this stage a man feels severe pain during an erection, the appearance of the organ changes. The patient urinates extremely rarely, with pain and discomfort. Sexual life becomes impossible due to fear and panic, the psyche suffers, and the man begins to feel inferior. An unpleasant odor, itching and burning may join the pain, due to the fact that the secret (sebum) and urine accumulate due to insufficient hygiene procedures. This process can be complicated by a number of other pathologies due to inadequate care.

Stage IV phimosis develops more often in those men who are not able to assess their condition on their own or are embarrassed to talk about it. Stage IV phimosis is manifested by sharp pains when the head is exposed, urination at this stage will be difficult, although urine will be excreted, but in meager portions or completely drip, most will accumulate in the cavity, thereby filling the preputial sac. Scientists compare this stage with the “elephant trunk”. The process can quickly regress and worsen, it is necessary to act quickly and decisively. Such a process can turn into cancer of the genital organ. . This is what the stages of phimosis look like, photo.

Forms of phimosis are very different, they depend on the anatomical structure of the genital organs and the foreskin itself. In all boys under the age of seven, phimosis is physiological. All other forms are pathological forms of the disease and are regarded, to a greater extent, as acquired, due to a number of reasons.

The following form can be attributed to hypertrophic phimosis (the case when there is a lot of foreskin and it is quite loose). This form is associated with an anatomical feature of the structure of the foreskin or obesity, in which the skin epithelium thickens.

Atrophic phimosis - in this form, everything happens the other way around - the tissue is significantly thinner, or completely absent. The cicatricial form is formed during mechanical damage with a predominance of adhesions.

Degrees

The degree of phimosis in boys most often depends on the narrowing of the foreskin; the more neglected the process, the more the foreskin grows to the head of the penis and does not allow it to be brought out.

The fourth stage is the most neglected, and the only treatment option is surgical, at this stage a sufficient number of severe complications occur.

So, there are only four stages of the severity of the disease. The first stage means the physiological course of phimosis, so to speak, a very slight change, which will subsequently resolve itself. Only close observation of the status change is recommended.

The second stage is regarded as mild, where changes are not always visible, but the manifestations of the disease are more symptomatic. This stage requires specialist supervision and conservative treatment.

The third stage is manifested by a symptom complex and external changes in the penis, the clinical picture is of moderate severity.

And the fourth stage is the most neglected, where changes will have serious complications. This is a severe form of the disease, which can only be treated surgically by excising the foreskin completely.

The degrees of phimosis (photo) are set only for pathological phimosis, if a child was diagnosed with phimosis at an early age, then such phimosis (physiological) will not be divided into degrees.

By what criteria are the degrees of phimosis divided? Scientists divide by anatomical structures, below is an analysis of the degrees of phimosis in terms of anatomy.

Phimosis I degree (photo). This degree is characterized by minor changes that men most often do not pay any attention to. With this type, almost physiological, you can freely remove the glans penis not in an erectile state, but in a state of arousal it is much more difficult to do this, this sign can alert a man a little. Phimosis of the first degree does not pose a threat to life, but its presence can significantly reduce the quality of a man's sexual life. At the very beginning of the disease, pain will occur only at the time of sexual intercourse, or the state of excitation of the penis, which in the future can significantly affect relationships with the fair sex. Even at the first initial stage, the process can turn into serious complications, such as paraphimosis or balanoposthitis.

Treatment at home phimosis I degree does not take much time and effort. In modern medicine, there are many methods of influencing a mild form of the disease, along with surgical procedures, one can also turn to conservative methods. Men are recommended to mechanically stretch the foreskin every day, remove the head on their own to discomfort, you can use various dilators for this manipulation, you can use lubricants or ointments to soften the skin. You can also use baths with a decoction of the string. Phimosis of the first degree, photo.

Phimosis II degree, photo. Further, the condition will only worsen, the symptoms will increase, the removal process will be difficult in any condition, and you will not be able to remove the head completely without pain. During sexual intercourse, semen may not come out at all, and if you want to go to the toilet, urination will be difficult. These manifestations will disturb men much more often, pain will arise, and not only during arousal, but also during physiological bowel movements.

phimosis II degree treatment. At this stage, you can still try to resort to conservative methods of treatment with stretching. Steroid ointments will help soften and stretch the tissue of the foreskin. III degree of the process is more advanced than the previous one, the head of the penis does not open at all and does not come out from under the edge of the foreskin, it is completely impossible to remove it, the pain is sharp and strong. Patients experience discomfort with any mechanical irritation. Urination in this type is almost impossible, or urine is excreted in small portions. The pain will be strong and sharp. At the time of sexual intercourse or strong arousal, spotting can be observed, so experts do not recommend having sex during the period of diagnosis and diagnosis. Sexual life can injure the skin and mucous membrane of the foreskin and form deep scars or necrosis.

phimosis III degree treatment should not be carried out at home and, moreover, on your own. This is the form that can lead to complex consequences and complications. With this degree, it is urologists who will help to avoid trauma and infectious and inflammatory complications. Surgical care consists in partial or incomplete excision of the foreskin. With phimosis of the III degree, and even complicated by acute forms, only a longitudinal dissection of the foreskin is carried out.

Phimosis IV degree (photo). The problem is not only that sexual function is difficult, but also physiologically impossible, due to obturation of the lumen of the foreskin due to infection. Urine will accumulate in the bag and only after some time will begin to separate in partial small portions, or drip, while the discomfort will increase, and the pain will become sharp and pulsating. Such an organ will look swollen and inflamed, doctors still compare it with an “elephant proboscis”.

Treatment consists in excising the entire sac completely (such an operation is called circumcision) in order to reduce the risk of infringement of the glans penis or the occurrence of inflammatory diseases. Probably the most effective method of treatment is surgical, although many experts do not immediately recommend resorting to such radical methods, but still, in order to save the organ and prevent complications, everything must be done in a timely manner. Do not run your health, contact the specialists in time. Be healthy! Phimosis degree, photo

Classification

Phimosis - classification.

If you pay attention to the degree and stage of development of the pathology, then you can distinguish a sufficient number of varieties of phimosis: according to the degree of occurrence of the pathology (its nature), according to the mechanism of damage to the organ itself, according to the severity of the course of the disease, according to the anatomical nature and structure of the foreskin, according to the rudiments of intrauterine development , as well as the structure of the altered tissue around the glans penis. There is even a separate subgroup of consequences associated with phimosis, as complications.

The disease can be primary, such a pathology is more common in newborns (it is considered to be a congenital pathology). This condition is considered physiological, since the fusion of the foreskin in newborns protects the structures of the organ from the ingress of unfavorable microflora and the development of inflammatory and infectious problems in the future. Since it is not possible to establish the cause of the onset of diseases in infancy, this condition is considered normal. The main reason that contributes to the development of such phimosis, experts tend to consider true synechia (embryonic adhesions), which appear even during fetal development to reduce trauma to the head of the penis. Such a disease does not go away on its own immediately, but closer to school age. When the physiological contractions expand, the skin becomes elastic and the boy can painlessly remove the glans penis on his own. But we must try to do this from the age of three, gradually developing the foreskin.

Secondary phimosis occurs at an older age when a number of reasons arise, such phimosis is called acquired. It occurs as a result of long-term or chronic infectious and inflammatory diseases, frequent injuries of the genital organ; genetic predisposition also plays an important role. Mechanical damage leads to the appearance of scars and adhesions, which will further lead to a narrowing of the foreskin. Depending on the cause, the process is divided into physiological and pathological. The physiological type of phimosis is a condition that normally occurs in infants and children of the first years of life, does not require treatment at an early stage, only if the process takes a long time, experts recommend that the child undergo a consultation with a urologist every six months, apply medical ointments , allowing to soften and stretch the tissue around the head.

In childhood, partial phimosis can also form, which may not bother during life, it manifests itself by incomplete removal of the head from the preputial sac. With this type of phimosis, there will be no clinical symptoms, this condition does not cause discomfort, up to a certain stage, and does not affect the life of a man. The pathological type of phimosis is formed a little later and is eliminated exclusively with the help of long-term conservative and drug treatment, and there are cases when these methods do not help, doctors recommend using surgical procedures. Types of phimosis photo.

Types of phimosis in boys are classified according to the violation of the technique of exposing the head of the penis. In young men, a narrowing of the tip of the bag is often observed, which makes it difficult to remove the head, this condition is considered physiological. In childhood and preschool age, fusion of the inner sheets of the sac and head can be observed, such phimosis is called false phimosis. In order to prevent the appearance of phimosis at different intervals of life, you should be attentive to the personal hygiene of the external genitalia, visit a specialist doctor, consult in a timely manner and not neglect your health. The reasons that contribute to the formation of various types of diseases are partly the genetic predisposition of the male body, partly arise due to infectious diseases of a latent nature, early injuries of the penis. Neglecting one's health is fraught with dire consequences; if you do not carry out the necessary personal hygiene measures, acute phimosis may develop.

