Phimosis (Greek. phimosis - tightening and compression) – this is a narrowing of the foreskin, which prevents removal of the glans penis. This mode is the norm for young representatives of the stronger sex, however, becomes a pathology, a stop after the time was over. Let's try to understand, where the border between.
Clearly imagine the problem phimosis, to remember the peculiarities of the anatomical structure of the prepuce "male dignity."
Penis (penis) consists of a body, head, and root. The head of the penis hidden behind the skin of the foreskin (prepuce), which the adult male is easily displaced, exposing the head. The foreskin consists of two leaves: the outer, which is no different than most other skin areas of the body and interior, soft and smooth, resembling mucous membrane. Between the head and the inner leaf of the foreskin has preputial space (sometimes called the preputial SAC). This cavity stands out as the secret of the glands under the foreskin and shape, special lubricant (smegma), which facilitates the sliding of the head. The underside of the penis the foreskin is attached to the head of the frenulum of the foreskin is the fold of skin where the vessels and nerves. The head is the external opening of the urethra.
Newborn knights of the glans is the foreskin attached to the kind of spikes that do not allow you to freely raise your head. This physiological feature - a kind of protective mechanism to reduce the likelihood of infection of the foreskin space and the development of inflammation - called physiological phimosis. Boys 3-7 years with physiological phimosis is completely normal! Statistics show that at the age of 1 year, the head of the penis to open 50 % of boys and 3 years - is already 89 %. The frequency of phimosis in 6-7-year-olds is 8 %, and 16 to 18-year-old boys - only 1 %.
The growth of the head member gradually pushes the foreskin, physiological sinehen destroyed. Well, the age of puberty, from 12 to 14 years old, when aktiviziruyutsya male sex hormones, allowing the fabric of the foreskin more elastic and flexible head opens fully.
Physiological phimosis does not require any treatment, but requires that parents pay attention to the condition of the external genitalia of the child. The condition of the glans penis, the prepuce and preputial SAC (the space) is easier to manage during daily cleaning, and then, when the baby urine. If the foreskin is swollen and reddened, and the child and then will stretch hand a causal place (and even more, if difficult urination), it is important to include children's services, and if such expert is not a pediatric surgeon or urologist.
About phimosis as a medical diagnosis (i.e., pathological narrowing of the foreskin) began to speak in that case, when you bring the head of the penis to the boy as of 6-7 years.
Phimosis, depending on the condition of the foreskin may be atrophic and hypertrophic. Atrophic phimosis skin of the foreskin is very thin and very susceptible to micro trauma, resulting in the formation of scars. In hypertrophic, the foreskin, on the contrary, quite thick, and in the form of "proboscis" talks a lot about boundaries over the glans penis.
In addition, phimosis, to distinguish the degrees. Depending on the severity of narrowing of the foreskin, there are 4 degrees of phimosis:
- 1 degree. Calm (relaxed) state, the head of the penis is exposed without problems, but during erection it requires a little effort.
- Of 2 degrees. During an erection the head does not open at all, calm effort.
- 3. degree. The head of the penis does not open at all, or is possible only with great effort, and only a calm state of the penis, but problems with urination phimosis, when I used it.
- 4 degrees. Urinating first swells of the foreskin bag, and then piss (trickle or dropwise) stands out. The head of the penis can not even reveal.
The main causes of phimosis are:
- Genetic predisposition to the formation of phimosis result of failure of the elastic part of connective tissue in the body;
- Trauma to the penis, which led to the formation of scar tissue, which leads to narrowing of the foreskin;
- Inflammation of the foreskin of the penis also lead to cicatricial changes.
It should also be noted that phimosis is a factor of the further narrowing of the foreskin. The fact that the presence of even a small contraction is continuing damage to the sheets of the foreskin, when the exposure head. This situation is particularly common in puberty and the emergence of the erection. During erection increases the size of the head and the body of the penis, which causes tension in the foreskin and the formation of its micro-gaps. In the process of healing in the field of micro-gaps is formed in scar tissue are not able to tension, which leads to the progression of phimosis.
What is dangerous phimosis
Because of the phimosis is a bit difficult to hygiene, if not careful care of the baby, the possible stagnation of smegma. Unfortunately, it is the perfect breeding ground for bacteria, which in turn can cause the development of inflammatory processes. In addition, long-term stagnation is even possible, the formation of dense formations - smegmatis (literally "stones smegma").
Especially dangerous is phimosis 4-th degree, which is the obstacles to the outflow of urine. The increased pressure on the foreskin sack at the end of urination, when you reduce the pressure on the bladder that leads to urine back flow and dissolved smegma urethra. This leads to the development of infectious complications in the urethra.
Complications of phimosis
Generally speaking, the greatest danger is not phimosis and its complications. The greatest of these is paraphimosis - infringement glans narrowed foreskin forced it open. This can happen when the family or child, which is called "on game" - the exposed ends, and to restore the foreskin in place are not able to. Paraphimosis can also occur later in life, during sexual intercourse or Masturbation. Violation leads to swelling of the penis head, that at one point makes the reverse reduction is impossible. As a result of violations of blood circulation in the head turns blue, and becomes sharply painful. And if not to provide emergency relief, can be necrosis (necrosis) of the head, leading to its amputation.
