Reduction of a tight foreskin

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

• 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