Purulent phimosis occurs as a result of a neglected course of the disease, when unfavorable microflora or infections associated with the organs of the reproductive system join. Often purulent inflammation is caused by fungi of the genus Candida. Such a disease manifests itself with an unpleasant odor, yellow-green discharge, itching, and an increase in local and local temperature. This process is joined by hyperemia of the organ, pain on palpation, severe (bluish) edema.

There are cases when men complain of repeated phimosis, experts often associate its occurrence with an untimely operation, when adhesions grow deep into the tissue, and the operation for incomplete excision of the foreskin is not extensive enough. The operation should be carried out by complete excision (circular) of the foreskin, then the disease will not be able to recur. Recurrent phimosis can also occur in preschool children. It would seem that the specialist helped to bring the head of the penis beyond the foreskin, the mother did all the necessary hygiene procedures, took regular baths, applied ointments, followed all the instructions of the attending physician, but, alas, the problem returned again. It depends on the anatomical structure of the organ, on the physiological features of the structure of the foreskin and the organs themselves as a whole. At an older age, when this problem will cause discomfort in a man, urologists will offer him to get rid of phimosis once and for all with the help of a circular excision of the foreskin (the operation is called circumcision).

Physiological phimosis

Physiological phimosis in children. The genital organs and the reproductive system of a man are of great importance, no less than the female reproductive system, primarily for the reason that it ensures the reproductive function. In men, the genital organs are closely connected with the urinary organs, which are necessary for the normal functioning of the whole organism as a whole. There are cases when men have their own structural features of the genital organs, which leads to the formation of physiological phimosis. Photo of physiological phimosis.

Physiological phimosis in infants is due to a genetic predisposition and the physiological characteristics of the structure of the genital organs. At birth, in males, the head of the penis is tightly covered by the foreskin. The foreskin begins to develop from the coronal sulcus, which forms the preputial cavity (pouch). In a normal state, the cavity should be easily retracted and expose the head of the penis. At the very beginning, the foreskin is represented by a duplication of the skin, it has two sheets, and they are fused at birth. The inner leaf of the foreskin fuses in the posterior area with the tissue of the head and forms the frenulum of the foreskin. All these structures are of great functional importance - they cover the urethra, protecting it from the penetration of pathogenic microorganisms, the skin protects against mechanical damage and irritation, while maintaining sensitivity, and takes part in the production of secretions (smegma).

Mothers often ask the question: physiological phimosis lasts until what age? It should be noted that in children at birth, non-disclosure of the foreskin is a physiological process. The lack of removal of the head in infants is not associated with pathological narrowing of the skin, but with its own physiological characteristics. Therefore, urologists do not recommend forcibly removing the head, thereby mechanically injuring the tissues - this is hello to the appearance of erosion. If the child is not bothered by anything, the child urinates on his own without pain, the skin is of normal color, there are no visible changes, then you should not interfere. It is only required to perform daily care of the genitals, wash with soap and water under running water and, as far as possible, gently remove the head and preputial sac. Self-excretion of the head occurs closer to preschool age, this process is gradual, separation occurs due to desquamation of the epithelium and stretching of the skin of the foreskin. In modern medicine, cases are described when, even before the age of 14, phimosis is considered physiological, but it is more generally accepted that before the age when the boy begins to grow up and enters puberty, physiological phimosis should pass, and the head should be removed completely. A large number of classifications for this disease are described in the world literature, but the most complete picture of this disease can be seen in the description included in the international classification with a diagnosis of physiological phimosis ICD-10. Enlarged foreskin, phimosis of the glans penis, and a number of complications, such as paraphimosis, all belong to the same group of diseases and are coded under one nomenclature number in the genitourinary system section and assigned the number N47.

Phimosis, a physiological code according to ICD 10, is used from the point of view of practical medicine for the differential diagnosis of a diagnosis among all diseases of this section, to determine the pathogenesis and determine the etiology of the disease, to further determine the treatment regimen. Turning to the ICD classification, the specialist receives complete information about the disease and the further development of complications due to this pathology. Physiological phimosis in boys, photo.

Physiological phimosis, Komarovsky - there are many statements by Dr. Komarovsky on the issue of physiological phimosis. So, he argued that all these problems are connected for the most part with physiology. Physiological phimosis is a normal, natural process - the inability to bare the head before puberty, all boys go through this. According to Dr. Komarovsky, phimosis up to 15 years old is considered the norm (this period lasts until the very process of puberty). Physiological phimosis in boys, Komarovsky video

Pathological phimosis

Pathological phimosis in boys, photo.

If a problem with the penis occurs after puberty, if the glans penis is not completely exposed or the foreskin is tight to the glans penis and causes discomfort during removal, then such phimosis is called pathological. The reasons for the formation of such a process are often external factors: infectious problems and diseases, injuries of the genital organs due to previous diseases, such as balanoposthitis or balanitis. Another important reason for the occurrence of pathological phimosis is the neglect of the rules of personal hygiene. Pathological phimosis can change in tissues and cause such varieties of the disease as hypertrophic, atrophic phimosis. This species is characterized by the growth of the foreskin and thickening in the region of the prepuce. There is a hanging of the foreskin from the penis, this type of organ resembles an "elephant's trunk", there is a narrowing down, which does not allow the head to be removed. Atrophic phimosis is manifested by thinning of the skin in all layers, the skin becomes flabby, dry and thin, pale in color. The ring of the foreskin looks shortened and fits snugly to the head; mechanical removal with this form is not recommended at all, since adjacent tissues can be injured. For this reason, in the medical literature it is also called cicatricial. The problem may arise from physiological phimosis if the parents did not pay attention to the problem in time or did not follow the necessary hygiene measures, if they were careless with the foreskin when bathing. Pathological phimosis in any of its manifestations requires an individual approach to treatment, regardless of the severity and mechanism of formation. Drug therapy should be carried out immediately, if therapy does not help, you need to resort to a conservative method, and in extreme cases, a radical method of surgery is necessary - complete excision of the foreskin.

Congenital and acquired phimosis

Phimosis is a common disease of the male genital organs that occurs in men at different periods of life, it may even be a congenital pathology - this is due to the fact that the glans penis and the foreskin during their intrauterine development are formed from one germ. The development of the reproductive system itself continues until the period of puberty, so congenital phimosis in boys (photo) appears in most newborns. After one year of life in boys, the head does not open completely, it is necessary to carry out proper care for the external genitalia, hygiene measures contribute to the prevention of the disease. As a rule, congenital physiological phimosis regresses at preschool age.

The foreskin in the neonatal period protects the sensitive head from mechanical damage, as it is dense and not sufficiently stretched, fits snugly to the head and does not allow the head to be removed from the bag. At an older age, closer to puberty, due to an increased level of sex hormones, the foreskin stretches and softens, due to involuntary erection, the foreskin shifts and its displacement occurs, which allows the head of the penis to be completely removed. If the head of the penis is not completely exposed during puberty, such phimosis is called pathological, acquired phimosis. Factors in the formation of the disease can be considered insufficient hygiene, carelessness in washing the child's genitals, genetic disorders, injuries, inflammatory diseases. It is possible to establish a diagnosis - acquired phimosis - only after 13 - 14 years of life with the help of instrumental studies. And the treatment for such a pathology will be more radical and extensive.

Hypertrophic phimosis

There are a large number of types of phimosis, due to different types of disease, treatment tactics vary, and the method of getting rid of it will be chosen individually.

Hypertrophic phimosis in boys (photo) - this form of the disease is more typical for young boys with a large body weight. Obesity in principle entails a large number of health problems. The reason for the development of hypertrophic phimosis can be considered a large deposition of adipose tissue in the region of the preputial sac, as a result of which the penis increases significantly in size, the foreskin becomes dense and tight. This type of phimosis is described in the medical literature as proboscis. This situation favorably affects the development of the infectious and inflammatory process due to the accumulation of excess moisture in the secretion. When trying to expose the head of the penis, the child experiences pain and discomfort, can get a wound surface, subsequently scars and adhesions form at this place.

Hypertrophic phimosis in boys, treatment. If you consult a doctor in a timely manner, the problem can be cured conservatively and with medication. At the present stage, there are a sufficient number of methods to eliminate hypertrophic phimosis. Doctors do not recommend everyone to resort to such methods of treatment, the methods are selected individually.

The method of tension is daily attempts to stretch the foreskin and expose the head. This method is used at an early stage of the development of the disease, before the severe pain that boys experience. Along with the first method, corticosteroid ointments can be used to increase the elasticity and stretch the bag. Ointments based on hormonal drugs will reduce the risk of inflammation. But conservative treatment is not always successful, so experts recommend surgical methods of treatment - stretching with certain instruments, excision of the inner sheets of the preputial sac, plastic surgery of the foreskin, laser correction, full or partial. Each method is selected individually, depending on the type and severity of the disease. The disease is not critical and has a favorable outcome, especially if the patient seeks help from a specialist in a timely manner and receives quality medical care. Photo of hypertrophic phimosis.

