With paraphimosis the foreskin is stuck behind the glans and can no longer be moved forward. The trapped rim and the glans swell up. That swelling makes the constriction tighter still. This should be assessed by a doctor the same day.
On this page you can read how to recognise paraphimosis, what you should and should not do at that moment, how it differs from foreskin narrowing (phimosis), and why a circumcision prevents it from happening again.
With these symptoms, see a doctor straight away
- The foreskin is behind the glans and will not go back into place
- A tight, swollen ring just behind the glans
- The glans is swollen, tense and painful
- Discolouration of the glans or of the swollen rim
If in doubt, call your general practitioner, or the out-of-hours service outside office hours. Do not wait until the next day. The longer the foreskin stays trapped, the more it swells, and the harder it becomes to move it back into place.
We are not an emergency clinic. Our doctors work in hospital during the week and often carry out circumcisions at the weekend. Paraphimosis cannot wait for that. Have the problem resolved first by your general practitioner or at the out-of-hours service; afterwards you are welcome to come to us for a treatment that prevents it from happening again.
What exactly is paraphimosis?
Normally the foreskin lies over the glans and can be moved smoothly back and forth over it. With paraphimosis the foreskin has been pulled back and stays stuck there, with a tight rim just behind the glans.
That rim acts like a tight band. It obstructs the drainage of fluid from the glans, so the glans swells. That swelling makes the rim tighter, which obstructs the drainage further. In this way the problem sustains itself and gets worse.
The Dutch name for the condition, Spaanse kraag or Spanish collar, comes from the pleated ruff of the seventeenth century. The swollen ring around the glans resembles it. The medical term is paraphimosis.
The difference from foreskin narrowing (phimosis)
The two are often confused, while they are almost the opposite of each other:
- With foreskin narrowing (phimosis) the foreskin cannot be pulled back, or only with difficulty, so it cannot be moved over the glans.
- With paraphimosis the foreskin cannot be moved forward, so it cannot be brought back over the glans.
Foreskin narrowing is unpleasant and can cause complaints, but it is rarely urgent. Paraphimosis is urgent. Anyone with a tight foreskin also runs a greater risk of paraphimosis, because it is precisely with narrowed skin that the foreskin easily gets stuck behind the glans.
How does it happen?
Almost always because the foreskin has been pulled back and then not returned to its place. This happens, for example:
- during washing, particularly in young children whose foreskin is still tight
- after a physical examination, if the foreskin is left behind the glans for too long
- after the insertion of a bladder catheter
- during sexual activity
In babies and young children the foreskin is still naturally attached to the glans. It does not need to be pulled back for cleaning. That is advised against.
What the doctor does
The doctor first tries to reduce the swelling and then to bring the foreskin forward again. If necessary this is done under local anaesthetic. If that does not succeed, a small procedure is needed to relieve the constricting rim.
Do not try to resolve it yourself by force. Pulling or pushing makes the swelling worse.
Why a circumcision prevents it from happening again
Once the paraphimosis has been resolved, the cause remains: a foreskin that easily gets stuck behind the glans. In some men and boys it can happen again.
A circumcision removes that cause. The foreskin is removed completely or partly, so there is no longer any narrowed skin that can become trapped. It is therefore the only permanent solution.
At Vatan Kliniek this is done as an outpatient procedure, under local anaesthetic, and you go home the same day. The procedure takes about half an hour.
Frequently asked questions
Is paraphimosis dangerous?
It is a condition that needs to be assessed quickly. The longer the foreskin stays trapped, the further the swelling increases. So if in doubt, contact your general practitioner or the out-of-hours service the same day.
Can I move it back myself?
Do not do so by force. Pulling or pushing increases the swelling and makes it harder. Have it assessed by a doctor.
What is the difference between paraphimosis and foreskin narrowing?
With foreskin narrowing the foreskin cannot be pulled back over the glans, or only with difficulty. With paraphimosis it is stuck behind the glans instead and will no longer move forward.
Can it happen again?
Yes. The cause, a foreskin that easily gets stuck behind the glans, does not disappear by itself. A circumcision removes that cause.
Can I come to Vatan Kliniek for this?
For the acute problem, no: for that you go to your general practitioner or the out-of-hours service. For a circumcision to prevent it from happening again you are certainly welcome to register with us. Our doctors have extensive experience with circumcisions.
Is this reimbursed?
With a medical indication many insurers reimburse part of the costs. For that you do need a referral from your general practitioner. Please state this clearly when you make an appointment. You receive an invoice from us that you submit yourself to your health insurer.
