Generality
Fimosi serrata is the most severe form of phimosis ever.
In fact, it corresponds to a narrowing of the foreskin of such a high degree that it completely prevents the backward sliding of the same, even in the situation of a flaccid penis.
The close phimosis can be congenital or acquired. The congenital phimosis is a condition with unknown causes, which can also be solved spontaneously, with growth; the acquired 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, the phimosis serrata is the cause of various symptoms and signs, including: difficulty in urinating and emitting sperm, fine urine flow, swelling at the level of the foreskin at the time of urination, pain in the glans during sexual intercourse and loss of pus from the urethral orifice (only, however, if the condition is the result of an infection).
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 surrounds it.
What is Fimosi Serrata?
The close phimosis is the narrowing of the foreskin of such a degree as to completely prevent it from sliding backwards, even in the situation of a flaccid penis .
Fimosi serrata is the most serious form of phimosis ever; the presence, in fact, can be an obstacle to urination and sperm emission.
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
The close phimosis can be a congenital condition - that is, present since birth - or acquired - that is, developed over the course of life, due to a very specific cause.
Fimosi Serrata Congenita: the Causes
The congenital phimosis is the result of an abnormal fetal development of the foreskin.
It is not a serious condition, since, in most cases, it tends to regress spontaneously with growth (in general, it disappears at the age of 10).
Did you know that ...
In the United States, about 10% of newborns present with congenital phimosis, which spontaneously heals in most circumstances.
Fimosi Serrata Acquita: the Causes
The acquired intense phimosis recognizes various causes, including:
- Balanitis . It is the inflammation of the glans penis.
Balanitis can be the result of: 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 close phimosis: redness, itching and swelling at glans level; pain during urination; emission of foul-smelling fluid from the urethral orifice.
- Balanoposthitis . It is the simultaneous inflammation of the glans and foreskin of the penis.
Balanoposthitis is a condition whose causes are similar to those of balanitis.
Other consequences, in addition to the close phimosis: redness, itching and swelling at the level of 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, affects the skin and mucous membranes of the genital areas, determining on these the formation of characteristic whitish patches and scar tissue.
Example of sclerosis (due to the fact that it induces the formation of scar tissue), the lichen sclerosus is probably the main cause of acquired tight phimosis.
Other consequences, in addition to the close phimosis: whitish patches, excoriations, microlesions, itching, penodynia, 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 TIGHTENED RISK FACTORS ACQUIRED
Among the main factors favoring the development of the acquired close phimosis, there are: poor intimate hygiene (predisposes to genital infections, therefore also to balanitis and balanoposthitis), unprotected sexual relations (predisposes to genital infections), diabetes when it is inadequately cared for (predisposes to infections, therefore also to balanitis and balanoposthitis), prolonged use of the urinary catheter (predisposes to genital infections) and advanced age (leads to a reduction in the elasticity of the foreskin).
Pathophysiology: how Fimosi Serrata originates
Considering the pathophysiology of tight phimosis, the latter may be the result of:
- A preputial orifice that is too narrow and / or very little elastic . The preputial orifice is the terminal part 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 term "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.
The presence of adhesions between the internal surface of the foreskin and the glans is peculiar to the cases of 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.
As a rule, the short frenulum depends on a history of traumas / lacerations of the penis / foreskin.
Symptoms and Complications
The typical symptoms and signs of tight phimosis are:
- Inability to retract the foreskin, not only during an erection, but also to a flaccid penis;
- Difficulty urinating, due to the presence of a physical impediment at the urethral orifice;
- Difficulty in emitting sperm, for the same reason mentioned in the previous point;
- Thin urine flow;
- Swelling of the foreskin at the time of urination, following the accumulation of urine in the space between the glans and the foreskin itself;
- Loss of pus from the urethral orifice. This symptom is exclusive of when the close phimosis depends on a balanitis or balanopostitis of infectious origin;
- Pain during sexual intercourse ( dyspareunia ).
Complications
When severe, tight phimosis can prevent the emission of urine and sperm.
The more difficult the urine expulsion is, the greater the risk of developing urinary infections ; consequently, an individual with a severe tight phimosis is subject to recurrent urinary infections.
When should I go to the doctor?
If the congenital phimosis is deserving of the doctor's attention when it does not resolve spontaneously, the acquired phimosis is a condition that always requires the consultation of an expert in pathologies of the male genital tract.
Diagnosis
A physical examination is sufficient to make the diagnosis of tight phimosis. In medicine, the physical examination is the medical observation of the patient, aimed at detecting any pathological signs and to accurately outline a complete picture of the symptoms present.