Atrophic (cicatricial) phimosis

Under cicatricial phimosis is meant a disease associated with thinning of the foreskin due to a decrease in skin elasticity due to the appearance of scars and adhesions. It looks like whitish areas, coarser than the surrounding tissues, it is a kind of dying tissue, they do not have elastic fibers and therefore cannot be stretched, which is why phimosis is manifested by the inability to remove the glans penis from the foreskin cavity. Atrophic phimosis appears as a result of trauma, an attempt to remove, expose the head of the penis by force leads to traumatization of the foreskin, subsequently a scar appears, which itself will not physiologically stretch. Many inflammatory problems of the genital organs can lead to scarring, which will also entail a persistent increment to the head itself, hence the disease occurs - cicatricial phimosis. In another case, swelling and inflammation of the preputial sac appear, the skin that has grown, tears, and a scar gradually forms in the place where the mechanical tear occurred.

Cicatricial phimosis in an 11-year-old child is formed more often due to mechanical traumatic damage to the foreskin and head in the case when the child is not bathed carefully, or the tissue is trying to move sharply, preventing it from stretching and softening. Cicatricial phimosis brings a large number of inconveniences to the child - pain during normal hygiene measures, and with advanced forms, it can also lead to impaired urination. Due to insufficient hygiene measures, a large amount of smegma accumulates in the preputial sac, which allows bacteria to multiply rapidly and cause a number of the following diseases: balanitis, balanoposthitis, urethritis, prostatocystitis, orchiepididymitis, pyelonephritis.

How to determine cicatricial phimosis ICD 10. There are many symptoms that characterize this type, all of them are described in the ICD10 classification. Urologists can make a diagnosis - cicatricial phimosis according to typical signs after a physical examination, revealing the following symptoms: the inability to open the head on their own with the help of hands, the appearance of white or gray cicatricial changes, pain when removing the head or even when moving the foreskin. With this form of phimosis, sexual intercourse is impossible due to unpleasant painful sensations. This occurs due to the blood filling of the cavernous bodies of the penis and the enlargement of the penis, while mechanical compression of the phimous ring occurs. Due to trauma and poor elasticity, tears appear on the foreskin. Nocturnal physiological erection is manifested by painful sensations, and the addition of a bacterial component leads to purulent discharge, an unpleasant odor. What does cicatricial phimosis look like in boys, photo.

It is worth noting that cicatricial phimosis in a man cannot regress on his own, in this case, a consultation with a urologist and his medical care is necessary. Cicatricial phimosis without surgery, treatment is possible only in the initial stages, when pain is still absent, you can try to treat it with conservative methods. But it is worth remembering that in the future, men with this form of the disease, even if the outcome of the problem is positive, will be at risk for the recurrence of the disease, since there is a high risk of developing an adhesive process; a more positive effect of treatment will be with surgical intervention.

Cicatricial phimosis in adults, surgery. Before surgery for cicatricial phimosis in adults, doctors recommend stopping the inflammatory process, while you can use aseptic solutions: chlorhexedine, dioxedine, miramistin. Such preparations are used for baths and lotions, they can be combined with decoctions of herbs that have an anti-inflammatory effect: chamomile, calendula and many others. Also, before a planned operation, it is recommended to use ointments with an antibacterial effect, they inhibit the growth and reproduction of bacteria, corticosteroid ointments will also relieve the inflammatory reaction and increase skin elasticity, relieve swelling of the foreskin. Laser surgical manipulation is carried out exclusively in the early stages of the disease. The operation is performed as a photodestructor to solve a delicate problem, the manipulation is less traumatic and does not require long-term postoperative rehabilitation. This method has a sufficient number of advantages: quick recovery after surgery, the ability to save the foreskin and not disturb the sensitivity of the head; with this method, there is no massive bleeding, the risk of scarring is reduced to zero. With more protracted forms and advanced stages, doctors resort to circumcision surgery - a radical method of excision of the foreskin. This is a complete dissection and removal of the foreskin with the application of absorbable sutures.

Cicatricial phimosis after surgery. Postoperative rehabilitation is carried out in a hospital, the recovery period is up to a month, if the operation was successful and the tissues heal safely, you can live sexually a month later, but given the fact that the sensitivity of the head is increased, then the sexual intercourse will be fleeting and the sensations will be slightly changed. ICD code cicatricial phimosis photo in men.

Cicatricial phimosis in boys, operation, reviews. Many parents worry about the outcome of the operation in boys, as they are concerned about the reproductive function of the child. There are many opinions on this matter, but experts are sure of one thing - this will not affect the reproductive function in any way. It is necessary to properly and efficiently approach the care of the genital organs. Many mothers whose children have undergone surgery express their gratitude to the doctors who saved young men from problems quickly and painlessly. The child will get used to his peculiarities of the genital organs and will control further sexual life. For young boys, many experts recommend laser surgery and further proper care of the reproductive organ.

Cicatricial phimosis, surgery, reviews, most men complain about the strong sensitivity of the penis and the inability to deliver the proper sensation to the partner during intercourse, but it is worth noting that this happens only at the very beginning, immediately after the operation, in the future the head will be less sensitive and sex life will improve . The opinions of men about the operation differ, but most still believe that a radical technique must be applied in order for the disease to no longer develop.

Treatment

In most cases, experts recommend surgical treatment of phimosis, considering this method the most rational, but there are also non-surgical methods of treatment - conservative or medication. The latter method is used in very rare cases at the initial stage of the disease. Many use traditional medicine in the hope that this will alleviate their condition. The use of baths with decoctions of herbs of chamomile, succession, calendula, oak root will reduce the inflammatory process and alleviate the condition, but for a short time, you can also use ointments based on plantain and nettle.

Cicatricial phimosis, conservative treatment. True, this method of treatment does not always give the expected result. The main and fairly good method is the method of stretching the foreskin. It is based on an independent step-by-step stretching of the foreskin, daily with the help of masturbation, with maximum retractions of the preputial sac until the head of the penis is completely exposed. This manipulation is carried out several times until moderate pain appears, it is recommended to carry out this procedure after taking a bath or during. There is another type of stretching, with the help of fingers. Two little fingers are inserted into the preputial sac and the foreskin is stretched in different directions to uncomfortable sensations. Cicatricial phimosis in adults, treatment. The most commonly used method for stretching the foreskin by masturbation in adults, the man himself can control the degree of tension and the force of pressing and in this way gradually expose the head.

Treatment of cicatricial phimosis in children is carried out quite delicately and in a timely manner, the choice of method depends on the age at which this pathology was detected, as well as the degree of the disease. More often, the two-finger method is used, in which stretching occurs, it is considered less traumatic and painless for the child. Doctors recommend taking a warm bath before this procedure, so that the skin becomes softer and more elastic.

Cicatricial phimosis at the age of 7 is treated only if it is complicated by other diseases. A complication can occur due to an inflammatory infectious disease, with insufficient hygiene care in boys. If the foreskin is injured and inflamed due to insufficiently accurate procedures during bathing, then such a pathology requires medical treatment. In children, you can try to partially correct cicatricial phimosis with massage. Remove the head, albeit not completely, but only on some part. Daily massage exercises will slightly stretch the foreskin and thereby improve the condition of phimosis.

There is another method of influencing phimosis - drug treatment. How to treat cicatricial phimosis, ointments? Today, this is a topical issue for all parents who do not want to injure boys. Corticosteroid ointments are used to improve the extensibility and elasticity of the skin, prevent an inflammatory reaction, and eliminate tissue swelling. It is best in such cases to use "Clobetasol" and "Betamethasone" daily once a day, applying to the skin of the foreskin.

Cicatricial phimosis in boys, treatment without surgery takes quite a long time, requires considerable effort and patience. You can use different methods of stretching of a mechanical nature or medication using hormonal ointments.

Cicatricial phimosis in adults can be treated without surgery using a conservative method. Patients respond positively to such treatment, stretching the foreskin is the main therapeutic method of treatment at home.

Cicatricial phimosis laser surgery, price. This method of new technologies has become quite popular in medical practice. The method has proven itself to be operationally easy. The advantages of this method are: a short rehabilitation period, no side effects, a minimum of blood loss, no pain, postoperative tissue edema is not formed. The effectiveness of the laser method increases every year, but if the effect is lower than expected, an operation is required.

Cicatricial phimosis circumcision in children forum reviews.

Many mothers, when confirming the diagnosis - phimosis in their child, consider only conservative methods of treatment, fearing to disturb the child's psyche, and many risk trying surgical methods of treatment and are satisfied. So it is with the circumcision of the foreskin, a large number of mothers are satisfied with the outcome of the operation and say that this technique allows you to forget about phimosis forever. Yes, the child has his own peculiarity in the future, but you can live with this and this does not affect the standard of living in any way. The sensitivity of the organ increases slightly at first, but in the future it will pass when the skin gets used to it and becomes less sensitive.

