Phimosis in boys: photos, causes and treatment, symptoms

"Muzzle", as dubbed by its Greeks or phimosis, is called the pathology of the prepuce, causing a narrowing of its outer edge( aperture).

This causes a limitation of mobility of the foreskin tissue, and problems in the full or partial exposure of the phallus head.

This fact may be a consequence of pathological processes or refers to the natural( physiological) form of the disease.

Physiological, natural phimosis refers to the primary, congenital form. There are no age limits, it can occur in both newborn boys and 16-year-olds.

Pathological phimosis is called secondary, acquired. This division into forms is rather arbitrary, but in medical practice the practical value lies in the definition of the tactics of medical measures.

Primary phimosis in boys

In physiological form, the leathery folds covering the part of the phallus are fused with its head with spikes( synechiae), limiting its free exit.

In children from three to seven years of age and some( 1%) "bridegrooms" of sixteen-year-olds, this phenomenon is considered a perfectly normal condition. As the phallus grows up and grows, the propulsion diverges gradually, causing the destruction of physiological synechia( adhesions).

And since the age of twelve, during the pubertal period of sexual development, the foreskin, as a result of the influence of sex hormones, acquires elasticity and is stretchable, which allows the head of the phallus to fully open.

This form of the disease does not provide for special treatment tactics, parents only require close monitoring of the penis condition. Daily hygiene procedures( washing), will avoid infections that cause puffiness and redness of the flesh. If there was a similar symptomatology, and it was joined by a difficult urination, then there was an occasion to apply for a consultation with a specialist.

Pathological secondary phimosis in adolescents

If after seven years of age the child can not open the head of the penis, the illness begins to be spoken of as a diagnosis. The pathological form of phimosis is atrophic and hypertrophic.

1. Atrophic appearance is distinguished by a thin skin of the prepuce. Which is easily traumatized, resulting in the formation of scars.
   
2. Hypertrophic appearance is characterized by a thick skin of the preceptum, which, with a "muzzle" covers the phallus and in the form of a "tail" goes beyond its boundaries.

In accordance with the condition of the prepuce, the degree of narrowing of its outer edge, the disease is classified into different degrees.

The degree of phimosis

1. The first degree - the opening of the head of an unheated phallus, is not difficult, during the erection it is possible to open with a little effort.
   
2. Second degree - can not open when excited. To open the head of the phallus, some effort is required, even if it is not excited.
   
3. Third degree - the opening of a member is impossible, or it opens with difficulty, provided a quiet state. Urine problems are not noted.
   
4. At the fourth degree - it is not possible even to slightly open the head of the phallus. There are violations in urination. At the beginning of the process, the urine fills the preputial sac, inflating it, then releasing it very slowly.

Causes of phimosis

The development of the disease in boys is possible for several reasons:

• is a hereditary predisposition;
  
• lack of elasticity in the tissues of the prepuce.
  
• trauma and inflammation of the penis;
  
• scar formation;

Penis trauma, characteristic of the pubertal period of sexual development. As a result of erection, the tension of the prepuce occurs, and as a result of increasing the size of the phallus and its head, it causes microcracks in it, provoking the formation of scars.

This situation contributes to the progression of the disease in fans of masturbation, the very fact of which, causes extensive injuries.

Symptoms of phimosis in boys

The main manifestations of phimosis in boys are symptoms corresponding to the degree of the disease, it can be:

• impossibility or difficulty in opening the head of the penis;
  
• problems with urination;
  
• pain during erection;
  
• at the psychological level - decreased potency at the time of sexual intercourse( subconscious expectation of pain);
  
• sensation of itching and soreness in the area of ​​the prepuce, both during urination and in normal condition;
  
• purulent discharge and unpleasant odor;
  
• may increase lymph nodes in the groin and a significant increase in temperature;
  
• pronounced pain and blue shade of the penis head is an indicator to urgent surgical intervention.

Complication of phimosis

The main danger lies not in the disease itself, but in the complications to which it can lead.

1. Infectious complications in the urethra, with insufficient care in the bag of the prepucium, there is a mixture of moisture, dead tissue epithelium, and the secretion of sebaceous glands( smegma), which serves as a "home" to bacteria causing various inflammations. The stagnant process of smegma is the cause of the formation of stones( smegmolites).This fact contributes to the development of infections in the urethra. Smegmolites serve as an obstacle to urination and provoke a reverse urine, but already with a dissolved infected smegma. The most serious complication caused by the stagnation of smegma is penis cancer.
   
2. Paraphimosis - exposure of the head of the penis by violent method, and the impossibility of the reverse process( return the pre-injection to the place), leads to infringement of the head of the phallus. This provokes swelling and the impossibility of the reverse process, only an operative intervention can correct the situation. Delay will lead to severe consequences - necrosis caused by a violation of the blood supply and as a result - amputation.
   
3. Balanoposthitis - non-observance of hygiene, low immunity and infectious diseases cause inflammation of the head of the penis and its skin folds, accompanied by swelling, pain and purulent discharge( see symptoms and treatment of balanoposthitis).What is the precondition for the formation of scar tissue in the prepuce and the progression of phimosis. The medical probe is divided into spikes, thus ensuring the outflow of purulent clusters. Complicated disease leads to ishuria( urine retention).In such cases, urine is withdrawn through a catheter.

Another unpleasant complication is the fusion of the prepuce with the head. This happens imperceptibly and gradually. Trying to solve the problem on your own can cause bleeding, so in this situation only surgical treatment is possible.

The treatment of phimosis in the mules

The curative program is made individually, selecting acceptable methods of conservative or operative treatment of phimosis in boys.

1. The use of conservative treatment of phimosis is possible only in the absence of any complications. The method is based on the gradual stretching of the skin folds. Which takes a long time and requires a lot of patience. Unsuccessfully performed manipulation can provoke paraphimosis. Correction of the disease with hormonal ointments is used. Mandatory monitoring of the doctor is necessary, which is not always convenient. In addition, in the treatment of cicatricial phimosis, the conservative method is generally not effective. Therefore, the most acceptable and fastest method is surgical.
   
2. Surgical method - circumcision. It is performed at any stage of the disease. The preexium can be removed partially and completely. This operation is not performed in the presence of balanoposthitis, due to the presence of an infection that does not contribute to the healing of sutures. For paraphimosis, the method of complete circumcision is also not acceptable due to circulatory problems.

Disease complicated by acute balanoposthitis or paraphimosis, is operated by the method of longitudinal dissection of the prepuce, restoring blood circulation, separating the ring compressing the penis, and eliminating the inflammatory process. The duration of the procedure is no more than a quarter of an hour. Children undergo general anesthesia. And already, a few hours later, urination normalizes.

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