The difficulty or inability to open the glans penis on a background of scarring and narrowing of the foreskin, called "cicatricial phimosis". In men pathology is usually secondary, or is a consequence of untreated phimosis in childhood. Pathology suffer 2 – 3% of men. Cicatricial phimosis brings a lot of inconvenience to the men, in addition to not being normal hygiene, such defect adversely affects the quality of sexual life, and in severe cases – to violate the act of urination.
In addition, due to the accumulation of smegma in the preputial SAC and breeding of bacteria can develop following diseases:
Smegma is a product of secretion of glands, has carcinogenic properties that could lead to cancer of the penis. Therefore, an adult male, even as a preventive measure, you need to get rid of phimosis.
The lack of skills of proper hygiene from a young age – pre-disposing factor to the formation of adhesions of the glans with the skin.
What is phimosis
In young children, lengthening and narrowing of the prepuce is of a physiological nature. As a rule, the growth of the penis, the head opens independently. Some boys is 3 to 4 years, others 6 – 7, to medical interventions running closer to adolescence. Exception – pronounced phimosis, in which there is an obstacle to the flow of urine and recurrent balanitis or balanoposthitis.
In adults, most are diagnosed with cicatricial phimosis. It leads to inflammation of the inner layer of the foreskin and the glans of the penis on the background of various diseases, where the leaders are infections that are transmitted sexually, recurrent urogenital candidiasis, diabetes, genetically determined change in the connective tissue, burns and injuries of the genital organs, obesity. The reason – decrease in elasticity of the tissue and formation of adhesions (scarring).
What are the symptoms of cicatricial phimosis
There are a number of symptoms of cicatricial phimosis, under which the urologist after the physical examination makes the diagnosis. Typical signs:
- the inability to access head;
- cicatricial changes in the skin;
- pain when trying to move the foreskin;
- discomfort during sexual intercourse caused by blood filling the corpora cavernosa, increase in the diameter of the member and the increased compression of the phimosis ring;
- the occurrence of gaps in the foreskin as a result of trauma and resilience;
- painful night erections.
When joining a secondary bacterial microflora appear purulent discharge.
Cicatricial phimosis in men is not solved by yourself, medical attention is necessary in 100% of cases.
This condition develops when you try to expose the head with a little effort, or after sudden movements during sexual intercourse. The foreskin moves, but the tight phimosis ring compresses the head of the penis, which leads to swelling and poor circulation in the body. Pain syndrome is expressed significantly in paraphimosis, the glans penis becomes bluish tint.
The state is considered to be in urology urgent and requires immediate hospitalization for urgent operative treatment.
Procrastination leads to tissue death, in the most extreme cases is amputation of the penis.
Stage cicatricial phimosis
There are 4 stages:
Stage 1: the glans is uncovered in "calm" state, during erection, difficulties may arise;
Stage 2: difficulties in the exposure head erectus and in a calm state, the pain.
Stage 3: the head is not open, the foreskin moves with great difficulty, the appearance of areas of trauma in the rupture of adhesions, the separation of droplets of blood. The progression of adhesions leads to the next stage.
Stage 4: the inability to bring the head, marked narrowing of phimosis ring problems with the flow of urine, filling her preputial pouch during the act of urination, change in the quality of the urine stream.
What tests are needed with cicatricial phimosis
Laboratory examination includes the following tests they will need before hospitalization for the treatment of:
- General analysis of blood and urine;
- blood for syphilis, hepatitis b and C, HIV infection;
- >blood sugar;
- screening for STDs to establish the possible cause;
- blood group and RH factor;
- determination of coagulation parameters of blood (coagulation);
- the study of urethral discharge with microscopy;
- with abundant purulent discharge – tank.sowing on flora and sensitivity to antibiotics.
Instrumental examinations with cicatricial phimosis uninformative and are suspected inflammatory diseases of the male genitalia.
If the exposure head is rendered any tumor, it is possible to perform biopsies with subsequent histological examination.
Sometimes in cases of suspected inguinal lymphadenitis prescribe ultrasound examination of regional lymph nodes.
Treatment of cicatricial phimosis in men
In the early stages of the disease and the absence of pain, perhaps the use of conservative therapy. Note that in the future, if a positive decision, these patients would be at risk for relapse. Since there is already a tendency to adhesion, a radical solution is surgery.
Drugs for conservative treatment:
- Corticosteroid ointment. Relieve inflammation, increases the elasticity of the foreskin, relieve swelling. Application of hormonal ointments artificially perform the stretching of the foreskin.
- Antibacterial drugs. Inhibit the growth and reproduction of bacteria, which have a pronounced anti-inflammatory effect. When severe inflammation antibiotics with broad spectrum of activity assigned to oral inside, for the local treatment of more suitable products in the form of creams.
- Antiseptic solutions. Apply baths or lotions with a solution of potassium permanganate (potassium permanganate), sodium bicarbonate (baking soda), herbal plants with anti-inflammatory, wound healing properties: chamomile, calendula, sage, St. John's wort, oak bark.
In any case, before the planned operative treatment is reasonable to stop the phenomena of inflammation.
Surgical treatment of cicatricial phimosis
Laser therapy is used at the initial stages of the disease. In these cases, the use of lasers like photo-degradation is an effective and less traumatic way of solving delicate problems.
The benefits include the following:
- fast recovery of a patient after intervention;
- the ability to save the foreskin and the usual sensitivity of the penis head;
- no bleeding, scar deformity;
- low risk of infection;
- the safety of the surrounding tissues;
- the ability to perform procedures in an outpatient setting.
Treatment of cicatricial phimosis is performed under anesthesia and lasts 30 to 40 minutes. Outpatient treatment involves applying anti-inflammatory creams, antiseptic baths.
The classic radical method of getting rid of phimosis include the operation Circumcisio (circumcision).
It is carried out in stationary conditions or in an outpatient surgery. Nature of the operation, the dissection and removal (full or partial) of the foreskin, cosmetic seams impose self-resorbable threads. The recovery period is 3 to 4 weeks. If the operation was successful, and postoperative periods without any complications, sex after circumcision can be practiced in about a month.
The main disadvantages include the increased sensitivity of the exposed head during sex, and as a result, early ejaculation or a change in sensation during intercourse. As a rule, these States do not require treatment.