Relative phimosis

Relative phimosis is rather a pathology that requires prompt intervention. With such a pathology, the patient cannot completely withdraw the head of the penis, this gives him a lot of discomfort. Sexual life with such a pathology is impossible. When the disease is advanced, the patient often complains about the inability to fully go to the toilet and urinate, there is an urge to urinate, but there is no urine. The further manifestation of phimosis will change somewhat, it all depends on the neglect of the process, on the form and causes of its occurrence. Therapeutic tactics for relative phimosis is selected in the same way as in other cases. With a mild form, in the first and second stages, the use of medical or conservative treatment is possible, and in the third and fourth stages, in severe forms, an urgent operation is required.

Complications of phimosis

Complication of phimosis. With any pathology from the genitourinary system, different types of complications can be observed, depending on the causes of the formation of the disease and the neglect of the process. With timely high-quality treatment, the outcome of the disease is favorable, recovery occurs in all cases. But the consequences after phimosis can still form, these include paraphimosis, balanoposthitis, anuria, an increase in the head to the foreskin, and in more severe degrees - cancer of the glans penis. Paraphimosis can be complicated by necrosis and gangrene, which will eventually lead to the removal of the organ completely.

A disease such as balanoposthitis occurs due to the defeat of the inflammatory process of the inner leaf of the foreskin and the head of the penis. The secret that is produced in the bag accumulates there, a favorable microflora is formed, and due to irregular care, inflammation occurs, a white color and a specific unpleasant odor appear. This pathology is characterized by itching, redness of the head, irritation around the focus, pain, swelling of the soft tissues, and subsequently - the release of pus from the preputial sac.

Paraphimosis - this problem often manifests itself in boys at a young age, if the head is pulled out sharply enough, then the preputial ring can tightly clasp under the head and infringe, which will cause pain and swelling after phimosis. After squeezing the blood vessels of the penis, their functional ability is somewhat lost, necrosis begins in the soft tissues of the head due to a lack of oxygen and nutrients. If you do not seek help in a timely manner, necrosis of the glans penis may occur.

Why is phimosis dangerous? It is known that phimosis is not a fatal disease, it is dangerous only for its consequences and an unpleasant long recovery period. At the initial stage of the disease, there is a risk of stagnation of the secret, impaired urine outflow, infringement of the foreskin of the head of the penis, inflammation of the head and preputial sac, synechia. Subsequently, the most dangerous manifestation may be cancer of the genital organ.

Complications after phimosis in a child are extremely rare, since before puberty, phimosis is considered a normal natural process in the life of every boy. It will be enough to closely monitor the condition of the genital organs of the child and consult with specialists, preferably regularly. Many parents worry that phimosis is the cause of infertility in boys, but we can say with confidence that the prognosis for this disease is favorable, the risk of developing negative consequences is minimal.

Is phimosis dangerous? The consequences in children can only be associated with infringement of the head, when you have to resort to a radical method of treatment - surgery. Phimosis in adults is a pathology. This condition must be treated under the supervision of an andrologist and urologist. The most unpleasant situation that can occur in a man is psychological depression associated with a violation of the sexual function of the body. A man may lose his desire to have sex because of embarrassment and ugly appearance, painful sensations during an erection. Does phimosis affect the size of the penis? Definitely not, the disease will not affect the size of the penis in any way.

Operation, phimosis, complications.

You should also not forget about the postoperative period, since complications are often formed in this period of time. In the postoperative period, both in children and in adult men, various complications can be observed; young boys, of course, are less susceptible to complications, since the body is young and the ability of tissue to regenerate is much higher than that of an organism that is sufficiently depleted.

Phimosis is a complication after surgery, a significant place is occupied by swelling of the foreskin after phimosis. Surgical excision of the sac may be accompanied by chronic complications: bleeding, acute anuria, suppuration of wounds, scarring and extensive adhesions. A side result is observed after a poor-quality operation in unsanitary conditions. You should choose a reliable medical institution, it is better to trust a qualified specialist to perform the operation. It is worth worrying about your health and not bringing the disease to pathological forms.

Treatment

A few years ago, most doctors were convinced that the treatment of phimosis was possible due to surgical manipulations, i.e. circumcision of the foreskin. Many people ask questions, but how to cure phimosis without circumcision?

To date, there are a sufficient number of methods of treatment:

• Daily exposure of the penis head. It is important to do this systematically, for 7-12 minutes two or three times a day, and not skip it.
• Stretching of the foreskin. This procedure is performed on an empty bladder. The main thing is to do this every day, but carefully, for 2-3 months.
• Stretching the preputial sac with simultaneous insertion of the fingers.
• Medical treatment. Ointments help a lot. They have an anti-inflammatory and analgesic effect, stretch the foreskin. With the above methods, they have a positive effect in the fight against the disease.

Many experts do not believe in the positive effect of these treatments. Since after many attempts at self-treatment, most patients come to doctors with complications, and apart from the surgical method, doctors have nothing to offer them. And all this happens due to the fact that competent consultation with specialists was not carried out and many mistakes were made in the conduct of conservative therapy. For example, the cicatricial form of phimosis can be treated only with the help of surgical intervention, due to the inability of the scar tissue to stretch.

The above methods are good because they are natural.

And yet, before starting the treatment of phimosis, you need to consult a doctor, and if there are no contraindications, then conservative methods can have a positive effect.

• Exposure of the head of the penis.

General principles of this technique:

• The process of stretching should be carried out smoothly, gradually, to avoid pain.
• Frequency. Every day for 7-17 minutes, two or three times a day, and do not allow passes.
• The bottom line is the daily exposure of the glans penis.
• Stretching of the prepuce. The essence of this method is to stretch the prepuce until discomfort appears. This method is also effective in children, if the spontaneous process of eliminating phimosis has not occurred. Duration up to several months.
• Stretching of the foreskin with simultaneous insertion of the fingers and their subsequent dilution. Before this, you need to treat your hands with an antiseptic, take a warm shower, then the skin will become soft and pliable, and lubricate the foreskin with a nourishing cream or petroleum jelly. Then gradually insert your fingers into the preputial sac and stretch the skin with smooth movements. This method is used in children and adolescents. For the treatment of phimosis in adults of the first and second degree, a special glanshy tool is used. The essence of the method remains the same.

Phimosis photo, treatment

If phimosis is diagnosed, treatment without surgery is possible. It is important to follow all the recommendations of experts. But all these methods are good, with the first or second degree of phimosis, in children and adolescents. In men, the chances of eliminating the disease by these methods are sharply reduced.

How to get rid of phimosis without surgery?

There are also folk ways to treat phimosis. Use herbal decoctions that have anti-inflammatory and antiseptic effects. The most commonly used herbs are:

• Chamomile. One of the most effective herbs in the treatment of phimosis. It relieves irritation well and has an antiseptic effect.
• Calendula. Also has a calming effect. To prepare a decoction, you need 1 tablespoon per glass of boiling water, insist and strain. Apply in the form of compresses.
• Series. It has regenerative abilities, restores the body.
• Centennial juice. It is injected directly into the preputial sac at night. It has a pronounced anti-inflammatory effect.
• Barley. 3 tablespoons of barley, pour 400 ml of boiling water, and leave for an hour. Use in baths.

Herbs can cause side effects such as irritation, redness, or allergic reactions. If you want to avoid such complications, then it is worthwhile to manipulate these herbs on an open area of ​​\u200b\u200bthe skin, and follow the result.

These herbs are used in the form of decoctions, both individually and together. Warm baths are made from the prepared broth. They soften the skin well, and then the stretching methods are easy and painless. It is important to note that herbs should be used in complex therapy.

Another way is kneading the penis using sea buckthorn or viburnum oil. Massage movements cause the head to slide, which leads to an acceleration of its lagging behind the skin of the preputial sac.

Salt baths are helpful. More often, sea salt is added, which steams the skin, making it more elastic. But the drying effect of salt is pronounced, so it is often not worth doing such a procedure.

How to treat phimosis without surgery?

It happens that in the place of phimosis the penis hurts, and the patient experiences discomfort. Tolerate such discomfort in the groin is not necessary. In this case, treatment is carried out symptomatically. What can be done in such a situation? First, take a warm shower/bath. Antipruritic and antihistamine ointments/creams can help relieve symptoms in a few minutes. It contains substances that soothe the skin.

Treatment of phimosis without surgery in children, reviews. If the mother suspected a problem in time and consulted a doctor in a timely manner, then conservative methods of treating phimosis are ideal for getting rid of this ailment. Treatment of phimosis, reviews from the above methods are positive. 90% of patients or their parents noticed a positive trend after the treatment of phimosis with non-surgical methods of treatment.

Treatment of phimosis, price. For conservative treatment, large expenses are not required, the main thing is to follow all the doctor's recommendations, daily and without gaps, and in a month the result will not be long in coming.

Medical treatment of phimosis

All drugs intended for the treatment of phimosis are divided into the following groups:

• Ointment, with the effect of stretching. Most often they are prescribed to children and adolescents.
• Ointments with the addition of antiseptics. They are prescribed if, against the background of a general disease, an infection joins.
• Ointments with anti-inflammatory and hyposensitizing effects.
• Solutions that relieve itching, inflammation, discomfort. They are usually multicomponent.