As you know, helps in this case can only be a specialist. Immediately call an ambulance. Procrastination as an attempt to cope with this problem itself, is fraught with the loss of valuable time and serious consequences.
A dangerous complication of phimosis can be balanoposthitis - inflammation of the foreskin and the glans of the penis. It develops when the poor cleanliness of the genital organs and infection of the foreskin space. The opportunity to develop balanoposthitis growth in children with reduced immunity or against other infectious diseases. Inflammation of the foreskin is characterized by swelling, redness (hyperemia), pain, purulent secretions from preputial space. The result of inflammation can become cicatricial degeneration of the skin of the foreskin and, as a consequence, further development of phimosis. Balanoposthitis is a disease, which requires urgent medical help. The doctor inserts a special probe between the glans penis and the skin of the foreskin, which neatly divided the available sinehen, which creates preconditions for the outflow of the accumulated pus.
Another complication of phimosis require immediate treatment to the doctor with acute urinary retention. This condition is more common in young children, and is reflex in nature, as a reaction to the pain. Child for a long time could not urinate, becomes restless, complains of pain in the stomach and above the vagina, with a palpable distended bladder. Handling process, the baby will be given pain medication, do a cleansing enema (intestines filled with feces, no more pressed, and does not prevent the flow of urine), and then make a warm bath with potassium permanganate, during which the child tries to urinate. If it doesn't work, the urine passes through the catheter.
Complication of phimosis grade 3 and 4 can be also increase the foreskin to the head. Usually the first growth in this small area, so the area of the seam to expand and eventually the foreskin attaches to the glans penis in its entirety. In this case, trying to open the head accompanied by sharp pain and bleeding. This condition is not an emergency, but to start it should be. When the insertion of the foreskin is only possible surgical treatment. But, as a large plot of fusion intervention can be difficult, the earlier a problem is detected, the easier it is to solve.
Treatment of phimosis
Treatment of phimosis can be applied to both conservative and surgical methods.
Conservative treatment of phimosis
In hypertrophic phimosis, if there are no complications, a possible conservative treatment, which consists in the gradual stretching of the foreskin. Manipulation can be performed by parents at home. Three times a week, when bathing in decoctions of herbs (succession, daisies) is the displacement of the foreskin until the child is in pain, and then the foreskin space is introduced a few drops of sterile paraffin oil. The duration of treatment is several months. The procedure should be done very carefully in order to avoid paraphimosis. Success depends on the perseverance of the parents and the severity of phimosis.
In recent years, is used to repair phimosis hormonal ointments, which lay in the preputial space. They make it easier to stretch the fabric. The treatment is carried out by parents under compulsory medical supervision.
Atrophic (scar) phimosis conservative treatment is not effective. In this case, surgical methods are used.
Surgical treatment of phimosis
Indications for surgery are paraphimosis expressed cicatricial changes of the foreskin, the repeated recurrence of balanoposthitis, violation of urination.
The fastest and most effective treatment of phimosis - an operation called circumcision or circumcision. In this speech, the foreskin is removed, which eliminates the risk exposure of the glans penis. This procedure lasts 10-15 minutes and is usually performed under general anesthesia. The foreskin is cut circularly (circles), with preservation of the frenulum. The inner and outer sheets of the foreskin is sewn together with catgut (suture material, which in addition does not require removal of sutures, such as self-centered). After surgery, a bandage with vaseline oil. A few hours after surgery, the child can walk, restored self urination. Circumcision is meant any degree of phimosis.
Contraindications for circumcision are balanoposthitis and paraphimosis.
A longitudinal cut of the foreskin
This operation is used when a full circumcision may not be possible. As a rule, its treatment two types of complications of phimosis, acute balanoposthitis, and paraphimosis. In the first case, a longitudinal incision of the foreskin is resorted to due to the fact that the opening of the inflamed glans penis can be circumcised, because the infection can lead to insolvency seams. Well, paraphimosis, when the acute circulatory failure does not allow a full circumcision, a longitudinal incision of the foreskin is the only way to "break up" the tire to squeeze the glans penis.
By the way, in any case, after the acute period (that is, when the worst is behind us), your doctor may recommend to perform circumcision, which would have been a non-medicinal and cosmetic value.
Prevention of phimosis
Development of phimosis is largely due to genetic predisposition, so radical measures, prevention of this disease medicine can offer. But we can talk about prevention of complications of phimosis. Here, the first and most important role is played by hygiene.
Infancy proper hygiene care limited to daily bathing of children and washing once baby's dirty diaper or a diaper. While bathing under the foreskin, becomes water, which naturally flushes out accumulated secret. At least once a week, you should wash the penis and testicles with soap and water. It is better to use baby soap or special baby bathing facilities. Not recommended for daily use of antibacterial Soaps or gels. With frequent use they can upset the balance of normal microbial environment necessary for healthy skin.