What are the next steps?
Once the presence of closed phimosis has been identified, the diagnostic doctor starts the investigations necessary to discover the causes of the penile anomaly in progress.
As a rule, these investigations include a careful medical history and blood tests .
- Anamnesis: it is an investigation that serves to clarify the symptoms and shed light on the triggering causes.
For example, from the anamnesis emerges when the phimosis serrata is due to an infection of the glans or of the glans and of the foreskin; when the phimosis is congenital; when the phimosis serrata is associated with lichen sclerosus ; etc.
- Blood analysis: they serve to confirm the suspicion of an infectious origin of the close phimosis.
Therapy
The therapeutic approach adopted in the presence of tight phimosis varies according to whether the condition is congenital or acquired.
This chapter of this article will focus its attention, first on the therapy of congenital phimosis and subsequently on the therapy of acquired phimosis tightened.
Fimosi Serrata Congenita: the Cure
Despite the numerous debates on the subject, the best strategy for treating congenital heart failure is still a source of disagreement with the medical community.
Having said this, according to most experts, the most efficient therapeutic approach is:
- Wait for the situation to evolve, as congenital phimosis (as with all other forms of 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 delicate stretching exercises of the foreskin .
- In the event of ineffectiveness of local applications or in the presence of a very severe form of congenital phimosis, rely on surgery; currently 3 surgical options are available: circumcision, prepuzioplasty and frenuloplasty .
MEDICATIONS FOR FIMOSI SERRATA: HOW DO THEY WORK?
The cortisone-based creams used in the treatment of tight phimosis fall into the category of anti-inflammatories and negative moderators of the immune response.
To justify their use is the ability to restore elasticity to the skin of the application site (the foreskin), allowing the expansion of the so-called preputial ring (band of elastic tissue located just before the preputial opening).
Based on the statistics, the pharmacological treatment of congenital phimosis would be effective in 90% of cases.
PREPARATION STRETCHING: WHAT IS IT?
The foreskin stretching exercises are, in fact, sliding movements of the foreskin, aimed at dilating this characteristic cutaneous portion of the penis.
Their correct practice is essential to achieve maximum results from drug therapy.
SURGERY: WHAT DO THE VARIOUS TREATMENTS CONSIST OF?
- Circumcision: performed under local anesthesia, 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 partially uncovered even with a flaccid penis.
As regards the recovery from the circumcision procedure, it is important to emphasize that:
- The surgical wound heals within 14 days e
- For older patients, a period of about 4 weeks of sexual abstinence is indicated.
- 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.
Being less invasive than circumcision, prepuzioplasty has faster healing times.
- Frenuloplasty: is the operation of remodeling the penis frenulum, carried out through appropriate incisions on the latter and the strategic application of different sutures.
Normally, the use of frenuloplasty takes place when the congenital phimosis is associated with a condition of short frenulum.
The frenuloplasty has healing times similar to those of prepuzioplasty.
The choice of surgical technique to adopt is the responsibility of the doctor who will carry out the operation and is essentially based on the characteristics of the present congenital phimosis (to understand, consider what has just been said about the indications of frenuloplasty).
Fimosi Serrata Acquired: the Cure
The therapeutic approach for acquired cases of closed 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, ie a treatment aimed at contrasting the signs and symptoms of the condition in course.
Important : unlike the congenital phimosis, the acquired phimosis always requires a specific treatment, as it is not possible to heal spontaneously.
CAUSAL THERAPY: AN EXAMPLE
Causal therapy varies depending on the causal factor.
In practical terms, this means that, if the acquired phimosis is the result of a bacterial balanitis, the causal therapy will consist in a pharmacological treatment based on antibiotics .
SYMPTOMATIC THERAPY
The symptomatic therapy for acquired phimosis includes, in fact, the same pharmacological and surgical treatments mentioned above, when the topic of discussion was the treatment of congenital phimosis.
For the avoidance of doubt, it is important to point out that, as in the case of 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 tight phimosis depends on several factors, including:
- The severity of the preputial restriction. The more the preputial narrowing is severe and the greater the probability that the therapies are not very effective or that, however, invasive treatments (surgery) are necessary;
- The nature of the condition. Unlike the episodes of acquired phimosis, the episodes of congenital phimosis are resolved spontaneously, with time;
- Early treatment. Especially in cases of acquired phimosis, early treatment prevents unpleasant complications.
Prevention
The only form of tight phimosis for which a prevention plan exists is the acquired 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 not known.