For the treatment of phimosis, herbal decoctions that can be made at home help well. They relieve redness, burning and itching. Ointments are prescribed for 1-2 stages of phimosis. With the ineffectiveness of conservative therapy, resort to surgical treatment.

Phimosis in men, treatment, ointments

What you need to know when choosing an ointment?

• Before you go to the pharmacy and buy the drug, be sure to consult your doctor in order to avoid complications.
• Not in every case, ointments can have the desired effect. So, for example, with stage 3-4 phimosis, they do not help.
• Hormonal drugs in the form of an ointment are prescribed only for adults. It is strictly forbidden for children to use them.
• All drugs are used in a course. Its duration is up to 2-3 months.

One of the most popular drugs is Diprosalik ointment, with phimosis, it relieves redness, burning sensation, itching, and stretches the foreskin. It consists of two components: salicylic acid and a hormonal drug - betamethasone. Apply the ointment after taking a shower, on softened skin. Once the ointment is applied, gently stretch the foreskin with your fingers. The duration of this manipulation is 10-15 minutes, 2-3 times a day for 1-2 months.

Diprosalik, reviews for phimosis

The effectiveness of this drug is 90% in the initial stages of the disease. At the second and third degree about 50-60%. In general, the reviews are positive if this procedure is carried out regularly.

Medical phimosis, hormonal treatment

Hydrocortisone for phimosis is used 2-3 times a day. Ointment, in its composition contains the active ingredient of the same name. The tissue of the foreskin, with regular use, begins to stretch after two to three weeks. Hydrocortisone acetate kills the infection and speeds up the process of restoring normal microflora. To increase efficiency, you need to massage the penis with light, smooth movements, and stretch the foreskin with your fingers.

So you can easily cure phimosis. The exercises and manipulations that need to be carried out must be shown to you by a specialist.

Betamethasone also has a good effect on phimosis. The main substance of this drug has an anti-inflammatory, anti-edematous effect, is involved in the process of skin stretching. It is necessary to apply the ointment 2 times a day, for two to three weeks. In this case, you need to lubricate the end of the penis and gradually stretch the foreskin for about five to seven minutes.

Levomekol has a similar effect. It contains an antibiotic and methyluracil. The latter accelerates regenerative processes, has a local immunostimulating effect. The ointment heals the formed cracks and wounds on the foreskin. You need to lubricate 2 times a day, preferably in the morning and before bedtime. Regeneration processes are noticeable after a couple of weeks. Apply the ointment only on softened skin, after a shower.

Well in the initial stages helps to treat phimosis - furatsilin. It also relieves redness, heals cracks and wounds, and has an antimicrobial effect. A solution of furacilin is diluted in equal proportions with water. A bandage moistened with a solution or a piece of gauze is applied to the affected area for 15-20 minutes, for 10-14 days.

Phimosis can also be treated with a solution of potassium permanganate. A couple of drops are added to warm water until a light pink color appears. Apply in the form of baths, for 15 minutes, for 14 days, every other day.

In addition to medicines, expander rings are used to treat phimosis. They are inserted into the foreskin, and a process of gradual stretching occurs. To do this, rings of various diameters are used, they are changed as the foreskin is stretched and removed when the head can be freely exposed. They are worn two or three times a day, one hour each. The duration of this course is 2-3 months, and depends on the stage of the disease.

At the very beginning, the doctor selects the first ring of the right size. At the same time, the foreskin is stretched, and the diameter is measured using a compass. The replacement of the ring, with a larger diameter, is carried out when the tension process, felt by the patient, stops. You need to insert the ring carefully, while squeezing it, pulling back the foreskin and inserting it. Production material - silicone. Rings for the treatment of phimosis can be bought at the pharmacy. Sold in a set of 6 pieces in different sizes. This method of treatment is popular in foreign countries. In the CIS countries, it began to be applied relatively recently.

Laser treatment of phimosis consists in the use of modern technologies, namely laser equipment. Its essence is as follows. With the help of a laser, the foreskin is excised, due to the photodestructive component. The temperature of the beam is about three hundred degrees, due to this, tissue evaporation occurs. This method has many positives:

• No anesthesia is required for this procedure, local anesthesia is sufficient.
• Due to high temperatures, all blood vessels are cauterized, while blood loss is completely excluded.
• There are no complications after the operation. The penis does not swell, as is the case with classical surgical interventions.
• Small recovery period. Healing is fast. Follow-up in the clinic after this manipulation is not necessary. Patients can go home.
• Painlessness.
• The duration of laser treatment is up to half an hour.

How exactly is laser treatment performed?

• An injection with an anesthetic is given locally.
• The doctor marks with a marker where the incision will take place.
• A laser, or rather its beam, makes an incision.
• Excised unnecessary tissue.
• Treatment of the surgical wound with an antiseptic solution.

When all methods of conservative treatment of phimosis have been tried, or complications develop, then specialists resort to a surgical method of treatment.

Indications for surgical treatment:

• Inflammatory changes in the head of the penis, poorly cured by medication. It develops due to stagnation of the secretory fluid, due to such a strong narrowing of the preputial sac.
• Paraphimosis. It is a serious complication. At the same time, the preputial sac is so narrowed that it leads to infringement of the head of the penis, circulatory disorders and, as a result, tissue necrosis.
• Cicatricial forms of phimosis.
• Violation of urination. The patient cannot normally go to the toilet, experiences pain, cramps.

Preparation for the surgical method of treatment.

First of all, the patient who agreed to the operation (if it is a child, then the consent is given by the parents, in writing), will meet with the anesthesiologist. A thorough conversation is conducted with the patient, his anamnesis and medical documentation are studied. After that, the most optimal method of anesthesia is selected, which depends on the age of the patient, his physical parameters, and the equipment of the clinic.

During the operation, children, especially if it is a newborn or a child of preschool age, prefer local anesthesia, while the child's body is firmly fixed. Since general anesthesia can lead to serious consequences.

Mask anesthesia is performed on older children. Their body is able to tolerate small doses of anesthesia, without the development of consequences.

Men calmly endure the operation under general anesthesia. The difficulties of general anesthesia lie in the fact that patients need to undergo high-quality preoperative preparation, for example, 10 hours before the proposed operation, do not eat or drink.

General preparation, both for local anesthesia and general anesthesia, is as follows:

• The genitals need to be washed.
• Remove pubic hair.

This operation is called circumcision of the prepuce. There is a total or subtotal, removal of the foreskin. The surgeon makes a circular skin incision near the head of the pnis with a scalpel. Next, the edges of the resulting skin flaps are sutured using catgut. A bandage is applied, which the doctor changes, about 1 time per day, until complete healing. Patients should avoid getting urine on the wound and should not be sexually active for one month. At home, experts recommend taking baths with a solution of furacilin or potassium permanganate to speed up wound healing.

Treatment of phimosis, surgery in adults

Types of circumcision:

• Subtotal or partial. There is a problem in the form of phimosis, but the patient's desire is not to completely expose the head.
• Total. Complete removal of the prepuce.
• Not tight. The head is freely exposed, but the skin folds in the region of the coronal sulcus remain.
• Moderate. Similar to the previous type of circumcision, but there is a small fold of skin in the region of the coronal sulcus.

Circumcision with dorsal suture. Skin flaps are fixed with clamps. The skin is excised at the twelve o'clock position relative to the marking line. Using scissors, a section of skin is cut along the dotted line. The rest of the flesh is sutured.

Phimosis in men operation, video

Circumcision without removal of the foreskin. In this case, the inner layer of the foreskin is dissected, the suture material is applied to the leaves of the prepuce.

Operation phimosis in children, video

Roser's method. A probe is inserted into the cavity of the preputial sac, two sheets of the foreskin are cut along it. The inner layer is cut less than the outer one. Next, the sheets are sewn with knots.

Phimosis operation, photo

With the formation of synechia in the area of ​​​​the preputial sac, an operative method of treatment is used - preputioplasty. Its essence lies in the dissection of synechia, and the release of the glans penis. The skin of the foreskin is not removed. The operation does not cause complications, discomfort disappears in a short time.

Phimosis in boys operation, video

Meatoplasty is an operation to correct the size of the outer part of the urethra. This method is used for some types of phimosis.

Phimosis before and after surgery, photo

After all the above methods of treatment, recurrence of phimosis never happens.

Phimosis in boys, operation, photo

Rehabilitation.

Patients may experience pain for some time after surgery. They are especially pronounced when urinating. Careful care is needed for the postoperative wound. Dressings are carried out every day. The dressing must be dry and uncontaminated. Urine should not get on the bandage. If this happens often, then urine can cause irritation, inflammation, and thus the wound healing process slows down.

Assigned to wear underwear, which will hold the penis in one position, which will create conditions for the rapid healing of the wound.

Complications.

