Emergent Care / Stabilization:
Paraphimosis is a urologic emergency that can cause necrosis of the foreskin and glans penis. Before attempting treatment, assess for necrosis and check whether the patient has a Foley catheter.

If the tissue is neither necrotic nor ulcerated, providers may attempt manual paraphimosis reduction (see Therapy). If manual reduction fails, emergency circumcision is recommended.

Paraphimosis is often a painful condition that may require pain medication. Commonly used topical anesthetics include 2% lidocaine and EMLA (lidocaine and prilocaine). A dorsal penile nerve block using 1% lidocaine without epinephrine may also be performed.

Diagnosis Overview:
Paraphimosis is a condition where the foreskin is retracted behind the glans and cannot be returned distally. This occurs if the foreskin has been traumatically reduced or has remained retracted for an extended period. The foreskin forms a constricting band, preventing lymph and blood flow to and from the glans and foreskin. After hours to days of prolonged retraction, the distal penis will swell and the tissue may begin to necrose.

Patients present with a retracted foreskin and swelling of the glans and foreskin, and with a flaccid and unremarkable penile shaft. Penile pain is common but not always present.

Paraphimosis can occur in uncircumcised or partially circumcised patients. Other risk factors include previous history of balanoposthitis (inflammation of foreskin and glans), relative phimosis, and poor hygiene. This condition can occur in any age group but is most common among adolescents and older adults.

Notably, paraphimosis commonly occurs iatrogenically, such as after placement of a Foley catheter if the foreskin is not returned to its normal position. Other causes often include sexual activity and forceful retraction.