Can improper hygiene cause phimosis?

My 6 year old son has phimosis. When bathing him, I often pull the foreskin back to clean him, but I pull it back quite hard and the foreskin does not retract on its own.

I have waited for more than a day but the condition has not improved, even the glans penis is swollen and purple causing pain. What should I do, doctor? (Minh Hoa, Vung Tau).

Reply:

According to the description, the baby is likely to have paraphimosis (phimosis). This is a medical emergency that occurs in uncircumcised boys or men. The foreskin is trapped behind the head of the penis and cannot be pulled back to cover the entire penis. This causes strangulation of the glans, vascular damage (due to venous and lymphatic congestion), pain, increasing swelling if not resolved, and can even lead to glans necrosis.

Children with phimosis often have symptoms of genital pain, swelling and discoloration of the penis (red, blue, or purple), and difficulty urinating.

Dr. Nguyen Do Trong (left), Department of Pediatric Surgery - Cardiovascular Surgery, is performing surgery on a child patient at Tam Anh General Hospital. Photo: Tue Diem — Dr. Nguyen Do Trong (left), Department of Pediatric Surgery - Cardiovascular Surgery, is performing surgery on a child patient at Tam Anh General Hospital. Photo: *Tue Diem*

Children with paraphimosis need emergency surgery as soon as possible to avoid complications such as bruising and necrosis of the glans. Usually, children with paraphimosis are curious and pull the glans up and down and it does not slide back to its original position, or parents pull the glans down to clean it but do not pull it back like in your case. Besides, there are other causes such as infection, physical trauma to the genital area, pulling the foreskin too hard, the foreskin structure is tighter than normal...

Paraphimosis cannot disappear on its own. Therefore, you need to take your baby to the hospital immediately for timely intervention by a doctor to avoid affecting the function of the baby's genitals later. Treatment methods include:

Apply pain-relieving anesthetic to the head of the baby's penis, then use gauze or your hand to smooth the foreskin (if the baby is given emergency treatment early, the penis is not swollen much).

In case of penile stenosis, swelling, and severe pain, the doctor will make an incision in the foreskin to help it move up over the glans more easily. In some cases, the child will need surgery to remove the foreskin.

After the procedure, your doctor may prescribe antibiotics to treat infection if needed.

The only way to completely prevent paraphimosis is to completely circumcise the foreskin. Other preventive measures include: maintaining genital hygiene and cleaning the tip of the penis regularly; pulling the foreskin back over the tip of the penis after cleaning or urinating...

MD.CKII Nguyen Do Trong
Department of Pediatric Surgery - Cardiovascular Surgery, Tam Anh General Hospital, Ho Chi Minh City

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