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Treatment To Resolve Paraphimosis
Medically reviewed by Jamin Brahmbhatt, MD
Paraphimosis is a condition in which the foreskin becomes trapped behind the head of an uncircumcised penis. This can quickly become a medical emergency if left untreated as blood flow to the head of the penis is cut off. It can lead to tissue damage and, in extreme cases, gangrene (tissue death).
Paraphimosis can often be corrected with manual manipulation. Failing this, circumcision (surgical removal of the foreskin) or other procedures may be needed.
This article describes the causes and symptoms of paraphimosis and explains when it is time to seek emergency care. It also offers prevention tips and guidance on how to treat mild paraphimosis at home.
Photo composite by Joules Garcia for Verywell Health; Getty Images
Paraphimosis vs. PhimosisParaphimosis should not be confused with phimosis. Phimosis is when the foreskin of a penis is tight and cannot be retracted (pulled back) over the head of the penis. Phimosis is normal in uncircumcised children and usually corrects itself by age 13. In others, phimosis can lead to swelling, pain with erections, and even erectile dysfunction.
Paraphimosis and Risks of Pulled-Back ForeskinParaphimosis occurs when the foreskin (prepuce) is pulled and gets stuck behind the head of the penis (glans). This creates a restrictive band around the shaft of the penis, cutting off blood flow and causing painful engorgement of the penis head.
Paraphimosis may occur due to incorrect manipulation of the foreskin or not repositioning it properly after urination or cleansing. This condition can also arise when parents prematurely attempt to retract a child's foreskin that is not yet ready to be pulled back.
Caregivers in adult care homes can sometimes cause paraphimosis by forgetting to restore the foreskin after cleaning older adult residents. The same can occur in healthcare settings after a penile examination or the placement of a urinary catheter.
Paraphimosis can even sometimes occur after sexual intercourse, which some colloquially refer to as "nuptial night tragedy."
Risk factors for paraphimosis include:
A tight foreskin
Phimosis
Foreskin infections
Penile injuries
Reliance on a caregiver for daily cleaning
Urinary catheterization (inserting a flexible tube to empty the bladder)
Related: Causes of a Swollen Penis
Signs and Symptoms of ParaphimosisParaphimosis can often go unnoticed when the foreskin entrapment first occurs. Over time, however, the constriction of the penis can cause the glans to swell more and more due to the buildup of fluid (known as edema). Within a relatively short time, mild paraphimosis can turn severe.
When symptoms develop, paraphimosis is easy to detect and causes:
An inability to restore the foreskin back over the head of the penis
Painful swelling of the head of the penis
Increasing swelling with a purplish or bluish discoloration
Penile pain
Difficulty or inability to urinate
Paraphimosis can be gradual and cumulative, causing relatively little pain in some people, even when the swelling is severe. Pain should not be the measure of whether paraphimosis is serious or not. If you cannot release the foreskin, do not ignore it or go to bed hoping it will settle. Seek immediate care at your nearest emergency department.
Untreated, Worsening SymptomsParaphimosis can lead to serious complications if left untreated. Ongoing swelling and constriction can lead to complete strangulation, in which blood flow to the head of the penis is entirely cut off. The restriction of blood flow, in turn, can cause necrosis (tissue death).
If the strangulation persists, gangrene can start to set in. Gangrene is a type of necrosis in which the breakdown of tissues leads to putrification (the process of decaying or rotting). This usually occurs over the course of days rather than hours.
At this stage, symptoms of paraphimosis may include:
In some cases, partial or complete amputation of the penis is needed to prevent what is known as "gas gangrene." This is a complication of gangrene in which bacteria inside dying tissues produce gases that can lead to shock and death, often within 48 hours.
Even if amputation is not needed, gangrene can cause severe disfiguration of the penis and a loss of sexual function.
Related: What Is That Bump on My Penis?
Emergency Paraphimosis TreatmentThe first-line emergency treatment of paraphimosis is manual manipulation, also known as manual reduction. This involves using the hands to compress penis head while moving the foreskin back to its normal position. The process may be aided with a lubricant, compression bandages, and a cold compress.
If the pain is severe, an injection of a local anesthetic into the shaft of the penis may be used. A topical numbing cream containing lidocaine is especially useful in children.
If edema is severe, an injection of hyaluronidase into the head of the penis can help. This is an enzyme that breaks down compounds that contribute to edema, allowing trapped fluids to be reabsorbed by tissues.
Failing these interventions, surgery may be needed to release the trapped foreskin. There are two options commonly used: dorsal slit and circumcision.
Dorsal SlitDorsal slit is a simple procedure in which the outer rim of the foreskin is cut to widen the opening. It can be done in the office with local anesthesia or in the operating room under general anesthesia. This method is often elected by individuals who wish to keep their foreskins while addressing conditions like phimosis or paraphimosis.
