Phimosis is a condition in which you can not take the crown of the foreskin due to its narrowing. It is found in 90% of children before the beginning of the pubertal period and is a manifestation of physiological maturation of the penis. Phimosis in men is a pathological state. Develops 2-3% of adults and leads to a series of serious complications, impoverishes the feeling of sex. In the early stages of the phimosis is treatable with conservative methods, so it is important to detect the condition and consult a doctor.
The mechanism of development
The penis is the exterior male sexual organ, the main function of which – to introduce the sperm into the vagina of the woman. The most sensitive part is the head, in it is concentrated the largest number of nerve endings. Covered it with a thin smooth epithelium, which is similar in structure to the red edge of the lips. At the top of the head opens the urethra. Its lower part it works with the cavernous bodies of the penis, constitute the trunk. In this place the penis has the thickening of the coronary sulcus, can be felt just below the head.
Protects the delicate skin of the head of the damage skin fold of foreskin. Consists of 2 sheets:
- Exterior – for the structure identical to that of the epidermis of the skin, has a top-keratinizing layer;
- Internal – is covered by epithelium, equal to the mucous membranes of the necessary corrections.
The flesh of his foreskin begins of coronary grooves and covers the entire head, forming prepucialis the cavity. The forehead is opened a hole, that stretches with ease and produces the crown out. In the standard polovozrelogo a men of the flesh of his foreskin moves easily, fully exposing the upper part of the penis. In the back of the head of the internal leaf of the cavity firmly to the skin of their tissues in the form of a horseshoe. In the column of the frenulum lies a huge amount of nerve endings, and capillaries, so that the stimulation during the intercourse gives the man the pleasure.
The foreskin has the following functions:
- Protects the urethra against the penetration of pathogenic micro-organisms, covering his hole;
- Prevents mechanical irritation and damage thin epithelium of the surface of the head, keeping your sensitivity;
- It facilitates the slipping in the sexual act, through the development of smegma and soft interior of a sheet;
- Increases the enjoyment in the process of sexual intercourse due to stimulation of the nerve endings of the head and the frenulum. This is an important factor in evolutionary terms: without strong positive emotions, the people refused to less sex and were less likely than the continuation of the species.
Phimosis, as pathological condition develops after inflammation or injury extremely meat. As a result of the exposure are destroyed tissues and start the inflammatory process. He passes through certain stages and it always ends in the organization of the restoration of the integrity of the authority. The deep damage is replaced with the gross formation of connective tissue, which significantly reduces the elasticity extreme of the flesh. The high activity of the processes of restoration leads to the formation of connective tissue septa between the inside of the fig leaf of the cavity and the head of the penis. Are clamped firmly together and leave the exposure the top of the penis.
It should be understood that the phimosis is not a disease but a special state, which is due to physiological traits of an organism (the age), heredity, and damage to the tissue of the foreskin. In this sense, we distinguish the following forms of phimosis:
- Physiological – is found in the majority of the boys before the onset of puberty is related to a process of maturation prepucialis of the cavity. It is not the pathology and the self resolves after 7 years.
- The interruption occurs as a result of inflammation, injury, metabolic disorders, and require treatment:
- Hypertrophic (proboscis);
- The scar.
The frequency of occurrence of one form or another phimosis is directly dependent on the age. Children in large number of cases it is of a physiological nature, the men had scars changes.
The expressiveness of the process distinguish 4 degrees of phimosis:
- At rest the head is completely liberated, to the erection of its excretion is difficult and painful;
- In the resting state the head of a member of shows with the work, during erection, is fully covered by the foreskin and is not released;
- The head can be derived partially only at rest;
- The head constantly hidden the foreskin, not shown. When this at the time of micturition the urine is excreted out drop by drop.
The sex organs of the child begin to form after 11-12 weeks of gestation. The glans and the prepuce are formed from general Bud in the third trimester of pregnancy, their separation occurs in the place of coronary grooves. Cells prepuce begin to share much more quickly than in the growth of the tissues of the penis. At the end, surrounded by a head in the form of a cup and close the cavity. The anatomical proximity and the community of tissue leading to the formation of the tender epithelial partitions between the inside with a sheet very of the flesh and the skin of the head.
In the newborn prepucialis cavity completely closed to the environment to the tastes of the shots, that excludes in it pathogens of the intestinal flora. The 3-4 month of life begin to work the sebaceous glands of the skin of the foreskin. Is produce smegma, which accumulates in a small amount in the cavity. The infection and the development of the inflammatory process prevent epithelial of the partition in the area of the orifice of the prepuce. Gradually these fine shots are destroyed, smegma is shifted to the output and is excreted through which is formed a free space. You can see in the form of small wax flakes of white color in the underwear of the child.
At the time of puberty of the partition partially or completely reduced, and the extreme mobility of the meat increases. During the masturbation or after the start of the sexual life of the head begins fully released, although the first time, the process can be painful. Therefore, the phimosis physiological same is resolved in a period of puberty and requires no treatment.
The treatment in the case of inflammation
Despite the naturalness phimosis in some cases, the need arises for medical attention. The little child's care or breach of that were of personal hygiene in prepucialis bag of skin is microflora pathogenic and develops the inflammatory process. Clinically, this is manifested by redness on the edge of the hole prepuce local, tenderness and with bad smell of the penis. Subsequently, the inflammation leads to the formation of the scar phimosis, that will require surgical treatment.
To detect this kind of symptoms in the child, parents should consult with the urologist. Above was widely practiced methodology unique to the opening of the meat is very abrupt movement. This procedure is very painful for the child and can cause psychological trauma. In addition, the earlier of the opening damages the foreskin and can cause a scar phimosis in the future.
