Phimosis: norm and pathology, the symptoms, when and how to treat

Phimosis is the condition in which it is impossible to completely withdraw the head from the foreskin of her contractions. It is found in 90% of the boys before the start of the puberty and is the result of physiological maturation of the penis. Phimosis in men is a pathological condition. He develops in 2-3% of adults and leads to many serious complications, reduces the sense of sexual relations. In the early stages of phimosis can be treated successfully with conservative methods, therefore, it is important to notice the disease and seek medical help.

the mechanism of phimosis

The mechanism of the development of

The Penis is the external sex organ of men, whose main purpose is to Deposit sperm in the female vagina. The most sensitive part is the head, is concentrated the largest number of nerve endings. It is covered with a delicate epithelium, which is similar to the structure of the red border of the lips. At the top of the head, opens the urethra. Its lower part is combined with the cavernous bodies of the penis, which form the trunk. In this place the penis is a thickening of the coronary sulcus can be felt, immediately below the head.

Protects the delicate skin of the head against damage to the skin fold the foreskin. It consists of 2 sheets:

  • The outer – in structure identical to the skin epidermis, it has an upper cornified layer;
  • The inside is covered with a thin epithelium, which is similar to the mucous membranes.

In foreskin starts from coronal sulcus and closely covers the entire head, forming prepucialis cavity. She opens the front opening which easily expands and releases the head out. In normal adult men, the foreskin moves easily, completely exposed to the upper part of the penis. In the back of the head of inner leaf of the cavity closely aggregated tissue in the form of a bridle. In the thickness of the bridle is behind the huge number of nerve endings and capillaries, therefore, stimulates the during sexual intercourse gives a man pleasure.

The foreskin performs the following functions:

  1. Protects the urethra against the invasion of pathogens, which comprises a hole;
  2. To prevent mechanical irritation and injury to the thin epithelium on the surface of the head, keeping the sensitivity;
  3. Makes it easy to slide in intercourse, the production of smegma, and a smooth inner layer;
  4. Increases the pleasure received during intercourse due to stimulation of nerve endings of the glans and frenulum. This is an important factor in the evolutionary plan: without a strong positive emotion of people who would refuse sex and were less likely to procreate.

Phimosis as a pathological condition develops after inflammation or injury to the foreskin. Consequently, the impact of destroyed tissue and initiate the inflammatory process. He passes through certain stages, and always ends with the restoration of the integrity of the body. Deep damage shall be replaced by the formation of coarse connective tissue, which significantly reduces the elasticity of the foreskin. The high activity of reduction processes leads to the formation of connective tissue septa between the inner leaf of the cavity and at the head of the penis. They firmly hold together and prevent the denudation the upper part of the penis.

classification of phimosis

Classification

It is understood that phimosis is not a disease, but specific condition that is associated with the physiological properties of the organism (life), heredity, and damage to the material, the foreskin. In this regard, there are the following forms of phimosis:

  • Physiologic – occurs in most boys before puberty, is associated with functional maturation of the prepucialis cavity. Is not a disease and is itself resolved after 7 years.
  • Pathological – occurs as a result of inflammation, injury, metabolic disorders, and require treatment:
  • Hypertrophic (sura);
  • Atrophic;
  • Scar.

The frequency of occurrence of a particular form of phimosis depends on the age. Kids in most cases is physiological in nature, but in men it causes scarring.

Depending on the severity of the process there are 4 degrees of phimosis:

  1. In the relaxed state the head is released in full, during the erection, its the secretion of the obstacle and painful;
  2. At rest, the penis is excreted in the work, during erection is completely covered by foreskin and not released;
  3. The head can be partially withdrawn only at rest;
  4. Head constantly hidden by the foreskin, is not displayed. During urination urine out drop by drop.

Physiological phimosis

The genitals of the boy began to draw after 11-12 weeks of fetal development. The head of the penis and foreskin are formed from a common rudiment in the third trimester of pregnancy, their separation happens when the coronal sulcus. The cells of the prepuce started to share, well ahead of its tissue growth in the penis. In the end, they surround the head in the form of a Cup and close the cavity. Anatomic proximity and common tissue lead to the formation of the delicate epithelial walls between the inner leaf of the foreskin and the skin on the head.

A newborn child prepucialis cavity is completely closed from the environment such direction, which eliminates the entry into it of pathogenic organisms. After the 3-4 month of life the beginning of the functioning of the sebaceous glands in the foreskin. Produce smegma, which accumulates in a small amount in the cavity. Your infection and the development of suppress the inflammation of the epithelial septum in the region of the hole of the foreskin. Gradually these subtle nor destroyed, smegma transferred to the output and released through the formed space. You can see this in the form of small waxy flakes white to the linen of children.

For the time of puberty the partition in whole or in part have reduced the mobility of the foreskin increases. During the Masturbation or after the beginning of sexual life the head begins to be fully released, although for the first time, the process can be painful. Thus, the physiological phimosis self-resolves in puberty and do not require treatment.

phimosis child

Treatment in case of inflammation

Despite the naturalness of phimosis in some cases, it is necessary for the medical care. With just a little care for a boy, or a disregard for personal hygiene in prepucialis bag with leather gets pathogenic microflora and inflammation develops. Clinically is manifested by redness around the edge of the holes prepuce, local pain and foul smell from the penis. In the subsequent inflammation leads to the formation of cicatricial phimosis that will require surgical treatment.

Upon detection of these symptoms of the child, parents should consult a pediatric urologist. Previously often done the way open at the same time foreskin a sharp movement. This procedure is very painful for the boy and can cause psychological trauma. In addition, at the same time opening damages the foreskin and can cause scarring of the phimosis in the future.