In emergency situations, a dorsal slit may be the initial treatment option. If the dorsal slit does not sufficiently resolve the issue, then circumcision can be considered as a future option. This approach provides a stepwise strategy for treatment, starting with less invasive measures.
CircumcisionCircumcision is a surgical procedure involving the complete removal of the foreskin. It uses precise cuts with a scalpel, followed by stitches to aid healing. This definitive method effectively prevents the recurrence of paraphimosis.
In severe cases, particularly when other treatments are ineffective, circumcision may be the necessary course of action.
Circumcision or Not?The decision to undergo circumcision, even in emergency situations, can be difficult based on your religious, cultural, or personal beliefs. It is important to understand, however, that circumcision does not reduce penile sensitivity or sexual function, as some people may believe.
If you are in a situation in which circumcision is advised and you want to keep your foreskin, ask the surgeon if a dorsal slit is a reasonable option and, if not, why.
Related: Circumcision: 6 Factors to Consider
Treating Mild Paraphimosis at HomeParaphimosis can sometimes be treated at home with manual reduction if the swelling is relatively mild. The steps, as follow, are similar to what would be performed at a hospital emergency department and may be suitable for adults and children:
Wrap the penis snugly in plastic wrap to gently compress it without causing pain.
Apply an ice pack on the swollen areas for no more than 10 to 15 minutes. Keep the ice pack moving and place a cloth between the skin and the ice pack to prevent frostbite. You can apply the ice pack several times, waiting 30 to 40 minutes between applications.
When the swelling goes down, remove the plastic wrap.
Wash your hands and put on a pair of surgical gloves if you have any. If your nails are long, trim them.
Using both hands, hold the penis securely using your middle and index fingers. For children, one hand will usually do.
Next, apply steady, gentle pressure with one thumb to push the head through the opening of the foreskin while using the other thumb to encourage movement of the foreskin toward you.
You can use a personal lubricant to reduce friction but avoid lotions or soaps that can cause stinging if they get into the opening of the penis.
If these measures don't work, seek emergency care. Do not continue if the reduction causes pain or the swelling gets worse.
Even if you are able to reduce at home, to avoid future occurrences, make an appointment with a healthcare provider to discuss circumcision.
When to Roll Foreskin Back DownThe foreskin is meant to retract, and doing so is a part of good penile hygiene. This allows the head of the penis to be cleaned of accumulated oils and dead skin cells (called smegma). This, in turn, prevents infection, unpleasant odors, or inflammation of the penis head, known as balanitis.
Pulling the foreskin back also avoids dribbling while peeing and prevents urine from pooling in the foreskin, which can irritate the head.
For most uncircumcised people, the foreskin also retracts manually or on its own during an erection, exposing the sensitive head to stimulation during sexual intercourse.
Foreskin retraction also allows for an examination of the penis by a urologist, medical procedures like cystoscopy, or the placement of a urinary catheter.
To this end, proper foreskin care is needed to reduce your risk of paraphimosis. This includes:
Regularly cleaning the head and inner foreskin with water and a gentle soap
Always pulling the foreskin back over the head after cleaning, peeing, or having sex
Ensuring that healthcare providers or caregivers return the foreskin to its normal position after an exam, procedure, or cleaning
Never leaving the foreskin behind the head of the penis for extended periods
Teaching your child how to care for their foreskin if uncircumcised
If any of these are issues for you, you may want to consider circumcision, which is the only guaranteed way to prevent paraphimosis.
Related: Pros and Cons of Circumcision
SummaryParaphimosis is a medical emergency where the foreskin of the penis gets stuck behind the head. This cuts off circulation and causes pain, redness, and swelling of the penis head. If left untreated, paraphimosis can lead to tissue death and, in extreme cases, gangrene.
Paraphimosis can often be treated with manual manipulation to gently ease the foreskin back over the head. If this doesn't help, surgery may be needed, including circumcision.
Related: 11 Penile Disorders You Should Know About
Read the original article on Verywell Health.
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Does Broccoli Give You Gas? Here's What That Says About Your Health — And How To Avoid It
Broccoli is a plant-based staple in the American diet. A recent survey of over 5,000 people listed it as the No. 2 favorite veggie among American adults. It's versatile, inexpensive and a great addition to soups, stir-fries and pasta. Not only does it add flavor and texture to a dish, but broccoli has also many health benefits.
Broccoli is part of the cruciferous vegetable family, known for its robust antioxidant profile. This green flower — yes, broccoli is the flowering part of the plant — may protect against cancer, safeguard the heart and promote digestive health. And you can do so much more with broccoli than you may think, like grating it into a salad or making a broccoli pesto.
