Phimosis from the Greek. phimosis - tightening of the compression) – this is a narrowing of the foreskin that prevents the removal of the glans of the penis. This is the norm for the young people and the representatives of the stronger sex, but it becomes a pathology, a break at the time, it was the end of it. Let's try to understand where is the border between the countries.
To clearly represent the problem of the phimosis, to draw attention to the peculiarities of the anatomical structure of the prepuce "male dignity."
The Penis (of the penis) is made up of a body, a head and a stem. The head of the penis hidden behind the skin of the foreskin (prepuce), which in the adult male is easily displaced, exposing the head. The foreskin is made up of two sheets: the external, which is no different than most of the other parts of the skin of the body, and the interior is 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 is the secret of the glands of the under the foreskin and form a special lubricant (smegma), which allows for the sliding of the head. On the lower surface of the penis foreskin is connected to the head of the frenulum of the prepuce is a skin fold, in which the blood vessels and nerves. The head is the external opening of the urethra.
Children of the knights of the glans is the prepuce adherent to a kind of the tip, which does not allow you to freely withdraw its head. This is the physiological function of the - a kind of protective mechanism, in order to reduce the likelihood of infections of the preputial space, and for the development of the inflammation is known as physiological phimosis. For boys of 3 to 7 years of age, with the physiologic phimosis is the normal state! Statistics show that at the age of 1 year, the head of the penis is opened in 50% of boys and by 3 years - is already at 89 %. The frequency of phimosis in the 6-7-year-olds (8 % of 16-18-year-old boys is only 1 %.
The growth of the head member gradually pushes the prepuce, it is sinehii be destroyed. Now, in puberty, and from 12-14 years of age, when the aktiviziruyutsya male sex hormones, due to which the fabric of the foreskin more elastic and stretchable headband shown in its entirety.
Physiological phimosis does not require treatment, however, required the parents to pay close attention to the condition of the external genitalia of the child. The status of the glans penis, the prepuce and preputial SAC (the space) is the easiest to control, daily cleanup, and then, when the baby urinates. If the foreskin is swollen and reddened, and the baby, and then extends the hand to cause the city (and even more so in the case of tough urination), it is imperative that you consult with children's services, and if such a specialist does not have a pediatric surgeon or a urologist.
Of phimosis as a medical diagnosis (i.e., pathological narrowing of the prepuce) to have to speak to in the event that the head of your penis, don't be the guy after 6-7 years.
Phimosis, with regard to the condition of the prepuce may be atrophic and hypertrophic. In atrophic phimosis skin of the foreskin is very thin and is very susceptible to microtrauma, which results in the formation of a scar. In hypertrophy, the prepuce, on the contrary, quite thick, and is in the form of a "proboscis" to talk far beyond the borders of the glans of the penis.
In addition, phimosis, make a distinction between the degrees. Depending on the severity of the narrowing of the foreskin, there are 4 degrees of phimosis:
The main causes of phimosis are the following:
It should also be noted, however, that phimosis is a factor for a further reduction of the foreskin. The fact that the presence of even a slight decrease of the constant injury on the leaves of the foreskin after exposure to the head. This situation is especially common in puberty and the formation of an erection. During an erection, increases the size of the header and the body of the penis, which causes the voltage of the foreskin, and the investment in the micro-gap. In the process of the healing of the field in micro-gap, which is formed in scar tissue are not able to tension, which leads to the progression of the phimosis.
Because of the phimosis it is a bit difficult to clean, if you aren't careful to care for the child, a possible stagnation of smegma. Unfortunately, this is the perfect breeding ground for bacteria, which can lead to the development of the inflammatory process. In addition to this, the long-term stagnation it is possible the formation of a dense formation - smegmatis (literally, "the stones of smegma").
Especially, it is dangerous to phimosis the 4-th level, in which there are barriers to the outflow of urine. Increased pressure in the preputial sack, at the end of urination, when you lower the pressure in the bladder leading to a backflow of urine and the dissolved smegma urethra. This leads to the development of infectious complications in the urethra.
In general, the main danger is not phimosis and all its complications. The most powerful of these is the paraphimosis - infringement of the glans narrowed foreskin by forcibly opened. This can happen when the family or child, it's called "got game" - exposed to the head, and return the foreskin to the city is not able to. Paraphimosis may occur at a later age, during sexual intercourse or Masturbation. A violation leads to the swelling of the penis head, that, at a certain level it makes the gear reduction is not possible. As a result of violations of blood circulation in the head will turn blue and become very painful. And, if you do not provide the necessary assistance, may lead to necrosis (necrosis) of the head, leading to its amputation.
As you know, is to help, in this case, you can only be a specialist. Immediately call an ambulance. Procrastination as an attempt to cope with that problem by your own, it is fraught with the loss of valuable time, and the dire consequences.
