Paraphimosis is a painful form of narrowing of the foreskin. It is considered a medical emergency.


What is paraphimosis?

Paraphimosis is when the foreskin of the penis is pulled back behind the glans (glans penis) as part of a narrowing of the foreskin (phimosis) and it gets caught on the glans.

Paraphimosis is also known as Spanish collar. See ezhoushan for What does HC Stand for.

The resting of the acorn on the acorn wreath is reminiscent of the collar of a Spanish nobleman in the 16th century. A painful constriction forms, which leads to a reduction in blood flow.

Paraphimosis is the result of an already existing narrowing of the foreskin, which is called phimosis in medicine. It usually results from an erection and means a medical emergency.


The reason for paraphimosis is a narrowing of the foreskin. This phimosis is either congenital or acquired over the course of life. Possible causes for the acquired form are scarring. These are in turn triggered by inflammation, bleeding or tears. It is not yet known what causes congenital phimosis.

Acute paraphimosis can occur when the person pulls back their foreskin that is too tight to wash it. However, the foreskin cannot be pushed back afterwards. This problem most often occurs during sexual intercourse as a result of an erection. The foreskin of a non-erect penis usually still has the normal width. However, the increase in penis girth due to an erection can lead to paraphimosis. Another risk factor is the insertion of a urinary catheter. During this procedure, it is sometimes forgotten to pull back the foreskin after inserting the catheter.

In the case of acute paraphimosis, the foreskin cannot be returned to its original position. This results in the squeezing of the blood vessels. This causes water and blood to back up in the glans, which in turn causes the glans to swell. This makes it even more difficult for the affected person to return the foreskin to its original position.

Symptoms, Ailments & Signs

Constriction of the venous vessels of the penis results in an edematous swelling of the foreskin. Tissue fluid accumulates in the process. As a result, tissue located in deeper regions is also compressed. This is where the arterial blood vessels are located. Paraphimosis can affect the arterial blood supply and even bring it to a complete standstill.

If this circulatory disorder is not treated quickly by a doctor, the tissue threatens to die. Doctors refer to this process as glass gangrene. It can cause serious damage to the penis. A typical symptom of paraphimosis is the severe pain from which the affected person suffers. In addition, the glans and foreskin turn bluish to black.

Diagnosis & course of disease

Paraphimosis is classified as a medical emergency. This means that if the patient cannot pull the foreskin back on their own, they must go to a doctor or a hospital immediately. In a clinic, it is advisable to go to a specialist urology department immediately. The doctor diagnoses paraphimosis based on the typical node that develops in the glans sulcus.

Symptoms such as pain, swelling and discoloration of the penis help to support his judgement. For the course of a paraphimosis, it is extremely important to start medical treatment as soon as possible, otherwise there is a risk of inflammation of the glans. Another possible complication is the development of ulcers. In addition, tissue death can occur. However, if paraphimosis is treated early, it usually takes a positive course.


Paraphimosis is usually an emergency. For this reason, a doctor must be consulted immediately, otherwise serious complications and damage can occur. The tissue of the affected person is clearly compressed, resulting in severe pain. The blood flow to the tissue is also usually interrupted, so that in the worst case the tissue can also die.

Due to the disrupted blood supply, the extremities may also suffer from disorders or the extremities may die. This damage is irreversible. Paraphimosis can cause serious and irreversible damage to the penis in particular. The pain is usually very severe, so that those affected can also lose consciousness.

The treatment of paraphimosis usually takes place with the help of an intervention. There are no complications. However, the treatment must be carried out quickly, otherwise irreparable damage to the penis can occur. The life expectancy of the patient is not affected by the paraphimosis.

When should you go to the doctor?

If the foreskin is painfully pinched and cannot be pushed back, a doctor should be consulted immediately. At night and at weekends, it is best to go to the medical emergency service or the nearest clinic. If the symptoms recur, medical advice is required. A doctor must also be consulted in the event of severe pain that restricts well-being or causes problems during sexual intercourse. The doctor can determine the paraphimosis based on the visible injury and the typical swelling and redness and consult a specialist immediately.

