Phimosis is a condition in which it is impossible to completely withdraw the head from the foreskin of her contractions. It is found in 90% of boys before the beginning of puberty and is a manifestation of physiological ripening of the penis. Phimosis in men is a pathological condition. He develops in 2-3% of adults and leads to a number of serious complications, reduces the sensation of sexual intercourse. In the early stages of phimosis can be treated successfully with conservative methods, so it is important to notice the disease and to seek medical attention.
The mechanism of development
The penis is the external sexual organ of men, the main function of which is to Deposit sperm inside a woman's vagina. The most sensitive part is the head, it is concentrated the largest number of nerve endings. It is covered with a delicate epithelium, which is similar in structure to the red border of the lips. At the top of the head opens the urethra. Its lower part it is fused with the cavernous bodies of the penis, which form its trunk. In this place the penis is a thickening of the coronary sulcus, it can be felt immediately under the head.
Protects delicate scalp from damages a skin fold the foreskin. It consists of 2 sheets:
- The outer structure identical epidermis of the skin, has the upper cornified layer;
- The internal is covered with a thin epithelium, similar to the mucous membranes.
The foreskin starts from coronal sulcus and tightly covers the whole 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, fully exposing the upper part of the penis. In the back of the head of inner leaf of cavity tightly fused tissues in the form of a bridle. In the thickness of the bridle lies a large number of nerve endings and capillaries, therefore, the stimulation of her during sexual intercourse gives a man pleasure.
The foreskin performs the following functions:
- Protects the urethra against the penetration of pathogens, covering a hole;
- Prevents mechanical irritation and damage of the thin epithelium on the surface of the head, keeping it sensitivity;
- Makes it easy to slide in intercourse, the production of smegma and a smooth inner layer;
- Increases the pleasure received during intercourse due to stimulation of the nerve endings of the glans and the frenulum. This is an important factor in the evolutionary plan: without strong positive emotions people would refuse sex and were less likely to procreate.
Phimosis as a pathological condition develops after inflammation or injury very flesh. The resulting impact destroyed tissue and start an inflammatory process. He passes through certain stages and always ends with the restoration of the integrity of the authority. Deep damage is replaced with the formation of coarse connective tissue, which significantly reduces the elasticity of the very flesh. The high activity of reduction processes leads to the formation of connective tissue septa between the inner leaf of the cavity and the head of the penis. They firmly hold them together and prevent exposure of the upper part of the penis.
It should be understood that phimosis is not a disease, but specific condition that is associated with the physiological characteristics of the organism (age), heredity and damage to fabric of the foreskin. In this regard, there are the following forms of phimosis:
- Physiological – occurs in most boys before puberty, is associated with functional maturation prepucialis cavity. Is not a disease and is itself resolved after 7 years.
- Pathological – occurs as a result of inflammation, trauma, metabolic disorders and require treatment:
- Hypertrophic (proboscis);
The frequency of occurrence of a particular form of phimosis depends on the age. Children in the majority of cases it is physiological in nature, but in men is caused by scarring.
According to the severity of the process there are 4 degrees of phimosis:
- In repose the head is completely released, during erection, its excretion is hampered, and painful;
- At rest, the penis is excreted in the work, during erection it is completely covered by the foreskin and not freed.
- The head can be partially withdrawn only at rest;
- Head constantly hidden by the foreskin, is not displayed. During urination urine out drop by drop.
The genitals of the boy begin to form after 11-12 weeks of intrauterine development. The head of the penis and foreskin are formed from a common rudiment in the third trimester of pregnancy, their separation occurs where the coronal sulcus. The cells of the prepuce began to share, well ahead of its growth the tissues of the penis. In the end, they surround the head in the shape 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 very flesh and skin of the head.
A newborn child prepucialis cavity is completely closed from the environment such strands, which eliminates the ingress into it of pathogenic organisms. By 3-4 month life start functioning sebaceous glands of the foreskin. They produce smegma that accumulates in a small amount in the cavity. Her infection and the development of inflammation interfere with epithelial septum in the region of the hole of the foreskin. Gradually thin these heavy tanks are destroyed, smegma is shifted to the exit and released through the formed free space. It can be seen in the form of small waxy flakes white on linen child.
By the time puberty partitions completely or partially are reduced and mobility is increased very flesh. During Masturbation or after the beginning of sexual life the head starts completely free, although the first time, the process can be painful. Thus, physiological phimosis self-resolves in puberty and does not require treatment.
Treatment in case of inflammation
Despite the naturalness of phimosis in some cases, there is a need for medical care. With little care for the boy or the failure to observe personal hygiene in prepucialis bag with leather gets pathogenic microflora and inflammation develops. Clinically it is manifested by redness around the edge of the hole prepuce, local pain and an unpleasant odor from the penis. The following inflammation leads to the formation of cicatricial phimosis that requires surgical treatment.
Upon detection of such symptoms of the child, parents should consult a pediatric urologist. The previously widely practiced technique to simultaneously open the very flesh sharp movement. This procedure is very painful for the boy and can cause psychological trauma. In addition, simultaneously opening damages the foreskin and can cause cicatricial phimosis in the following.
