Phimosis in boys: photo, treatment
- A little anatomy
- What is phimosis?
- Types of phimosis
- Causes of phimosis
- Symptoms of phimosis in boys
- Complications of phimosis in boys
- Diagnosis of phimosis in boys
- Treatment of phimosis in boys
The reproductive system is very important for humans, primarily because it provides the continuation of the genus, and the existence of the species for a long time. In humans, this system is integrated with the urinary organs and, among other things, is necessary for the normal functioning of the body.
A little anatomy
In norm at representatives of a stronger sex the head of a sexual member is covered by an extreme flesh. This anatomical formation is a duplicate of the skin and has two sheets - the outer and the inner. The inner leaf of the prepuce most of the time covers the glans penis and acquires some features characteristic of the mucous membranes of the body.
The importance of this area of the flesh is still being actively disputed among scientists from around the world. Some believe that the foreskin is a kind of rudiment, does not bring the patient benefits, and in some cases even harmful, contributing to the accumulation of microorganisms. It also mentions the likelihood of development of oncological pathology of the foreskin, which does not threaten patients after circumcision. Their opponents claim that in fact the probability of developing urinary tract infections in circumcised and uncircumcised men is about 1%. Cancer of the foreskin is also extremely rare. Simultaneously, the surface of the glans penis is protected from the influence of unfavorable factors, the epithelium on it does not coarsen, and the sensitivity remains at the same level.
Normally, the foreskin covers the entire surface of the head in an unexcited state. During erection, it shifts and completely bares the head in most men. At the same time, there is no pain and discomfort. However, this is not found in all men.
What is phimosis?
Phimosis is a condition in which the foreskin has such a narrow opening that the head of the penis can not be fully exposed. It should not be rash to call phimosis all cases when the head of the penis can not be naked on its own and without additional efforts.
Virtually all healthy newborn boys can not completely expose the head of the penis. This is typical only for 4% of babies born. At the age of one year, in many boys the foreskin is still connected with the penis by the synechia and completely displaced only by a small percentage of children.
By the age of three every fifth child has an extreme flesh that is so mobile that the head of the member is exposed completely. That is why, until this age, it is not recommended to perform surgical interventions for phimosis. The fact is that pathology can retreat independently under the influence of changes that occur in the body of a child and a teenager in the process of growing up.
Not always this condition brings the patient discomfort. About a quarter of the young guys at the age of 18 can not completely expose the glans penis, but they do not bother much. Some even like their condition, and they deliberately do not conduct treatment.
The disease is important for children and adults. In the latter case, the presence of the disease is almost always due to the lack of adequate treatment in childhood. Indeed, in early childhood the head of the penis in most cases is not denuded, which is normal. Gradually the child grows up, and parents no longer often see his sexual organs (they used to take part in bathing a child). After puberty begins, and the teenager is already embarrassed by his nudity, unaware of the problem.
Types of phimosis
Physicians allocate several degrees of phimosis depending on how much the size of the prepuce does not correspond to the diameter of the head of the penis of the boy.
- 1 degree is characterized by the fact that the glans penis can be opened, but only in a calm state. During erection, the exposure of the head is difficult, and sometimes completely impossible.
- 2 degree - to expose the head is difficult in the unexcited state. With an erection, the glans penis is not exposed to the outside, or only the tip of the penis is exposed. In this extreme flesh strongly squeezes the tissue, which makes it difficult to drain the venous blood from the body. As a result, the terminal tip of the penis swells like a ball.
- 3 degree - during erection, the penis head can not be exposed even partially. In a calm state, it is only partially exposed, and it is never completely eliminated.
- 4 degree - the most pronounced, since the head of the penis is never exposed. In this case, there is a violation of urination due to difficulty in getting the urine out of the urethra. It accumulates under the foreskin (outwardly it looks like a swelling) and a thin trickle or completely drops out. Also, in these patients, ejaculation is difficult.
In addition, some scientists distinguish relative phimosis - a condition in which the narrowing of the foreskin becomes somewhat noticeable only during erection (this can include 1 degree of development of the disease).
Causes of phimosis
There are several reasons that can provoke phimosis in boys.
- Congenital phimosis occurs most often and develops due to a slight disruption in the formation of the genital organs. This may be due to the genetically predisposed deficiency of the elastic component in the tissues of the child's foreskin.
- Injuries of the penis cause the development of narrowing of the foreskin in those cases when a large scar from the connective tissue is formed during the healing of the lesion. It tightens the flesh and forms the so-called cicatricial stenosis.
- Balanoposthitis is an inflammation of the foreskin of the penis, which develops due to the action of pathogenic microorganisms. If appropriate measures are not taken in a timely manner, it is possible to damage a large volume of penile tissues and subsequently develop phimosis.
Symptoms of phimosis in boys
- The most important symptom of the disease is the inability to open the glans penis or the difficulties that arise when trying to do this.
- With pronounced phimosis, when the head is completely covered with the foreskin, urination is impaired. Little children at the same strain, worry, often cry. Urine droplets are released from the hole in the foreskin, and the preputial cavity is inflated as a sac.
- Older children can complain about the pain that occurs during an erection. It is important to have a trusting relationship with the child, and then he does not hesitate to tell the parents about the problem. Interestingly, the pain is more typical for 1 and 2 degrees of the disease. This is due to the fact that during the erection the head can still be exposed, but the preputial ring squeezes either its part or the trunk of the penis. At 3 and 4 degrees the foreskin covers the head even during erection and nothing is squeezed by the preputial ring.