Today, doctors recommend a gradual opening of the head for 1-2 mm., This will be done after a warm bath, preferably with the addition of antiseptic: a decoction of chamomile, calendula, sage. Should be 2-times per week 10-15 minutes. After the water treatment of the foreskin is treated with healing ointment or baby cream increases its elasticity and prevents tearing. Skin push not more than 2 mm in one case. This method can cure phimosis at home for several months.

The ineffectiveness of the above-described manner, the surgeon or urologist dissects the adhesions formed by the probe. He performs the procedure in an outpatient setting without anesthesia or under local anesthesia. The doctor inserts the prepucialis bag a thin metal rod with a rounded end and leads you around the range of the glans penis. Later should daily wash the penis the boy with the use of antiseptic solutions.

Pathological phimosis

Causes of pathological phimosis are:

  • The genetic defect of connective tissue;
  • On metabolic disorders;
  • Inflammatory diseases of the foreskin and penis head;
  • Injury to the penis;
  • The infections are transmitted sexually;
  • The age change.

Hypertrophic

Hypertrophic phimosis is an excessive development of the prepuce, which is a long proboscis, hanging from the penis. At the end of the "proboscis" is narrowed and opens with a dense ring, the removal of the head through which is not always possible.

The long proboscis extended route for excretion of urine and smegma, which favorable conditions for the growth of pathogenic micro-organisms. Increased humidity in the prepucialis of the bag and the accumulated sebum is a perfect breeding ground for bacteria. They damage the epithelium with the glans and inner layer of the foreskin with the development of inflammatory reactions. In children with diabetes in prepucialis bag often multiply the yeast fungi, which seem intolerable itching of the genitals and a thick white discharge. Balanoposthitis often ends with the formation of a scar forms of phimosis.

The second reason for the pathology – hypoplasia of penis normal size of the foreskin. This is detected in the process of puberty boy and is usually associated with inadequate secretion of testosterone by the testes. In this case phimosis, combined with low economic growth, lack of muscle mass, excessive hair growth, lack of growth of facial hair, high voice, and depression.

scarring phimosis

Scar

Scarring of the phimosis is the most common form of the disease among adult men. Reasons is any condition that leads to inflammation of the foreskin or the head. Between genital infections are the most common cause of balanoposthitis in the outcome of the Treponema pallidum. The Virus of genital herpes, human papillomavirus and Candida also often cause inflammation of the glans. In children with cicatricial phimosis is rare and approximately one third of the cases could not ascertain the cause of the disease.

The disease progresses slowly. In the first weeks after the inflammation is formed with a thin connective tissue bridges, which slightly restricts movement of the foreskin. Just a few months are quite thicken, become dense and hard. The mobility of the foreskin is reduced, the head is still in the closed state even during erection, and attempts to discover them accompanied by severe pain. The forced exposure of the head leads to a small tear, bleeding and the formation of new scars.

The last level of phimosis violate the self-cleaning of the cavity and the process of urination. At the end, the patient developed a urinary tract infection: urethritis, cystitis, pyelonephritis. In addition, scarring of the phimosis hinders the normal flow of sexual intercourse. There is a need for additional lubrication, a man is not getting enough stimulation and feel of pain when stretching the foreskin.

Treatment of pathological forms

Diagnosis and treatment of phimosis leading urologist, a surgeon. If the cause of the illness is the sexually transmitted disease, the patient is additionally watching the dermatologist, who prescribed therapy with antibiotics. Treatment in this case, should both partners.

Treatment conservative treatment is performed on the first two stages of phimosis, adhesions, if it is ok, and it was not more than a month. In such cases, the patient is recommended to gradual stretching of the foreskin after a warm bath. On the glans penis, apply anti-inflammatory ointments containing glucocorticoids and the absorption ointment. Open the head carefully, to avoid damaging the foreskin. According to the procedure shown medicinal drugs.

Surgical treatment method is trimming. The operation includes the complete removal of the foreskin, the glans after it remains permanently open. Intervention is performed under General anesthesia for children and local anesthesia for adults. First, the surgeon makes a cut and bends, the outer leaf of the foreskin, then carefully cut the adhesions. After both sheets selected, cuts them off at the coronal sulcus. The entry wound, the surgeon sews the stitching material, which later dissolves, that is, removing the stitching after the surgery is not needed. In the postoperative period of performance of 1-2 bandages and discharged the patient home. Complete tissue healing occurs in 2-3 weeks and after this period you can resume sexual activity.

Complications and prevention

Among the complications of phimosis occur most often:

complication and prevention
  1. Infringement of the head – it develops in the attempt to bring the head of the penis from the mouth. Tight ring in foreskin compresses the tissue of the head, it swells and increases the size of the. Due to its gear reduction becomes impossible, disrupted blood flow to the tissue and without medical emergency situation with a necrosis – necrosis of the strangulated part of the head.
  2. Inflammation of the foreskin and the penis head.
  3. Urethritis, cystitis, pyelonephritis – developed with 4 degrees of phimosis because of a violation of a urine stream.
  4. The increment of the foreskin to the glans – the most damaged areas due to tight junction between each other, to heal one scar, the cut, which is not always possible.

As preventive measures, the most important are:

  • Careful genital hygiene, daily washing away from the children and the timely change the diaper or diaper;
  • Use barrier methods of contraception (condom) during sex with a casual partner;and
  • Treatment of serious diseases (diabetes).
31.03.2019