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[[File:Paraphimosis.jpg|200px|thumb|right|Paraphimosis in a young adult.]]
Paraphimosis is a condition where a [[retraction of the foreskin|retracted]] [[foreskin]] becomes trapped behind the head of the [[penis]], and thus unable to return to its forward position covering the [[glans]]. If the condition is prolonged, paraphimosis can become an emergency.<ref name="DeVries">DeVries CR, Miller AK, Packer MG. [http://www.cirp.org/library/treatment/phimosis/devries/ Reduction of paraphimosis with hyaluronidase]. ''Urology'' 1996 48(3):464-465</ref> <ref name="NOCIRCpretract">[http://www.nocirc.org/publish/6pam.pdf ''Answers to Your Questions About Premature (Forcible) Retraction of Your Son's Foreskin'']. San Anselmo: NOCIRC, 2000.</ref> <ref name="Berk">Berk DA, Lee R. [https://www.aafp.org/afp/2004/0215/p807.html Paraphimosis in a middle-aged adult after intercourse]. ''Am Fam Physician'' 2004;69(4):807.</ref> The tissue may become oedematous and swell thus further aggravating the problem.<ref name="NOCIRCpretract"/>
== Cause ==
===Childhood===
Paraphimosis is a perfectly avoidable, [[iatrogenic]] condition. In infants and young children, this condition may occur as a result of doctors, parents or caretakers [[forced retraction|forcibly retracting]] the [[foreskin]] of a child's penis. It may also occur in older males as a result of [[Forced foreskin retraction| forcible retraction of a foreskin]] whose orifice has not yet dilated enough to allow the [[glans penis|glans]] through. (See [[phimosis]].) The first person to retract a boy's foreskin should be the boy himself.<ref name="wright1994">{{REFjournal
|last=Wright
|accessdate=2021-06-02
}}</ref>
===Adulthood===
Paraphimosis may result when a tight or phimotic [[foreskin]] is forcibly retracted. Paraphimosis may also result from sexual intercourse with a tight foreskin.
== First aid ==
First aid for this condition is simple. The head of the [[penis ]] must be squeezed very tightly between thumb and forefinger. This forces blood out of the head and reduces the size.<ref name="Berk"/> The [[foreskin ]] can then be brought forward to its normal position. Application of ice may also be helpful.<ref name="NOCIRCpretract"/> See the Video section for additional methods of reducing paraphimosis.
== Hospital treatment ==
Turner et al. recommend using Adson forceps to apply traction to return the prepuce to its normal forward position.<ref name="Turner">Turner CD, Kim HL, Cromie WJ. [http://www.cirp.org/library/treatment/paraphimosis/turner1/ Dorsal band traction for deduction of paraphimosis]. ''Urology'' 1999;54:917-8.</ref>
Some doctors recommend [[circumcision ]] as treatment, but there is no evidence in the medical literature to support this recommendation. Additionally, this radical form of treatment sacrifices the [[prepuce]], where patients may seek to preserve its function and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
==Video==
Dr. Pravin H. Shinde demostrates paraphimosis reduction without surgery.
<br><br>
<youtube>A21gDqW5e4E</youtube>
Paraphimosis reduction without surgery.
== Prevention ==
Education concerning proper care and development of the prepuce is the most effective way of preventing paraphimosis from occurring. Parents, doctors, and other caretakers should be instructed to never [[forced retraction|forcibly retract]] a boy's foreskin. In older males, the forcible retraction of a narrow [[foreskin ]] should be avoided.<ref name="Reynard" /> The foreskin [[foresk should be returned to the forward position after cleaning or sexual intercourse.<ref name="Choe">Choe JM. [http://www.aafp.org/afp/20001215/2623.html Paraphimosis: current treatment options]. ''Am Fam Physician'' 2000;62:2623-28.</ref> <ref name="Berk"/>
Some doctors recommend [[Adolescent and adult circumcision| circumcision]] as prevention, but there is no evidence in the medical literature to support this recommendation. Furthermore, this sacrifices the prepuce, where patients may seek to preserve its [http://www.intactaus.org/information/functionsoftheforeskin/ function] and value, and protection of the individual from unnecessarily radical surgery is always a doctor's prerogative.
Manual [[stretching]] of the tight tip of the [[foreskin]] to widen the narrow part will prevent recurrence of paraphimosis. [[Stretching ]] is not complete until the [[foreskin ]] will [[Gliding action|glide smoothly back and forth ]] while the [[penis ]] is in a state of [[erection]].
{{SEEALSO}}
* [[Foreskin]]
* [[Gliding action]]
* [[Penis]]
* [[Phimosis]]
* [[Reduction of paraphimosis]]
* [[Stretching]]
* [[Tissue expansion]]
{{LINKS}}
* {{REFjournal
|DOI=
|accessdate=2022-06-08
}}
* {{REFweb
|url=https://www.cirp.org/library/treatment/paraphimosis/
|title=Paraphimosis: Conservative Treatment
|last=Anonymous
|first=
|init=
|publisher=Circumcision Reference Library
|date=2004-04-17
|accessdate=2023-04-20
}}