Adverse reactions after phimosis, or rather operations to eliminate it, are extremely rare. It all depends on the postoperative period. If the patient violates and neglects personal hygiene and does not follow the wound surface, then complications such as swelling and inflammation cannot be avoided. But, nevertheless, the following undesirable consequences may occur:

• Hematomas and cicatricial changes in the suture area.
• Infection.
• Inflammatory changes in the urethra. The first signs are pain during urination.
• In the postoperative period often there is an erection, in the morning and in the evening. In this regard, the edges of the surgical wound may diverge, and the recovery period will be lengthened. It causes pain, impaired blood circulation in the body.
• Decreased sensitivity of the glans penis. Over time, she recovers.

Contraindications.

• Wounded or ulcerated surface of the penis.
• Hemophilia.
• oncological process.
• Chronic process of the genitourinary system.
• Anomalies in the development of the penis.
• The last stages of paraphimosis.

Phimosis in men, photo after surgery

Treatment of phimosis - surgery, price. In private clinics, this operation costs about 15,000 rubles.

Prevention of phimosis in boys

Preventive measures consist of certain principles:

• Preventive examinations by a pediatric surgeon.
• Children and their parents must observe the rules of personal hygiene.
• Use baby soap to wash the genitals.
• As soon as wounds, sores, cracks are found, treatment with antiseptics is important.
• Change underwear every day.
• If this is a small child, then change diapers / diapers often, and use wipes with antiseptics.
• And in no case should small children open the foreskin.

If parents are attentive to their children, adhere to all of the above rules, this will help to avoid or eliminate pathology in the initial stages of development.

Phimosis (from the Greek. "Contract") is a condition in which it is impossible to completely withdraw the head from the foreskin due to its narrowing. It occurs in 90% of boys before the onset of puberty and is a manifestation of the physiological maturation of the penis. Phimosis in men is a pathological condition. It develops in 2-3% of adults and leads to a number of serious complications, impoverishes the sensations of sexual intercourse. In the early stages, phimosis can be successfully treated with conservative methods, so it is important to notice the pathology in time and consult a doctor.

Development mechanism

The penis is the external genital organ of a man, the main function of which is to introduce sperm into the woman's vagina. The most sensitive part of it is called the head, it contains the largest number of nerve endings. It is covered with a thin delicate epithelium, which is similar in structure to the red border of the lips. At the top of the head, a slit-like opening opens the urethra - the male seminal and urinary tract. With its lower part, it fuses with the cavernous bodies of the penis, which form its trunk. In this place, the penis has a thickening - the coronal groove, it can be felt immediately under the head.

The skin fold - the foreskin (prepuce) protects the delicate skin of the head from damage. It consists of 2 sheets:

• External - identical in structure to the epidermis of the skin, has an upper stratum corneum;
• Internal - covered with thin epithelium, similar to mucous membranes. It has a large number of modified sebaceous glands that produce a waxy substance - smegma. Their secret serves to moisturize the head and facilitate sliding during sexual intercourse.

The foreskin starts from the coronal sulcus and tightly covers the entire head, forming a slit-like preputial cavity. In front, it opens with a hole that easily stretches and releases the head out. Normally, in a mature man, the foreskin is easily displaced, completely exposing the upper part of the penis. In the back of the head, the inner sheet of the prepuce is tightly fused with its tissues in the form of a frenulum. A huge number of nerve endings and capillaries lie in the thickness of the frenulum, so stimulating it during intercourse gives a man pleasure.

The foreskin performs the following functions:

1. Protects the urethra from the penetration of pathogens, covering its opening;
2. Prevents mechanical irritation and damage to the thin epithelium on the surface of the head, while maintaining its sensitivity;
3. Facilitates sliding during sexual intercourse due to the production of smegma and a smooth inner leaf;
4. Increases the pleasure received in the process of intercourse by stimulating the nerve endings of the head and frenulum. This is an important factor in evolutionary terms: without strong positive emotions, people would refuse sex and have less chance of procreation.

Phimosis, as a pathological condition, develops after inflammation or injury of the foreskin. As a result of exposure, tissues are destroyed and the inflammatory process starts. It goes through certain stages and necessarily ends with the organization - the restoration of the integrity of the body. Deep damage is replaced with the formation of coarse connective tissue, which significantly reduces the elasticity of the foreskin. High activity of recovery processes leads to the formation of synechia - connective tissue partitions between the inner leaf of the prepuce and the glans penis. They firmly hold them together and prevent the upper part of the penis from being exposed.

Classification

It should be understood that phimosis is not a disease, but a special condition that is associated with the physiological characteristics of the body (age), heredity and damage to the tissue of the foreskin. Due to this the following forms of phimosis are distinguished:

• Physiological - occurs in most boys before the onset of puberty, is associated with the functional maturation of the preputial cavity. It is not a pathology and resolves on its own after 7 years.
• Pathological - occurs as a result of inflammation, trauma, metabolic disorders and requires treatment:
• Hypertrophic (proboscis);
• atrophic;
• Cicatricial.

The frequency of occurrence of one form or another of phimosis directly depends on age. In children, in the vast majority of cases, it is physiological in nature, and in men it is due to cicatricial changes.

According to the severity of the process, 4 degrees of phimosis are distinguished:

1. In a calm state, the head is released completely, with an erection, its removal is difficult and painful;
2. At rest, the head of the penis is difficult to withdraw, during an erection it is completely covered by the foreskin and is not released;
3. The head can only be partially withdrawn at rest;
4. The head is constantly hidden by the foreskin, it is not displayed. At the same time, during urination, urine first fills the preputial sac and only after that is released drop by drop.

Physiological phimosis

The genital organs of a boy begin to form after 11-12 weeks of intrauterine development. The head of the penis and the foreskin are formed from a common germ in the third trimester of pregnancy, their separation occurs at the site of the coronal sulcus. The cells of the prepuce begin to actively divide, significantly outpacing the growth of the tissues of the penis. As a result, they surround the head in the form of a cup and close it with a cavity. The anatomical proximity and commonality of the tissue lead to the formation of delicate epithelial septa between the inner layer of the foreskin and the skin of the head.

The development of the penis during the growth of the child. Up to ~10 years, fused glans and foreskin are normal

In a newborn child, the preputial cavity is completely delimited from the environment by such cords, which excludes the ingress of pathogenic microflora into it. By 3-4 months of life, the sebaceous glands of the foreskin begin to function. They produce smegma, which accumulates in a small amount in the preputial cavity. Its infection and the development of the inflammatory process are prevented by epithelial septa in the region of the opening of the foreskin. Gradually, these thin strands are destroyed, the smegma is displaced towards the exit and is released through the formed free spaces. It can be seen as small white waxy flakes on the baby's underwear.

By the time of puberty, the septa are completely or partially reduced and the mobility of the foreskin increases. During masturbation or after the onset of sexual activity, the head begins to be completely released, although the process may be painful at first. Thus, Physiological phimosis resolves spontaneously during puberty and does not require treatment.

Treatment for inflammation

Despite the naturalness of phimosis, in some cases there is a need for medical care. With insufficient care for the boy or his non-compliance with personal hygiene, pathogenic microflora enters the preputial sac from the skin and an inflammatory process develops. Clinically, this is manifested by redness along the edge of the opening of the prepuce, local soreness and an unpleasant odor from the penis. Subsequently, inflammation leads to the formation of cicatricial phimosis, which will require surgical treatment.

If such symptoms are found in a child, parents should contact a pediatric urologist or pediatric andrologist. Previously, the technique of simultaneous opening of the foreskin with a sharp jerky movement was widely practiced. Such a procedure is extremely painful for the boy and can cause psychological trauma. In addition, a single opening damages the foreskin and can cause cicatricial phimosis in the future.

To date, doctors recommend a gradual opening of the head by 1-2 mm. It is carried out after a warm bath, preferably with the addition of antiseptics: a weak solution of potassium permanganate, a decoction of chamomile, calendula, sage. It should be taken 2 times a week for 10-15 minutes. After the water procedure, the foreskin is treated with a healing ointment (bepanten, solcoseryl) or baby cream to increase its elasticity and prevent rupture. The skin is retracted no more than 2 mm in one procedure. In this way, phimosis can be treated at home for several months.

If the method described above is ineffective, the surgeon or urologist dissects the adhesions formed with a probe. He performs the procedure on an outpatient basis without anesthesia or under local anesthesia. The doctor inserts a thin metal rod with a rounded end into the preputial sac and runs it along the circumference of the glans penis. Subsequently, the boy's penis should be washed daily using antiseptic solutions.

Video: phimosis - norm and pathology, Dr. Komarovsky

Pathological phimosis

The causes of pathological phimosis are:

• Genetic defect of connective tissue;
• Metabolic disease;
• Inflammatory diseases of the foreskin and head of the penis;
• penis trauma;
• sexually transmitted infections;
• Age changes.

hypertrophic

Hypertrophic phimosis in terms of frequency of occurrence in children is the next place after the physiological one. It is an overdevelopment of the foreskin, which hangs down from the penis with a long proboscis. At its end, the "proboscis" narrows and opens with a dense ring, the removal of the head through which is not always possible. As a rule, such a condition is due to the obesity of the child - excessively developed subcutaneous fat pulls the foreskin and reduces its elasticity.