Complications of phimosis in boys
In addition to the above clinical manifestations of the disease, it is possible to develop individual pathologies provoked by phimosis.
Balanoposthitis is an inflammation of the inner leaf of the prepuce and the glans penis. Special glands continuously secrete a specific secret (smegma), which falls on the head of the penis and in the presence of the foreskin accumulates during the day. Gradually, it mixes with the dying epithelium (this is a normal process of renewing the integument of the body) and a small amount of urine (in any case part of it remains on the head). As a result, a substance having a white color and a specific odor is formed.
Most boys who observe personal hygiene rules regularly wash their genitals and do not face problems. In the presence of phimosis, especially pronounced, it is difficult to conduct a thorough toilet of the penis head and foreskin. As a result, a large amount of smegma accumulates in the prepuce sack, which is a good nutrient medium for microorganisms. As a result, the risk of developing balanoposthitis increases several times in patients.
The disease is characterized by the following symptoms:
- Reddening of the head;
- Excretion of pus from the preputial sac.
A frequent condition developing in boys with phimosis. It is important to always remember: under no circumstances should you make great efforts when trying to expose the glans penis. The fact is that it gradually expands in the direction from the hole of the urethra, and the trunk of the penis is much narrower. As a result of forcible opening of the head, the foreskin is somewhat stretched (this can cause a short-term feeling of pain), and after tightly wrapping the ring with a penis behind the head.
The contracted blood vessels no longer fulfill their function, and the head tissues begin to lack oxygen and nutrients. If you do not take timely measures, then necrosis or gangrene of the penis may develop, which forces the doctors to remove the affected area - the patient becomes an invalid.
Manifestations of paraphimosis:
- The head is enlarged and swollen;
- The boy experiences a feeling of severe pain (babies cry and do not let them touch the penis).
The fusion of the head and foreskin
With prolonged contact, epithelial tissues gradually become more and more firmly adhered to each other and synechia - fusion is formed. This condition only aggravates the situation, making the opening of the head impossible.
Diagnosis of phimosis in boys
The disease is easily detected with a simple external examination. It is not necessary to resort to additional methods of investigation and subject the patient to various diagnostic manipulations.
The fact that the boy's foreskin can not expose the head, even a person without special education is able to determine, but the doctor's function here is different. Based on their experience and knowledge, medical workers can determine the degree of phimosis and choose the right treatment tactics.
Treatment of phimosis in boys
Doctors always try to avoid surgical intervention, because even the simplest operation involves certain risks. At the first stages resort to conservative methods, which in some cases eliminate the problem.
Since the foreskin is elastic enough, it can be stretched by some exercises, which can be taught to any teenager or parent of a baby (small children can not perform it themselves).
- Gradual stretching of the prepuce by partial stretching it on the head of the penis. Naked head is needed until a slight unpleasant sensation appears. If the child is small, then you need to be extremely careful and do not make great efforts. Exercise is necessary every day for 10 minutes. Sometimes, when full head exposures are possible, adolescent boys begin to masturbate. In this case, it only benefits, because masturbation promotes the stretching of the tissues of the foreskin and the elimination of the disease.
- You can also stretch the preputial ring with two fingers, which are inserted between the head and the flesh. They need to be planted in the sides, causing tension, each time more and more powerful. In 75% of cases with conscientious execution it is possible to get rid of the disease.
- While taking a bath or bathing under the influence of warm water, the tissues become more elastic. As a result, the exercise at this time is more productive. It is important not to exert much effort, so as not to provoke paraphimosis. According to the researchers, after 2 months you can achieve complete head opening, even with pronounced phimosis.
- To fix the foreskin in the desired position, special rings can be used, which are put on the penis.
When doing any exercise, you need to remember the golden rule: never try to sharply expose the head of the penis.
This treatment has not received wide distribution, but it is not necessary to forget about it. There is a technique in the use of ointments with glucocorticoids. If you rub it daily into the head of the penis and massage it, then you can very likely achieve a hurry.
Not all doctors want to apply hormonal ointment to boys, even though there were no side effects when used.
These methods are used only in cases where the previous methods did not bring the expected effect. In most cases, doctors perform longitudinal incisions of the prepuce and then cross-link it. This increases the diameter of the preputial ring, and the head can be exposed.
A number of patients are helped by an operation on the Schloffer. Under local anesthesia, the surgeon performs a zigzag incision, after which the edges of the wound formed are sewn in such a way that the area of the flesh increases while maintaining all of its tissues.
The solution to the problem can be circumcision - an operation in which the foreskin is completely excised and the glans penis remains nude all the time. The disadvantage can be considered the fact that over time, the open surface is somewhat coarsened and will change the sensitivity.
Surgical treatment is most effective and helps the patient in 99-100% of cases.
Treatment of paraphimosis
If suddenly it happened that the foreskin is moved behind the head of the penis and squeezes the underlying tissues, then it is necessary to immediately contact specialists without waiting for the deterioration. Otherwise, serious complications are possible.
If the squeezing of the penis is not strong, sometimes it is possible to eliminate the problem conservatively: the organ is smeared with petroleum jelly or other similar substance and the foreskin moves gently (without much effort). Otherwise, it is necessary to perform surgery: the foreskin is dissected and pressure is eliminated. Often the operation continues and the flesh is completely removed.