Today, doctors recommend gradual opening of the head for 1-2 mm., It is carried out after a warm bath, preferably with the addition of antiseptic: a decoction of chamomile, calendula, sage. Make it should be 2 times a week for 10-15 minutes. After the water treatment the foreskin is treated with healing ointment or baby cream to increase its elasticity and prevent tearing. Skin push not more than 2 mm in one procedure. This method can cure phimosis at home for several months.
The ineffectiveness of the above-described method, 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 prepucialis bag thin metal rod with a rounded end and conducts them around the circumference of the glans penis. You should continue daily to wash the boy's penis with the use of antiseptic solutions.
Causes of pathological phimosis are:
- A genetic defect of connective tissue;
- The metabolic disorders;
- Inflammatory diseases of the foreskin and the penis head;
- Trauma of the penis;
- The infections transmitted sexually;
- Age-related changes.
Hypertrophic phimosis is a excessive development of the prepuce, which is a long proboscis hangs down from the penis. At the end of the "proboscis" is narrowed and opens with a dense ring, removal of the head through which is not always possible.
A long proboscis extends the path for the excretion of urine and smegma, resulting in favorable conditions for the growth of pathogenic microorganisms. The increased humidity in prepucialis the bag and the accumulated sebum is a perfect breeding ground for bacteria. They damage the epithelium of the glans and the inner layer of the foreskin with the development of inflammatory reactions. In children with diabetes in prepucialis bag often multiply yeast fungi that appears intolerable itching of the genitals and a thick white discharge. Balanoposthitis often ends with the formation of scar forms of phimosis.
Another reason pathology – hypoplasia of penis normal size of the foreskin. It is expressed in the process of puberty boy and usually is associated with inadequate secretion of testosterone by the testes. In this case phimosis, combined with low growth, lack of muscle mass, excessive hair growth, lack of growth of facial hair, high voice, and depression.
Cicatricial phimosis is the most common form of the disease among adult men. Causes are any condition that cause inflammation of the foreskin or head. Among genital infections are the most common cause of balanoposthitis in the outcome is 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 gradually. In the first weeks after the inflammation is formed with a thin connective tissue bridges, which slightly restrict movement of the foreskin. Just a few months they considerably thicken, become dense and tough. The mobility of the foreskin is reduced, the head remains in the closed state even during erection, and attempts to discover them are accompanied by severe pain. The forced exposure of the head leads to a small gap, the discharge of blood and the formation of new scars.
The last degree of phimosis violate the self-cleaning of the cavity and the process of urination. As a result, the patient develops a urinary tract infection: urethritis, cystitis, pyelonephritis. In addition, cicatricial phimosis interferes with the normal flow of sexual intercourse. There is a need for additional lubrication, a man is not getting enough stimulation and is experiencing pain when stretching the foreskin.
Treatment of pathological forms
Diagnosis and treatment of phimosis conducts urologist, surgeon. If the cause of the disease was a sexually transmitted disease, the patient is additionally watching the dermatologist who prescribes antibiotic therapy. Is the treatment in this case, should both partners.
Treatment conservative treatment is carried out at the first two degrees of phimosis, when the spikes are thin and have not occurred more than a month ago. In such cases, the patient is recommended a gradual stretching of the foreskin after a hot bath. On the glans penis is applied anti-inflammatory ointment containing glucocorticoids and absorbable ointment. Open the head carefully, avoiding injury of the foreskin. After the procedure shown healing drugs.
Surgical method of treatment is a circumcision. The operation involves complete removal of the foreskin, head after her remains constantly open. The intervention is performed under General anesthesia in children and under local anaesthesia in adults. First, the surgeon makes an incision and bends the outer leaf of the foreskin, then carefully cut adhesions. After both sheets selected, it cuts them off at the coronal sulcus. The resulting wound, the surgeon sews the suture material, which later dissolves, that is, removal of sutures after surgery is not required. In the postoperative period perform 1-2 bandages and the patient is discharged home. Complete tissue healing occurs within 2-3 weeks and after this period you can resume sexual activity.
Complications and prevention
Among the complications of phimosis are encountered most frequently:
- Infringement of the head – it develops in the attempt to forcibly bring the head of the penis from the cavity. A dense ring of very flesh tissue squeezes the head, it swells and increases in size. As a result of its reverse reduction becomes impossible, disturbed blood supply to the tissue and without medical emergency situation ends with a necrosis – necrosis of the strangulated part of the head.
- Inflammation of the foreskin and the penis head.
- Urethritis, cystitis, pyelonephritis – developed with 4 degrees of phimosis because of a violation of a current of urine.
- The increment of the foreskin to the glans – the most damaged areas due to tight junction to each other to heal a single scar, cut, which is not always possible.
As preventive measures the most important are:
- Careful genital hygiene, daily washing away of the child and the timely changing of nappies or diapers;
- Use barrier methods of contraception (condom) during sex with a casual partner;
- Treatment of major diseases (diabetes).