A long proboscis lengthens the path for the excretion of urine and smegma, resulting in favorable conditions for the growth of pathogenic microflora. The increased moisture in the preputial sac and the accumulated secret of the sebaceous glands is an ideal breeding ground for bacteria. They damage the epithelium of the head and the inner leaf of the foreskin with the development of an inflammatory reaction -. In children with diabetes, yeast fungi often multiply in the preputial sac, which is manifested by unbearable itching of the genital organs and white curdled discharge. Balanoposthitis often ends with the formation of a cicatricial form of phimosis.

Another reason for the pathology is the underdevelopment of the penis against the background of the normal size of the foreskin. It comes to light in the course of puberty of the boy and is connected usually with insufficient production of testosterone by testicles (hypogonadism). In this case, phimosis is combined with short stature, lack of muscle mass, female-type hair growth, lack of facial hair growth, high voice, and depression. Treatment of this condition is carried out jointly by a urologist and an endocrinologist or andrologist.

cicatricial

Cicatricial phimosis is the most common form of the disease among adult men. Its causes are any conditions that lead to inflammation in the area of ​​​​the foreskin or head. Among genital infections, the most common cause of balanoposthitis with cicatricial phimosis in the outcome is pale treponema - the causative agent and. Virus, and also often cause inflammation of the head. In children, cicatricial phimosis is rare and in about a third of cases it is not possible to find out the cause of the disease.

The disease progresses gradually. In the first weeks after inflammation, thin connective tissue bridges are formed, which slightly limit the mobility of the foreskin. In just a few months, they thicken significantly, become dense and rough. The mobility of the foreskin is reduced, the head remains closed even during erection, and attempts to bring it out are accompanied by severe pain. Forcible exposure of the head leads to small tears, bleeding and the formation of new scars.

The last degrees of phimosis violate the self-cleaning of the preputial cavity and the process of urination. Urine bathes the glans, mixes with the infected smegma, and flows back into the urethra after the man stops urinating. As a result, the patient develops urinary tract infections: cystitis, pyelonephritis. In addition, cicatricial phimosis prevents the normal course of sexual intercourse. There is a need for additional lubrication, the man receives insufficient stimulation and feels sore when the foreskin is stretched.

Treatment of pathological forms

Diagnosis and treatment of phimosis is carried out by a urologist, surgeon or andrologist. If the cause of the disease was a sexual infection, then the patient is additionally observed by a dermatovenereologist, who prescribes antibiotic therapy. Both partners should be treated in this case.

Treatment with a conservative method is carried out with the first two degrees of phimosis, if the adhesions are thin and have arisen no more than a month ago. In such cases, the patient is advised to gradually stretch the foreskin after a hot bath. An anti-inflammatory ointment containing glucocorticoids (locoid, hydrocortisone) and absorbable ointment contratubex are applied to the head of the penis. Open the head carefully, avoiding injury to the foreskin. After the procedure, healing preparations (solcoseryl, bepanthen, panthenol) are indicated locally.

The surgical method of treatment is circumcision or circumcision. The operation implies the complete removal of the foreskin, the head after it remains permanently open. The intervention is performed under general anesthesia in children and under local anesthesia in adults. The surgeon first cuts and folds back the outer sheet of the foreskin, then carefully excised the adhesions in the preputial sac. After both leaves are selected, he cuts them off along the coronal sulcus. The surgeon sutures the resulting wound with absorbable suture material, that is, the removal of sutures after the operation is not required. In the postoperative period, 1-2 dressings are performed and the patient is discharged home. Complete healing of tissues occurs within 2-3 weeks and after this period, you can resume sexual activity.

surgery for phimosis

Complications and prevention

The most common complications of phimosis are:

1. Infringement of the head (paraphimosis) - develops when trying to forcibly remove the head of the penis from the preputial cavity. A dense ring of the foreskin compresses the tissue of the head, it swells and increases in size. As a result, its reverse reduction becomes impossible, the blood supply to the tissue is disrupted, and without urgent medical care, the situation ends with necrosis - necrosis of the strangulated part of the head.
2. Balanoposthitis - inflammation of the foreskin and head of the penis.
3. Urethritis, cystitis, pyelonephritis - develop at the 4th degree of phimosis due to a violation of the flow of urine.
4. The increment of the foreskin to the head - the most damaged areas, due to their tight adhesion to each other, heal with a single scar, which is not always possible to excise.

The most important preventive measures are:

• Careful hygiene of the genitals, daily washing of the child and timely change of diapers or diapers;
• Use of barrier methods of contraception (condom) during casual sexual intercourse;
• Treatment of underlying diseases (diabetes mellitus).

Video: doctor about phimosis in men

Phimosis is a pathological condition characterized by narrowing of the foreskin. Thus, the man fails to expose the head of the penis. The phenomenon can take a chronic course, which is clinically manifested by the appearance of pain. Phimosis occurs in 3% of cases in adult men and in 97% in children. If such a disease manifests itself before the age of seven, then this is considered the limit of the norm. In other cases, they talk about pathology.

How to treat phimosis in men and is it necessary at all? This article will answer all these questions, as well as tell you what phimosis is, its symptoms, the causes of the pathology, the consequences and methods of treatment.

Features of the disease

Given the statistics, phimosis occurs in 95% of newborn boys. The diagnosis is made by pediatricians even in the maternity hospital, if, when trying to move the skin fold of the penis, it is not possible to expose the head. This pathological process is called physiological phimosis, and normally it should go away.

However, this condition requires special attention. In the case of a protracted process, there is a risk that lubrication and smegma accumulating in the skin warehouses will lead to the development of complications. This can be manifested by itching, burning and discomfort. In the worst case, an infection of the head of the penis may join.

Types of phimosis

Pathology can be of two types:

• Congenital. Such a diagnosis is made if a boy with a previously identified physiological phimosis has unpleasant symptoms. These can be visible changes in the form of redness or swelling, pain in the area of ​​narrowing, problems with urination, discomfort, itching or burning. Congenital phimosis is detected in childhood and adolescence.
• Acquired. Phimosis in adult men is called acquired, occurs in adolescents and in men of mature age. The diagnosis of "acquired phimosis" is made if the patient had no pathology before, and the disease arose against the background of complete well-being.

Depending on the form of the disease, phimosis can be divided into three groups: cicatricial, atrophic, hypertrophic.

Causes

Consider the main causes of phimosis in adult men:

• scleroderma;
• consequences of injuries and surgeries;
• atrophic phenomena characteristic of the elderly;
• long-term inflammatory diseases of the head of the penis, acquiring a chronic course.

Symptoms depending on the degree

Complaints of the patient may vary depending on the course of the disease and the level of damage. Thus, there are four stages:

• Phimosis I degree - characterized by the fact that a man finds it difficult to move the foreskin. The disease manifests itself only when the penis is in the erection stage and enlarged in size.
• Phimosis II degree - the patient notes a feeling of discomfort when trying to expose the head of the penis in a relaxed state, and pain in an excited state.
• Phimosis III degree - characterized by a partial ability to move the foreskin in a relaxed state, and the complete inability to repeat the procedure during an erection.
• Phimosis IV degree - it is impossible to expose the head of the penis in both cases.

The fourth degree is the most dangerous, since the clinical picture is more pronounced. The patient complains of severe pain when trying to urinate. Visually, redness and swelling are noted on the genitals in the foreskin area. The man also notes itching and burning sensation. Perhaps the addition of bacterial flora, which leads to the development of inflammatory processes.

cicatricial phimosis

It develops as a result of past illnesses or after injuries and operations. The pathological process is characterized by the presence of abundant scars (scars) located in the area of ​​the foreskin. Visually they are defined as small pale lines. Usually, a frequent attempt to push the foreskin away leads to injury to the skin, which ultimately stretches the epidermis.

Gradually, microscopic lesions heal and scar. As you know, a scar is a collection of connective tissue that is devoid of elasticity and is not able to stretch. As a result of these changes, there is a narrowing in the area of ​​the foreskin, and any attempt to expose the head of the penis is doomed to failure.

Causes of development: any mechanical damage to the penis: burns, injuries and surgical interventions; transmission of venereal infections; a history of diseases of the endocrine glands (diabetes mellitus); metabolic disorders; the presence of chronic diseases of the genital organs.

Clinical picture

Symptoms of this pathology manifest themselves in different ways, depending on the degree of damage.

• Early stage. During this period, the patient is concerned about the feeling of discomfort and discomfort when the head is exposed during the period of excitation. The pain reaction occurs due to microtrauma. The early stage is not accompanied by visible changes on the penis in the form of swelling or redness. Each time a man repeats attempts to expose the head, the number of microtraumas increases, and over time, the number of scars also increases. Thus, the first stage gradually passes into the second.
• Clinical stage. At this stage, the patient complains of severe pain at the time when he pushes back the foreskin. The characteristic symptomatology already manifests itself in a relaxed state.
• late stage. Is the most difficult. It is characterized by a loss of the ability to urinate normally. A man during this period suffers from impotence, since the process of ejaculation is impossible. The foreskin narrows to such an extent that urine and seminal fluid accumulate in the preputial space. Visually, this is manifested by swelling of the penis.

