Fimosi Non Serrata by A.Griguolo

Generality

Unblocked phimosis is the narrowing of the foreskin which makes it impossible to uncover, even partially, the glans during an erection.

Unblocked phimosis can be congenital or acquired. Unconfined congenital phimosis is a condition with unknown causes, which can also be solved spontaneously, with growth; the acquired non-serrated phimosis, on the other hand, is a condition with very specific causes (including balanitis, balanopostitis and lichen sclerosus ), which always requires adequate treatment.

Diagnosed quickly by physical examination, unblocked phimosis causes symptoms, such as: pain in the penis and pain in the foreskin, in an attempt to force the glans open.

Brief review of the concept of Fimosi

In medicine, the word " phimosis " describes an exclusively masculine condition, in which a narrowing of the foreskin follows a difficulty of the same to flow backwards (a movement that, instead, falls back to normal) and partial or total closure (this depends on from the degree of the aforementioned narrowing) of the glans of the penis .

In practice, the subject carrying phimosis struggles or fails to uncover the terminal section of the penis from the characteristic portion of skin that envelops it.

What is Fimosi Non Serrata?

Unblocked phimosis is the narrowing of the foreskin of such a degree that it is impossible to discover the glans, even only partially, when an erection occurs.

Unblocked phimosis is contrasted, in a certain sense, with the close phimosis, ie the narrowing of the foreskin of such a severe entity as to be an obstacle to the glans sliding even in a flaccid penis condition.

Physiology of erection: to understand ...

The foreskin is the particular strip of skin that:

  • When the penis is flaccid, it covers the glans guaranteeing protection to the latter;
  • When instead the penis is erect, it is the protagonist of a backward sliding movement, which serves to discover the glans and favor the dynamics of the sexual act.

Causes

Unblocked phimosis can be a congenital condition - that is, present from birth - or acquired - that is, it arose in the course of life, due to a very specific cause.

Congenital Non-Serrated Phimosis: Causes

Congenital non-serrated phimosis is the result of an abnormal fetal development of the foreskin.

It is not a clinically relevant circumstance, since, in most cases, it tends to disappear spontaneously, with growth (normally, it disappears at the age of 10).

Did you know that ...

Only 5% of newborns have a completely retractable foreskin; the remaining 95%, therefore, presents a more or less high degree of phimosis.

Acquired Fimosi Not Locked: Causes

Unblocked phimosis recognizes at least 4 possible causes, which are:

  • Balanitis . It is the inflammation of the glans penis.

    Balanitis can result from: a bacterial, viral or fungal infection, a sexually transmitted infection (eg, gonorrhea, genital herpes, syphilis, etc.), a deficiency in the immune system or so-called contact dermatitis.

    Other consequences, in addition to the not close phimosis: redness, itching and swelling at the level of the glans; pain during urination; emission of foul-smelling fluid from the urethral orifice.

  • Balanoposthitis . Stackable to balanitis as regards the triggering causes, it is the simultaneous inflammation of the glans and foreskin of the penis.

    Other consequences, in addition to the not close phimosis: redness, itching and swelling in correspondence with the glans and foreskin; pain during urination; emission of foul-smelling fluid from the urethral orifice.

  • The lichen sclerosus . It is a chronic inflammatory condition with unknown causes, which, in both men and women, mainly affects the skin and mucous membranes of the genital areas, inducing the formation of characteristic whitish patches and scar tissue.

    An example of sclerosis (due to the fact that it is responsible for the formation of scar tissue), the lichen sclerosus is, according to experts, the main cause of acquired non-serrated phimosis.

    Other consequences, in addition to the not close phimosis: whitish patches, excoriations, microlesions, itching, penodynia (ie pain in the penis), dyspareunia, urethritis and urethral stenosis.

  • The traumas and lacerations of the foreskin, whose extent is such as to induce the formation of retracting scars, which in a certain sense restrict the foreskin.

FIMOSI UNLOCKED RISK FACTORS ACQUIRED

Among the most important risk factors of acquired non-tight phimosis are: poor intimate hygiene (favors genital infections, therefore also balanitis and balanoposthitis), unprotected sexual relations (predisposes to genital infections), diabetes not subjected to appropriate care (promotes infections in general, therefore also genital infections such as balanitis and balanoposthitis), prolonged use of the urinary catheter (promotes genital infections) and advanced age (is associated with a reduction of the elasticity of the foreskin).

