Prepared by Muhammad Waseem, MD, Attending Physician, and Gerard Devas, MD, Attending Physician, Emergency Department, Lincoln Hospital, Bronx, NY
A 4-year-old uncircumcised boy is brought to the emergency department because of pain and swelling of his penis (Figure). His mother states that he was with a babysitter while she was at work.
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| Figure |
Quiz Answer
Paraphimosis?In uncircumcised males, when the foreskin is retracted behind the glans and left in that position, paraphimosis, manifested as venous congestion and edema of the foreskin, can occur. Applying pressure to the glans (as if turning a sock inside out) for 5 minutes may reduce the edema, allowing reduction of the foreskin.
Phimosis is an inability to retract the foreskin proximally over the glans. This condition rarely brings patients to the emergency department.
Balanoposthitis is inflammation of the glans (balanitis) and foreskin (posthitis). It is a form of cellulitis that results in erythema and tenderness; a purulent exudate is usually present. If the condition is recurrent, diabetes mellitus should be excluded.
The presence of paraphimosis does not raise any red flags for abuse, unless there are other reasons to consider it.
