Reduction of a tight foreskin

Emergency procedure to loosen retracted, uncircumcised foreskin that has tightened around penis (paraphimosis) — Figure 9.29, Figure 9.30

Figure 9.29  

Figure 9.30  

Attention

  • Can usually do manual reduction in boys. More difficult in men
  • Paraphimosis and reduction can be very painful — consider pain relief or light sedation, use compression and ice. The more effective the pain relief the better the chance of reduction
  • If you can't do reduction — medical consult to send to hospital

What you need

  • Ice pack (eg crushed ice in disposable glove)
  • Gauze
  • Water-based lubricant
  • Lignocaine gel
  • Self-sticking compression bandage (eg Coban, Nexcare, Andover co-flex)

What to do

  • While you are getting ready, apply ice pack
  • Put lubricant on head of penis
  • Using gauze pads, grip penis over swelling with firm pressure
  • Hold until swelling goes down (person can do this)
  • Reduce tight foreskin by pushing back on head of penis with thumbs and pulling foreskin forward with fingers — Figure 9.31

Figure 9.31  
  • If unsuccessful, try compression technique

Compression technique

  • Give oral pain relief (eg paracetamol) and ensure person is supported and comfortable
  • If very painful — apply ice pack or lignocaine gel for topical pain relief
  • Wrap self-sticking compression bandage over oedematous area (area swollen with fluid) starting from the penis tip
  • Leave bandage on for 15 mins
  • Remove bandage and try drawing the foreskin over the glans — Figure 9.31
  • If unsuccessful, reapply the bandage for another 15mins and then try again
  • If unable to do reduction — medical consult for surgical advice