Pathophysiology: how Fimosi Non Serrata originates

Reasoning on the physiopathology of unfixed phimosis, the latter may originate from:

  • A preputial orifice that is too narrow and / or very little elastic . The preputial orifice is the terminal section of the foreskin as well as the opening that allows the uncovering of the glans.
  • The formation of adhesions between the inner surface of the foreskin and the glans . In medicine, the word "adherence" means a band of fibrous-cicatricial tissue, which anomalously joins normally disjoint parts of the same organ, or distinct organs or tissues, among which, however, there is a relationship of extreme closeness.

    Adherences between the inner surface of the foreskin and the glans are usually observed in cases of unconfined congenital phimosis.

  • An excessively too short frenulum of the penis ( short frenulum ). The frenulum of the penis is the thin band of elastic tissue, located in the lower part of the glans, which connects the latter to the foreskin and plays a key role in the mechanics of covering / uncovering the prepuce-glans complex and sexual dynamics.

    In general, the short frenulum is the result of traumas / lacerations of the penis / foreskin.

Symptoms and Complications

In the flaccid penis state, unblocked phimosis is not the cause of any symptom or particular sign ; on the contrary, it becomes a symptomatic condition when the patient has an erection.

Specifically, when an erection occurs, the typical symptoms and signs of unfixed phimosis are:

  • Failure to uncover, even partially, the glans;
  • Penile pain;
  • Pain in the area of ​​the foreskin, attempting to force the glans open.

Complications

If the patient or the patient's parents (in the case of a child) force the glans to open, unblocked phimosis may be a reason for paraphimosis . The paraphimosis consists in the impossibility for the foreskin to return to cover the glans, after the uncovering of this, combined with a phenomenon of strangulation at the level of the so-called glans crown .

The phenomenon of strangulation deriving from paraphimosis can, in the most severe cases, cause gangrene; therefore, paraphimosis is a very dangerous complication.

REPERCUSSIONS ON THE SEXUAL AND PSYCHOLOGICAL SPHERE

In adult subjects, unbroken phimosis represents an interference with sexual life, as it is an impediment to a correct erection.

Interference from the phimosis that is not tightened in the sexual life can compromise the intimate relationships with a possible partner and can have repercussions on a psychological level, determining in the patient discontent, a sense of inadequacy, feelings of shame and real depression .

When should I go to the doctor?

While the congenital unblocked phimosis deserves the attention of the doctor only when it assumes a permanent character (therefore when it does not heal spontaneously), the acquired non-serrated phimosis is a condition for which the consultation of an expert in pathologies of the genital apparatus is always indicated male.

Diagnosis

For the diagnosis of unfixed phimosis, a physical examination is sufficient.

In medicine, the physical examination is the medical observation of the patient, aimed at detecting any pathological signs and to outline a complete picture of the symptoms present.

What are the next steps?

Upon detection of the unfixed phimosis, they always follow an investigation aimed at discovering the causes of the present condition.

As a rule, this survey includes a careful medical history and blood tests .

  • Anamnesis: it is a diagnostic study that serves to clarify the symptomatology in progress and shed light on the causes triggering this symptomatology.

    In a context of unstuck phimosis, the anamnesis makes it possible to establish whether the condition depends on an infection of the glans or glans and foreskin; if the condition is congenital; if the condition is associated with lichen sclerosus; etc.

  • Blood test: it allows to search for possible pathogens in the blood.

    In a context of unstoppable phimosis, it serves to confirm the suspicion of an infectious origin of the condition (eg, unblocked phimosis resulting from a balanitis).

Therapy

The way of treating unblocked phimosis (the so-called therapeutic approach) varies depending on whether the condition is congenital or acquired.

In this chapter, the article will first give space to the therapy of unconstrained congenital phimosis and, subsequently, to the therapy of acquired non-serrated phimosis.

Congenital Non-Serrated Phimosis: the Cure

Despite numerous studies on the subject, the best strategy for treating uninitiated congenital phimosis is still the reason for many debates in the medical community.

Having said that, according to most experts, the most effective therapeutic approach is:

  • Wait for the situation to evolve, as the uninitiated congenital phimosis (as well as all other forms of congenital phimosis) can resolve spontaneously with growth.
  • In the absence of spontaneous healing, resort to local applications (therefore on the foreskin) of cortisone-based creams, combined with the practice of delicate stretching exercises of the foreskin.
  • In case of ineffectiveness of cortisone-based creams, turn to surgery ; currently 3 surgical options are available: circumcision, prepuzioplasty and frenuloplasty .