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Over time, this condition progresses and, if the bacterial flora is attached, an infection develops.

Complications

Among the complications are often observed:

• Balonitis is an inflammatory lesion of the head of the penis;
• Balanoposthitis - an infection affects the head of the penis and its mucous membrane.
• Infertility.
• Paraphimosis is one of the most dangerous complications. It is characterized by compression of the head by dense scar tissue. Pinching it can be so strong that it leads to a violation of the outflow of blood. The result may be the appearance of necrotic spots in the area of ​​the foreskin. This complication requires immediate surgery.

A characteristic feature of cicatricial phimosis is that in the absence of proper treatment, the pathology progresses and leads to complications. A man feels constant discomfort, and sexual intercourse becomes impossible due to severe pain. Therefore, one should listen to the golden words of Persia, who said: "Prevent the disease when it just comes."

Therapeutic measures

Therapeutic measures are divided into two methods: surgical (surgery) and medication (medication). Therapy is aimed at eliminating the connective tissue narrowing surgically. There are three methods of operation: circumcision, plastic and laser correction. Let's consider each of them in detail.

Circumcision

In surgery, the operation is called circumcision, which in Latin means circular excision of the foreskin. The technique is very simple and takes only half an hour. The patient is given local anesthesia before the operation.

Circumcision with cicatricial phimosis differs from traditional circumcision, where it is customary to stretch the foreskin to the sides. In this case, the narrowing site is removed, without pre-tensioning the skin fold. This technique is the most popular, it is used at any stage of phimosis and does not cause complications.

Plastic

When performing this technique, the foreskin is not removed. Why do doctors try to save the skin fold? The fact is that it performs a number of important functions:

• barrier protection. The foreskin covers the head and prevents the effects of environmental factors.
• Hydration. The head of the penis itself does not have secret glands that provide a moisturizing function.
• Maintain normal temperature and pH environment.
• Self-purification - occurs during urination. The foreskin is washed with sterile urine, which removes any impurities and germs. However, the inside of the foreskin is washed by its own secretion.
• immunological protection. The fact is that the secretory glands of the foreskin daily produce proteins that have antibacterial and antiviral effects. This helps prevent the development of inflammation of the male genital organs.
• Sensitivity during intercourse. The foreskin is equipped with many nerve endings that are responsible for receiving pleasure during sexual intercourse.
• The foreskin produces male pheromones. Sexual attraction hormones are produced in the exocrine glands and excreted. Pheromones are odorless, but they are caught by the opposite sex at the expense of the vomeronasal organ. It is located in the mucous membrane of the nasal cavity.

Summarizing the above functions that the foreskin performs, we can conclude that it is very important for a man. That is why plastic surgery is now more relevant than circumcision.

The operation consists in making small incisions on the skin near the head, which ultimately expands the narrowed scar ring. Thus, the possibility of exposing the head is resumed.

Phimosis correction with a laser

Manipulation is carried out using special equipment that affects the skin with a laser beam. This allows you to make thin incisions that free the foreskin from cicatricial narrowing. After that, the ability of the head to show outward returns.

Laser correction has a number of advantages compared to other operations:

• Painless manipulation;
• This is a bloodless process;
• The foreskin is preserved;
• There is no need for rehabilitation;
• The risk of complications is excluded.

Cicatricial phimosis does not go away on its own, and moreover, it can lead to adverse consequences. That is why you should contact surgeons already in the early stages of the disease.

atrophic phimosis

The disease is characterized by thinning in the area of ​​the foreskin. Visually, shortening of the foreskin is noted, as a result of which the head is tightly covered. The main distinguishing feature of atrophic phimosis is the presence of a small hole in the apical region of the head. This species is more common in older men.

The disease requires only surgical intervention, since home treatment is not effective.

If you do not see a doctor in time, the results of phimosis can be very dangerous. The foreskin eventually becomes covered with small tears, which leads to bruising. When bacteria or viruses attach, infection may develop.

Hypertrophic phimosis

This phenomenon is opposite to atrophic phimosis. If in the first variant the foreskin is thin and short, then in the hypertrophic process it is thicker and longer. The skin noticeably hangs down and takes on the appearance of a "proboscis". Most often occurs in childhood.

The disease does not show any symptoms. However, the long foreskin does not allow for full hygiene measures. Thus, impurities and secretions accumulate on the inner surface of the mucous membrane. It is dangerous by the addition of a secondary infection.

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Hypertrophic phimosis is one of the few pathological processes that can be treated without surgery at home.

The basis of therapeutic measures includes proper care and simple exercise. Doctors recommend gradually tightening the foreskin. Such a procedure will eventually lead to its shortening.

paraphimosis

This is one of the complications that occurs in men against the background of progressive phimosis. Paraphimosis is characterized by compression of the head by the narrowed part of the foreskin. As a result, she cannot take her former position and remains turned outward.

The patient will complain of severe pain in the narrowed area. Visually, you can observe blue or reddening of the head of the penis, as well as its increase due to edema.

Among the reasons are:

• Most often, paraphimosis occurs in boys and young men. The cause of the occurrence is the progressive course of phimosis in men. This complication occurs only in the second and third stages of the disease, since in the first stage there is still no obvious narrowing, and in the fourth - the pathology is so advanced that it is impossible to expose the head.
• Adult patients usually experience pinching of the head at the time of sexual intercourse or masturbation, and boys - during hygiene procedures.
• In addition, there is a so-called iatrogenic phimosis. It occurs during medical procedures such as catheter placement and cystoscopy.

First aid for paraphimosis.

A pinched head is an acute condition, and therefore requires urgent medical attention. An ice pack should be applied to the affected area. You can apply anesthetic ointment. This will help reduce swelling and reduce pain. After that, treatment is carried out in a hospital. Under local anesthesia, the urologist repositions the head of the penis. After the completion of the manipulation, the patient is prescribed local applications with prednisolone ointment. In the event that attempts to set the head did not lead to success, then the patient is sent to the operating room. Treatment of phimosis in men is surgically aimed at excision of the narrowed ring.

Can surgery be avoided?

Having found out the cause of the disease and having learned what it is, we will consider how to get rid of phimosis and whether it is possible to get by with treatment at home.

Drug therapy is carried out in the early stages of the disease, when there are no obvious pathological changes in the genital organ. This method of treatment is also called conservative or non-surgical. Taking medication helps only with the first degree of phimosis. After the diagnosis is made, the attending physician prescribes a hormonal ointment (corticosteroids). The tool helps in the process of regeneration of microtraumas, and also helps to eliminate swelling and redness.

Tension method

Non-surgical treatment includes the foreskin stretching method. The exercise is quite simple and does not require special skills. It allows you to treat phimosis at home in adults. The meaning of the treatment of phimosis without surgery is that the patient must pull the foreskin in the area of ​​its narrowing. Thus, the technique for eliminating phimosis at home can be carried out by the patient himself, subject to prior agreement with the urologist.

Most patients manage this simple task. However, to treat without surgery, the Glansha apparatus can also help. It was first invented in Japan, but today this instrument can be found in Moscow. It has a fairly simple design and its application does not cause difficulties.

The procedure for eliminating phimosis in men by stretching the skin fold is contraindicated in patients with cracks and microtraumas. Perhaps this will lead to the development of a secondary infection.

Glansha apparatus

How to cure phimosis using the Glansha apparatus? The device looks like scissors, only its ends are rounded, they work on the principle of percentage. What to do?

With the help of the Glansha apparatus, one should grab the free edge of the skin flesh and gradually remove it. The advantage of using the tool is that it allows you to stretch the foreskin up to 6 mm. Thus, the ability to cure phimosis without surgery increases three times. Signs that allow you to determine the correctness of the manipulation: the absence of pain and the effectiveness of eliminating phimosis when treated at home.

There are several rules that should be followed before starting treatment for phimosis in adults:

• Hygiene. Hands must be washed well before the procedure. It is best to use an antiseptic (non-alcohol).
• Before proceeding with the technique, it is recommended to take a bath for twenty minutes.
• Preparation of the skin of the penis - involves the treatment of the narrowing zone with any emollient cream (preferably for children). This will give the skin elasticity, which will facilitate the treatment of phimosis without surgery. The cream should be applied in small portions, gently and evenly distributing it.

In addition, treatment with herbal baths will help get rid of phimosis in men. For this, decoctions of chamomile, mint and calendula are suitable.

As you can see, phimosis can be cured both surgically and by folk methods. However, it is worth remembering that the disease is easier to treat in the early stages of development. As Cervantes said: "Consciousness of one's illness, and willingness to be treated is already the beginning of healing."