Phimosis is a condition in which it is impossible to completely pull the head the foreskin of her contractions. It is found in 90% of boys before the beginning of puberty and is a manifestation of the physiological maturation of the penis. Phimosis in men is a pathological condition. He develops in 2-3% of adults and often leads to serious complications, reducing the sensation during sexual intercourse. The initial stage of phimosis can be treated successfully with conservative methods, so it is important to note the disease and seek medical attention.
The mechanism of the development of
The Penis is an external sexual organ of men, whose main task is to Deposit sperm inside a woman's vagina. The sensitive part is the head, it is concentrated the largest number of nerve endings. It is covered with a delicate epithelium, which is similar in structure to the red border of the lips. At the top of the head opens the urethra. Its lower part is fused with the cavernous bodies of the penis, forming a frame. In this place the penis is a thickening of the coronary sulcus, it can be felt immediately under the head.
Protect the delicate skin of the head lesions of the skin fold of the foreskin. It consists of 2 sheets:
- The outer structure identical to the skin's epidermis, is the upper cornified layer;
- The internal is covered with a thin epithelium, which is similar to the mucous membranes.
The foreskin began to coronal sulcus and tightly cover the entire head, forming prepucialis cavity. He opens the front opening which easily expands and releases the head off. Normal adult men, the foreskin moves easily to fully reveal the upper part of the penis. The back of the head the inner leaf of the cavity tightly fused tissue in the form of a bridle. The thickness of the bridle lies in the huge number of nerve endings, and capillaries, so promoting during sexual intercourse gives a man pleasure.
The foreskin performs the following functions:
- Protects the urethra against the penetration of pathogens, covering the hole;
- To prevent mechanical irritation and damage to the thin epithelial surface of the head, keep it sensitivity;
- It is easy to slide your sexual intercourse, the production of smegma and a smooth inner layer;
- Add to the pleasure received during intercourse because the stimulation of nerve endings in the glans and frenulum. This is an important factor, the evolution of the plan: without strong positive emotions people would refuse sex and were less likely to reproduce.
Phimosis, such as a pathological condition develops when inflammation or injury of the foreskin. The resulting impact destroyed the tissue and start an inflammatory process. He passes through certain stages and always ends with the restoration of the integrity of the authority. Deep damage has been replaced by the formation of coarse connective tissue, which significantly reduces the flexibility of the foreskin. The high activity of the reduction processes lead to the formation of connective tissue septa of the inner leaf of the cavity and the head of the penis. They tightly hold them together and prevent the denudation of the upper part of the penis.
It should be clear that phimosis is not a disease, but a special mode, which is related to the physiological properties of the organism (age), heredity and damage the fabric of the foreskin. In this regard, there are the following forms of phimosis:
- Physiological – occurs in most boys before puberty, is associated with functional maturation of the prepucialis cavity. Is not a disease, and is self-solved after 7 years.
- Pathological – occurs as a result of inflammation, trauma, metabolic disorders and require treatment:
- Hypertrophic (proboscis);
The frequency in a certain form of phimosis depends on the age. Children in most cases is physiological in nature, but in men is caused by scarring.
According to the severity of the process is 4 degrees of phimosis:
- In a relaxed state of the leader is released completely, during the erection, its excretion is hampered, and painful;
- At rest, the penis is excreted in the work, during erection it is fully covered by the foreskin and is not published;
- The head can be partially withdrawn only at rest;
- The head is constantly hidden in the foreskin, not shown. Urinating urinary away drop by drop.
The genitals of boys began to form, after 11-12 weeks of fetal development. The head of the penis and the foreskin is formed in the common rudiment of the third trimester of pregnancy, their separation occurs, if the coronal sulcus. The cells of the foreskin began to share, in good time before the growth of the tissues of the penis. In the end, they surrounded the head in the shape of a Cup and close the cavity. The anatomical proximity and joint tissue leads to the formation of the delicate epithelial walls of the inner leaf of the foreskin and the skin of the head.
The newborn child prepucialis cavity is a completely closed environment, such as strands, which eliminates the penetration into it of pathogenic organisms. 3-4 months, life starts the activity of the sebaceous glands of the foreskin. They produce smegma to accumulate a small amount in the cavity. Its infection and the development of inflammation prevents the epithelium of the intermediate wall region of the opening of the foreskin. Gradually these subtle strands is destroyed, the smegma is shifted out and released through the formed free space. It can be seen in the form of small waxy flakes white linen child.
When puberty partitions completely or partly reduced and the movement of the foreskin more. During the Masturbation or after the beginning of sexual life the head begins to be fully liberalized, although for the first time, the process can be painful. Thus, the physiological phimosis self-resolves in puberty and does not require treatment.
Care if the inflammation
Despite the naturalness of phimosis in some cases, there is the need for treatment. With a little care for a son or for failure to comply with personal hygiene prepucialis bag leather gets pathogenic microflora and inflammation develops. Clinically it is manifested by redness around the edge of the hole of the foreskin, the local pain and the unpleasant smell of the penis. The subsequent inflammation leads to the formation of cicatricial phimosis requiring surgical treatment.
Upon detection of such symptoms of the child, parents should consult a pediatric urologist. The previously widely practiced method at the same time open the foreskin with a sharp movement. This procedure is very painful for the boy and can cause psychological trauma. In addition, simultaneously with the opening damages the foreskin and can cause cicatricial phimosis in the future.
