Phimosis and paraphimosis

phimosis is inability to retract the foreskin; paraphimosis in entrapment of the foreskin in the retrected posistion.

phimosis is normal in children and typically resolves by adolscence. treatment in not required in absence of
complications such balanitis , urinary infection , unresponsive dermatilogical disease , or suspicion of
carcinoma .

Three months of betamethasone cream 0.05% bid  or tid applied to the tip of the foreskin and the area
touching the glans is often effective . stretching the  foreskin gentky with two fingers or over an erect  penis
for 2 to 3 weeks with care not to produce  paraphimosis is also successful. An  T  plasty is a foreskin
preserving procedure that is simple and effective and does not remove any tissue .Circumcision is always an
option.

paraphimosis is frequently iatrogenic , occuring during catheterization or physical examination .
 if the retracted foreskin is somewhat tight . it functions as tourniquet , causing the glans to swell , both blocking the foreskin from returning to its normal position and worsening the constriction . It should be regarded as an emergency , because constriction lead quickly to vascular compromise and necrosis . firm circumfereantial compression of the glans with the hand may relieve edema sufficiently to allow the foreskin to restored to its  normal position  .
If this is ineffective , a dorsal slit performed using alocal anaeshtetic relieves the condition temporarily .Circumcision is then performed when edema has resolved.