Paraphimosis often has to be treated surgically. If the symptoms mentioned occur during sexual intercourse or masturbation or in the event of an accident, paraphimosis is most likely the cause. Symptoms that occur after placement of a urinary catheter also indicate the presence of a medical emergency. In addition to the family doctor, the urologist can be consulted. Depending on the severity of the symptoms, you can also involve a dermatologist in the treatment. If the symptoms are severe, a visit to the hospital is recommended.

Treatment & Therapy

If an acute paraphimosis occurs, the patient can first try to return the foreskin to its previous position. However, even if this procedure is successful, a specialist should be consulted afterwards. This can prevent further paraphimoses from occurring in the future. For example, the foreskin can be surgically removed by a circumcision.

If you are unable to retract the foreskin on your own, seek medical help immediately. On the way there, it is advisable to cool the penis with ice. It makes the most sense to have treatment by an experienced urologist. This gently squeezes the swollen glans. Since this process is very painful, the patient is given an anesthetic beforehand. Squeezing the foreskin makes it easier to return it to its original position.

A less painful alternative is to squeeze the swollen glans in a compress soaked in a solution of saline. The process takes about ten minutes. It is sufficient to numb only the penile nerves. In most cases, squeezing allows the doctor to move the patient’s foreskin back in the anterior direction.

If it is a severe case of paraphimosis, in which, for example, the foreskin has already started to die, an operation is necessary, but this only rarely happens. Doctors often recommend surgery to avoid scarring. A circumcision, in which the foreskin is cut, usually occurs when it cannot be successfully returned to its original position.

Outlook & Forecast

Paraphimosis is a medical emergency. If the foreskin, which has been slipped over the glans, can no longer be returned to its original position, this blocks the blood flow in the penis. Such an incident, also known as a “Spanish collar” in medical jargon, can cause permanent damage. If the condition is not treated promptly, there is a risk of losing the limb. At the same time, early treatment is almost always successful. Insofar as no vessels have died, the male genitalia recovers completely within a few days. Subsequently or immediately after the incident, the foreskin is usually surgically shortened in order to avoid renewed paraphimosis or phimosis.

In the case of paraphimosis, a urologist should be consulted immediately. The doctor can loosen the foreskin and give a prognosis. Initially, swelling may remain on the glans after the procedure. Inflammation and pain are also typical symptoms, but they should subside quickly. Depending on the treatment method, the therapy itself can be relatively painful because the swollen glans has to be squeezed out. The treatment is usually performed under anesthesia and therefore carries the potential for side effects. In the case of emergency medical treatment, a further examination by a specialist is necessary.


To prevent paraphimosis from occurring in the first place, it is advisable not to use force to pull back the narrowed foreskin. After washing, it is important to return them to their original position immediately.


In the case of paraphimosis, the measures and the options for aftercare are significantly limited in most cases. For this reason, the affected person should consult a doctor very early on, so that further complications or symptoms do not occur later on. In any case, this is an emergency, which must be treated immediately by a doctor so that the patient does not suffer irreversible damage.

As a rule, a surgical intervention is necessary for paraphimosis, through which this complaint is alleviated. The affected person should rest after such an operation and protect his body. Avoid exertion or physical and stressful activities. The region around the penis in particular should be treated carefully and cautiously.

After the wound has healed, regular checks and examinations by a doctor are still necessary in order to identify and treat other damage at an early stage. As a rule, paraphimosis can be completely cured if a doctor is consulted in good time. Further measures and options for aftercare are not available to the patient. The disease does not reduce the life expectancy of those affected.

You can do that yourself

A paraphimosis represents a medical emergency. The affected person should immediately call an ambulance or go to the nearest hospital. To avoid injuries, the foreskin must not be moved jerkily. It is advisable to cool the penis slightly and to assume a comfortable position in which the shaft is as exposed as possible. This can delay any cessation of blood flow.

After medical treatment, the patient should initially refrain from sexual activities. If the course is positive, the swelling should have subsided within a few days. The patient should speak to the urologist about circumcision to prevent recurrence of paraphimosis.

If complications arise as a result of paraphimosis, surgery must be performed immediately in many cases. After the procedure, the usual medical requirements apply. Physical exertion should be avoided, while light physical therapy exercises can aid recovery. Sexual activity should be avoided for a few days after surgery. If there are major symptoms in connection with paraphimosis, it is best to inform the responsible urologist or the medical emergency service.