Today, doctors recommend a gradual opening of the head of 1-2 mm., It is performed after a warm bath, preferably with the addition of antiseptic: a decoction of chamomile, calendula, sage. Make it should be 2 times a week for 10-15 minutes. After water treatment of the foreskin is treated with healing ointment or baby cream to increase its elasticity and prevent tearing. Skin push-up to 2 mm, one procedure. This method can cure phimosis at home for several months.
The ineffectiveness of the above-described method, the surgeon or urologist dissects the adhesions formed in the sensor. He will perform the procedure on an outpatient basis without anesthesia or under local anesthesia. The doctor inserts a prepucialis bag with a thin metal rod with a rounded end and engage them around the circumference of the glans penis. Later would daily wash the penis boy use antiseptic solutions.
Causes of pathological phimosis include:
- A genetic defect of the connective tissue;
- Metabolic disorders;
- Inflammatory diseases of the foreskin and penis head;
- Trauma of the penis;
- Infection transmitted sexually;
- Age-related changes.
Hypertrophic phimosis is the excessive development of the foreskin, which is a long proboscis hanging penis. At the end of the "proboscis" has narrowed and open dense ring, remove the head, which is not always possible.
Long snout lengthen the path of the excretion of urine and smegma, resulting in favorable conditions for pathogenic micro-organisms. Increased humidity prepucialis bags and the accumulated sebum is a perfect breeding ground for bacteria. They damage the epithelium of the glans penis and the inner layer of the foreskin development of inflammatory reactions. Children with diabetes prepucialis bag often multiply the yeast fungus that becomes unbearable itching of the genitals and a thick white discharge. Balanoposthitis often ends with the formation of scar forms of phimosis.
Another cause of the pathology – hypoplasia of penis normal size of the foreskin. It is observed that the process of puberty in boys and usually is associated with inadequate secretion of testosterone from the testes. In this case phimosis, coupled with the low growth, lack of muscle mass, excessive hair growth, lack of growth of facial hair, high voice, and depression.
Cicatricial phimosis is a common disease among adult men. Reasons, it is any condition that leads to inflammation of the foreskin or head. Among genital infections are the most common cause of balanoposthitis the result is Treponema pallidum. Virus genital herpes, human papilloma virus and Candida also often cause inflammation of the glans penis. In children with cicatricial phimosis is rare, and approximately one third of cases can not find out the cause of a disease.
The disease progresses gradually. The first week after the inflammation is formed by a thin connective tissue bridges, which slightly restricts movement of the foreskin. Just a few months, they considerably thicken, to become dense and hard. The mobility of the foreskin is reduced, the head remains in the closed state even during erection, and try to find them are accompanied by severe pain. To the exposure of the leader to lead a small rupture, bleeding and the formation of new scars.
The last degree of phimosis violate the self-cleaning of the cavity and the process of urination. Eventually, the patient developed a urinary tract infection: urethritis, cystitis, pyelonephritis. In addition to cicatricial phimosis interferes with normal sexual intercourse. The need for additional lubrication, a man is not getting enough stimulation and feel of pain, when stretching the foreskin.
The treatment of the pathological forms of
Diagnosis and treatment of phimosis makes a urologist, a surgeon. If the cause of the disease was a sexually transmitted disease, the patient is in addition to watching the dermatologist, who will prescribe antibiotic treatment. Treatment in this case, would be for both parties.
Treatment conservative treatment is performed in the first two degrees of phimosis, adhesions, if the condition and there was no more than a month ago. In such cases, the patient is recommended, with gradual stretching of the foreskin after a hot bath. The glans penis to apply anti-inflammatory ointment containing glucocorticoids and absorbable cream. Open the head carefully, avoiding injury of the foreskin. After the procedure shown healing drugs.
Surgical method of treatment is circumcision. The action involves the complete removal of the foreskin, the glans penis after it remains constantly open. The intervention is performed under general anesthesia in children and under local anesthesia in adults. First, the surgeon makes an incision and bend the outer leaf of the foreskin, then gently cut the adhesions. When both sheets selected, it will cut them out of the coronal sulcus. As a result of the wound, the surgeon sews the stitches in the material, which later dissolves, that is, removal of sutures after surgery is not required. Surgery performed 1-2 ties and let the patient's home. Complete tissue healing occurs in 2-3 weeks and after this you can resume sexual activity.
Complications and prevention
Among the complications of phimosis are encountered more often:
- Violation of the head – it develops trying to forcibly bring the head of the penis cavity. A tight ring of foreskin compress the tissue of the head, it swells and increases in size. As a result of its turn the reduction is impossible, disturbed blood circulation in the tissue and without an emergency situation ending in gangrene – gangrene of the strangulated part of the head.
- Inflammation of the foreskin and penis head.
- Urethritis, cystitis, pyelonephritis – developed with 4 degrees of phimosis, as a violation of the current of urine.
- The insertion of the foreskin of the glans penis – the most damaged areas, because of the tight junction to each other to heal one scar, cut, which is not always possible.
As preventive measures, the most important of which are:
- Careful genital hygiene, daily washing out of the child and the timely change the diaper or diaper;
- Use mechanical contraception (condoms) during sex with a casual partner;
- Treatment of major diseases (diabetes).