Today, doctors recommend that the gradual opening up of the head of 1-2 mm carried out after the warm bath, preferably with the addition of an antiseptic effective: the decoction of chamomile, calendula, sage. Take should 2 times a week for 10 to 15 minutes. After water procedure foreskin process restores the ointment or the cream, to improve its elasticity and prevent the breakdown. The skin at not more than 2 mm by a procedure. This way you can treat phimosis at home for several months.
The ineffectiveness of the above-described fashion, the surgeon or urologist dissects the that have formed the points of the probe. A procedure is performed on an outpatient basis, without anesthesia or with local anesthesia. The doctor introduces in prepucialis bag thin metal rod with a rounded end and passes through the circumference of the head of the penis. Subsequently every day, wash the penis of the boy with the use of antiseptic solutions.
The causes of phimosis are:
- The genetic defect of the connective tissue;
- The alteration of the metabolism;
- Inflammatory diseases of the skin of the foreskin and the glans of the penis;
- The injury of the penis;
- Sexually transmitted infections;
- The changes of age.
Hypertrophic phimosis is excess of development of the foreskin, that long hobotkom hangs from the penis. In his end of "the siphon" is narrow and opens with a dense ring, the deduction of the head through which is not always possible.
The long siphon is elongated the way to extract the urine and smegma, and, in consequence, are created favorable conditions for the growth of pathogens in the intestinal flora. The increase of moisture in prepucialis the bag and accumulated the secret of the sebaceous glands is an ideal habitat for the reproduction of the bacteria. Injure the epithelium of the head and the inner sheet and the foreskin with the development of the inflammatory response. Children with diabetes in prepucialis bag is often multiplied by a yeast fungus, which is manifested by the unbearable itching genital white, and thick secretions. Balanoposthitis often completed the formation of the scar of the way the phimosis.
Another reason for the pathology is hypoplasia of the penis in the background of normal size of the foreskin. Has been identified in the process of puberty, the child, and is normally related to the lack of secretion of testosterone in the testes. In this case, the phimosis is combined with the low growth, lack of muscle mass, excess hair growth, lack of growth of facial hair, high voice, and depression.
The scar phimosis is the most common form of the disease among adult men. The causes are those of any state, which lead to inflammation in the area of the foreskin or the glans. Between sexual infections more often the cause of balanoposthitis in the exodus is pale Treponema. The genital herpes virus, human papilloma virus and candida also often the cause of inflammation of the head. Children the scar phimosis is rare and approximately one-third of the cases you can not find the cause of the disease.
The disease progresses slowly. In the first weeks after the inflammation is formed by thin connective tissue bridges, which slightly limits the mobility of the foreskin. In just a few months, they are much thicken, become opaque and rough. The mobility of the skin of the foreskin is reduced, the head stays closed, even when it is erect, and the attempt to make her leave accompanied expressed by the pain. Forced exposure of the head leads to a small tear, the selection of the blood and the generation of new scars.
The last degree, phimosis violate self-cleaning of the cavity and the process of urination. Eventually the patient will develop urinary tract infections: urethritis, cystitis, pyelonephritis. In addition, the scar phimosis prevents the proper reduction of the risks of sexual intercourse. There arises the need of lubrication, the man receives the lack of stimulation and you feel pain when you stretch the foreskin.
The treatment of the pathological forms
Diagnosis and treatment of phimosis conducted by the doctor urologist, doctor-surgeon. If the cause of the disease has served as the gender of the infection, the patient advanced notice dermatologist, who assigned antibiotic therapy. The treatment in this case, should both members of the couple.
The conservative treatment method is carried out to the first two degrees of phimosis, if the points are subtle and not emerged for over a month. In these cases, the patient recommend stretching foreskin after a hot bath. In the head of the penis put anti-inflammatory cream that contains the glucocorticoid, and the resolution of the ointment. Open the head carefully, avoiding injury to the skin of the foreskin. After the procedure displays the properties of healing drugs.
Surgical treatment is circumcision. The operation involves a complete removal of the foreskin, the head after she remains constantly open. The intervention performed under general anaesthesia in children and under local anesthesia in adults. The surgeon first makes an incision and moves the outer leaf of the foreskin, carefully, cut out the adhesions. After that both data sheet selected, deviate from coronary along the line. Resulting from the wound, the surgeon re-closed by means of suture, suture material, which hereinafter will be reabsorbed, that is to say, the lifting of the seams after the operation is not necessary. In the postoperative period perform 1-2 of tubal ligation, and prescription of the patient's home. The complete tissue healing occurs in a period of 2-3 weeks and after this period, you can resume sexual activity.
Complications and prevention of
Among the complications of phimosis, the most common are:
- The violation of the head – it develops during attempts to force out the head of the penis of the cavity. A ring very flesh tightens the tissue of the head, it swells and increases in size. As a result of its inverse the reduction is impossible, if it disrupts the blood supply of the fabric and without any health care urgent situation produces necrosis – necrosis disadvantaged part of the head.
- The inflammation of the foreskin and the glans of the penis.
- Urethritis, cystitis, pyelonephritis, developed with 4 degrees of phimosis by the violation of the current of the urine.
- The increment of the foreskin to the head – most of the areas damaged by the dense adjunction of one to the other heal single scar, cut that it is not always possible.
As prevention measures of most importance are:
- Hygiene of the genitals, daily washing of the child, and timely change the diaper or diaper;
- The use of barrier methods of contraception (condom) in the case of gender relations;
- The treatment of the major diseases (diabetes mellitus).