Let's take a closer look at the nutrition and health benefits of broccoli and other frequently asked questions, like whether it has protein, and what's the deal with broccoli sprouts.
Broccoli nutrition factsAccording to the U.S. Department of Agriculture, one cup of raw broccoli has:
● 30 calories
● 2 grams protein
● 0 grams fat
● 5 grams carbohydrates
● 2 grams fiber
● 70 milligrams vitamin C (78% daily value
● 77 micrograms vitamin K (64% daily value)
The health benefits of broccoliBroccoli has many nutritious components, but the research surrounding broccoli focuses on glucosinolates, which are sulfur-containing compounds within the veggie. These chemicals give broccoli a strong smell and sharp flavor.
Reducing cancer riskAccording to the National Cancer Institute, during chewing, glucosinolates break down into smaller compounds, which may have anti-cancer effects. Eating foods with glucosinolates may protect cells from DNA damage, inactivate carcinogens, promote cancer cell death and have anti-inflammatory effects in the body. Various studies have shown a link between eating cruciferous vegetables and lower incidences of breast, lung and prostate cancer.
Protecting against heart diseaseAccording to a review in Nutrients, glucosinolates also have antioxidant properties that benefit the heart. At least eight studies have determined that people who eat more cruciferous vegetables have lower rates of developing cardiovascular disease and stroke.
Gut health and weight lossLastly, broccoli is a valuable source of fiber, which promotes digestion and helps control appetite. Fiber also plays a role in the collection of healthy bacteria in the gut. A recent study examined how eating broccoli affects the gastrointestinal microbiota of healthy adults. Eighteen people were instructed to eat 200 grams (about 2 cups) of cooked broccoli per day for 18 days.
At the end of the study, the researchers found that those who ate broccoli had positive changes in their gut microbiome. Broccoli consumers had less Firmicutes, a gut bacteria strain linked to chronic disease, and more Bacteroides, a beneficial gut bacteria strain. These results suggest that broccoli consumption positively affects the makeup and function of the microbiome.
Does eating broccoli have side effects?Broccoli makes some people gassy and bloated. It contains raffinose, a type of sugar that isn't digested in the intestines. Instead, the gut bacteria use fermentation to digest raffinose, and gas and bloating are side effects of this fermentation process.
Raffinose is broken down during cooking, so cooked broccoli doesn't cause as much gas and bloating. The digestive side effects are individualized; some people may not experience any gas from eating broccoli.
How to cook broccoliThere are many ways to cook broccoli. One of the easiest cooking methods is roasting it in the oven. Coat the broccoli in oil and seasoning, like salt and garlic powder, and roast in a 350-degree oven for about 20 minutes. The end result is slightly soft broccoli with golden brown char.
The air fryer also yields similar results in a quicker timeframe. Again, toss the broccoli in oil and seasoning, and place it in the air fryer for 10 minutes at 350. Since the air fryer circles heat around the broccoli, it creates a crispy, browned broccoli that is super satisfying. However, it can become bitter when charred, so don't overcook it.
Steaming broccoli is a good way to soften it for stir fries. Place broccoli in a steamer for 7-10 minutes to make it tender. Lastly, add chopped broccoli to soups, stir fries or boiling pasta to create a simple one-pot meal. It will become tender in the cooking liquid in about 10 minutes.
Is broccoli a good source of protein?One cup of broccoli has 2 grams of protein, more than many other vegetables. Protein needs differ among people, and the general recommendation is to consume at least 0.8 grams per kilogram (0.36 grams per pound) of body weight per day. For a 150-pound person, that's about 54 grams of protein per day or around 20 grams per meal. People who exercise and athletes need even more daily protein.
Broccoli contributes some protein to a meal, but it's not considered a good protein source. But it's a good way to add more plant-based protein to meals, especially if you're a vegan or vegetarian who struggles to consume enough of this important macronutrient.
What are broccoli sprouts?Broccoli sprouts are baby broccoli plants. They look like alfalfa sprouts or other microgreens, and they have a slightly bitter and crunchy taste. Broccoli sprouts are usually eaten raw on sandwiches or salads for an added crunch.
Broccoli sprouts are rich in antioxidants, so they are being studied for their potential to combat inflammation and insulin resistance.
Healthy broccoli recipesGet inspired to add more green to your daily meals. Eat broccoli raw or cooked in these creative and healthy dishes:
Rigatoni with Broccoli, Walnuts and Ricotta by Casey Barber
Broccoli-Cheddar Tots by Joy Bauer
Sesame Broccoli Poppers by Mia Rigden
Roasted Broccoli and Brussels Sprouts Salad by Romel Bruno
No-Cook Grated Broccoli-Feta Slaw by Ali Rosen
This article was originally published on TODAY.Com
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