A dangerous complication of phimosis can be balanoposthitis - an inflammation of the foreskin and the glans of the penis. It is being developed all the time, when the poor cleanliness of the genital area, and infection of the preputial space. The opportunity for the development of balanoposthitis is increased in children with reduced immunity, or to other infectious diseases. Inflammation of the foreskin it is characterized by swelling, redness (hyperemia), pain, purulent secretions from preputial space. The result is inflammation, which can become a cicatricial degeneration of the skin of the foreskin and, as a consequence, the further development of phimosis. Balanoposthitis is a disease in need of urgent medical attention. The doctor inserts a special probe in between the glans penis and the skin of the foreskin, which is neatly divided into, on the disposal of the sinehii, thus creating conditions for the outflow of the accumulated pus.
The other complication of phimosis that requires an immediate treatment to a doctor with acute retention of urine. However, this condition is more common in young children and is a "reflex" in nature, as a reaction to the pain. Of the child for a long time could not urinate, becomes restless, complains of pain in the stomach and above the vagina, where a palpable enlarged bladder. In the process, the baby is given pain medication, do a cleansing enema (the bowel full of stool, not further pressed, and does not impede the flow of urine), and then take a warm bath with potassium permanganate, in which the child tries to urinate. If that doesn't work, the urine flows through the catheter.
The complication of phimosis grade 3 and 4, it can also be the increment of the foreskin to the head. Usually the first to grow up in this small area, and the area of the seam to spread and, eventually, the foreskin adheres to the glans penis in its entirety. In this case, trying to open the head accompanied by sharp pain and bleeding. However, this condition is not an emergency, but for a start, they should not be. When the increment of the foreskin was the only possible surgical treatment. However, as with much of the plot of fusion reaction it may be difficult, the sooner the problem is discovered, the easier it is to get started.
In the treatment of phimosis can be used for both conservative and surgical methods.
In the hypertrophic phimosis, if there are no complications, may be conservative treatment, which includes gradual stretching of the foreskin. The manipulation can be carried out by parents in the home. Three times a week, while bathing with decoctions of herbs (succession, daisies) is to move the foreskin until the child is in the stomach, and then into the preputial space is introduced a few drops of sterile paraffin oil. The duration of treatment is several months old. The process has to be done very carefully in order to avoid paraphimosis. The success depends on the perseverance of the parents, and the severity of the phimosis.
In the last few years, which is to be used by the correction of phimosis hormone ointment, which she was still lying in the preputial space. They are easier to stretch the fabric. The treatment is carried out by parents, within the framework of the statutory supervision of a medical doctor.
In the atrophic (scar) phimosis conservative treatment is not effective. In this case, the surgical methods are to be used.
Indications for the surgery, the paraphimosis is expressed cicatricial changes in the prepuce, the multiple recurrence of balanoposthitis, a violation of urination.
The fastest and the most effective treatment of phimosis - operation, which is called the circumcision, or of circumcision. In this intervention, the foreskin is removed, which will eliminate the exposure of the glans of the penis. This operation lasts for 10 to 15 minutes and is usually performed under General anesthesia. The foreskin is cut to a circular (circle), with preservation of the frenulum. The inner and outer sheets of the foreskin is sewn together with catgut (suture material, which does not yet require the removal of the sutures, such as myself). After the surgery, a bandage with petroleum jelly, oil. A few hours after the surgery, the child is able to walk, restored self urination. Circumcision is indicated for any degree of phimosis.
Contra-indications for circumcision are balanoposthitis, and paraphimosis.
The longitudinal cut of the foreskin
This method can be used when full information may not be available. As a rule of thumb, that in his treatment of the two types of complications of phimosis, with acute balanoposthitis, and paraphimosis. In the first case, the longitudinal slit in the foreskin is so decided, that, due to the fact that the opening of the inflammation of the glans of the penis is not able to be circumcised, as the infection can lead to insolvency seams. Well, paraphimosis, when the acute circulatory failure does not allow for a full crop, a longitudinal cut of the foreskin is the only way to "break up" the ring squeezing the glans of the penis.
By the way, in any case, after the acute stage (that is, when it is the worst thing for the us), your doctor may recommend that you perform a circumcision, which would not drugs, and cosmetic value.
Development of phimosis in large part as a result of a genetic predisposition, thus the drastic measures of prevention of this disease medicine has to offer. You can, however, talk about the prevention of the complications of phimosis. Here, the first and the main role is played by the requirements.
The early stages of development, proper hygiene care is limited to daily bathing the child and washing once baby dirty nappies, or diapers. While digging under the foreskin goes in the water, which, of course, flushes out the accumulated game. At least once a week, you need to wash your penis and scrotum with soap and water. It is better that you use baby soap or special baby bath facilities. We do not recommend the daily use of antibacterial Soaps or gels. With frequent use, you may disrupt the balance of normal microbial environment which is needed for healthy skin.