DRY MEDICINAL FIMOSIS: HOW DO THEY WORK?

The cortisone-based creams used in the treatment of unbroken phimosis fall into the category of anti-inflammatories and negative moderators of the immune response.

Motivating the use of these medicines is their ability to restore elasticity to the skin of the application site (therefore the skin of the foreskin), allowing the dilation of the so-called preputial ring (band of elastic tissue located just before the preputial opening).

According to the medical reports, the pharmacological treatment of unfixed congenital phimosis would have a positive outcome in a very high percentage of cases.

PREPARATION STRETCHING: WHAT IS IT?

Stretching of the foreskin consists of maneuvers of sliding of the foreskin, aimed at dilating this characteristic skin portion of the penis.

Their correct execution (therefore with extreme delicacy) is essential to maximize the effects of drug therapy.

SURGERY: WHAT DO THE VARIOUS TREATMENTS CONSIST OF?

  • Circumcision: performed under local anesthesia in children and under general anesthesia in adults, it is essentially the total or partial removal of the foreskin; this means that, at its conclusion, the patient will present a glans completely or only partially discovered also with a flaccid penis.

    As regards the recovery from the circumcision procedure, it is important to report that:

    • The surgical wound heals within 14 days e
    • For older patients, a period of about 4 weeks of sexual abstinence is indicated.
Result of circumcision.
  • Prepuzioplasty: consists of the remodeling of the foreskin, through ad hoc incisions, in order to widen the preputial ring and consequently favor the uncovering of the glans.

    Because it is less invasive than circumcision, prepuzioplasty has faster healing times.

  • Frenuloplasty: is the operation of remodeling of the penis frenulum, carried out through appropriate incisions on the same frenulum and the strategic application of some stitches.

    The frenuloplasty is the ideal surgical treatment for cases of congenital non-serrated phimosis associated with a condition of short frenum.

    The frenuloplasty has healing times similar to those of prepuzioplasty.

The choice of surgical technique to be used is the responsibility of the doctor who will carry out the operation and is based essentially on the characteristics of the unconfined congenital phimosis present (to understand, think of what has just been reported on the indications of frenuloplasty).

Acquired Phimosis Not Locked: Care

The therapeutic approach for the cases of acquired non-serrated phimosis involves the planning of a causal therapy, that is a therapy aimed at eliminating the cause of the anomaly, and of a symptomatic therapy, that is a treatment aimed at contrasting the signs and symptoms of the condition in progress.

Important : unlike non-congenital phimosis, acquired non-serrated phimosis always requires specific treatment, as it is not a condition subject to spontaneous healing.

CAUSAL THERAPY: AN EXAMPLE

Causal therapy changes according to the causal factor.

Practically, this means that, if the acquired non-serrated phimosis is the result of a fungal balanitis, the causal therapy will consist in a pharmacological treatment based on antifungals .

SYMPTOMATIC THERAPY

Symptomatic therapy for acquired tight phimosis includes the same pharmacological and surgical treatments mentioned above, under the heading "unconstrained congenital phimosis: cure".

For the avoidance of doubt, it is important to point out that, as in the case of unconfined congenital phimosis, pharmacological treatments on surgical treatments (which, therefore, are reserved for more serious or non-responsive cases) take priority.

Prognosis

The prognosis in case of unstoppable phimosis is strictly dependent on:

  • The severity of the preputial narrowing : the more the preputial narrowing is severe and the greater the risk that the therapies are not very effective or that, however, invasive treatments are necessary (in practice, surgery);
  • The nature of the condition : as opposed to the acquired non-serrated phimosis, congenital phimosis can heal spontaneously, with time;
  • The adequacy of treatment : forcing the opening of the glans with inadequate foreskin stretching exercises could cause paraphimosis.

Prevention

The only form of unblocked phimosis for which there is a prevention plan is acquired non-tight phimosis.

Specifically, this prevention plan consists of controlling the risk factors of balanitis and balanoposthitis; in practical terms, therefore, it provides proper attention to intimate hygiene, diabetes care, the use of appropriate protections during risky sexual intercourse, etc.

The congenital phimosis is not preventable, since its triggering causes are unknown.

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