ABSTRACT
Phimosis is a condition in which the foreskin is too tight to be pulled back over the head or glans of the penis. It is the part of male reproductive organ which is located outside the body, external organs include penis, scrotum, testicles. The internal organs include vas deferens, prostate and urethra. It is mainly responsible for sexual functions and urination. The main function is to produce, maintain and transport the sperms. They discharge sperm into the female reproductive tract and secretes male sex hormone. These hormones are the chemicals which stimulate and regulate the activity of the cells which are involved in the functioning of the male reproductive system, the main hormones which are involved are follicle stimulating hormone (FSH), Luteinizing hormone (LH). These hormones are mainly produced by the pituitary gland which is located on the base of the brain and is responsible for functioning of the body. FSH is responsible for spermatogenesis, LH is responsible for production of testosterone which is important for development of male characteristics includes fat distribution, bone mass, sex drive. Penis is the main organ which is responsible for the sexual intercourse and has three parts which includes- the root, body and the glans. The glans is a cone shaped part which is covered by foreskin and the skin is removed known as circumcision. This is the part which is not retracted and seen in phimosis. In this topic we are going to study in detail about its causes, treatment and its ayurvedic management in detail.
INTRODUCTION
Phimosis is a condition of the penis that is seen in some adults and childrens whose glans is not circumcised. In this the foreskin cannot be retracted from the tip of the penis, can occur naturally or be the result of scarring. A balloon-like swelling is seen under the foreskin which occurs during urination. In teenagers and in adults it may cause pain during erection and those who are affected are at greater risk of the inflammation of the glans which is known as Balanitis. In childrens the condition can be normal and 90% cases can be prevented by preputial adhesions. The main complication arriving due to this condition is scarring which is due to balanitis and balanitis xerotica obliterans (BXO). It is found virtually in all newborns and 1% seen at 16 years of age. BXO is an insidious onset which causes irritation, local infection, bleeding and sometimes meatal stenosis. Glans is a sensitive bulbous structure which is at the distal end of the penis.
FACTS
- Non retractile foreskin is present in about 96% of males at the time of birth which slowly becomes retractable as they reach adolescence.
- The foreskin cannot be retracted completely before the age of 5
- Statistics say that 50% of uncircumcised boys have retractable foreskin by age of 1 and 99% by adolescence.
- Tight foreskin can be caused due to injury or by infection of the foreskin.
- They cause ballooning or blowing up the skin during passage of urine
- Tight foreskins (which are not circumcised in childhood) can further cause penile tumors.
- The tightness can cause and interfere with the normal passage of the urine and causes acute retention of urine.
TYPES
- Physiologic Phimosis - It is a type of phimosis which is present since birth and is mainly due to adhesions between the epithelial layers of the inner prepuce and glans penis. The foreskin is not retractable and does not require intervention. This phimosis can resolve with age as males grow and the adhesion is dissolved with erections. The foreskin retracts and there is accumulation of the white discharge known as Smegma. The urine can accumulate under foreskin which causes ballooning of penis. Forced retraction can be harmful to children and it must be avoided which further leads to soreness and bleeding.
- Pathologic Phimosis - This is due to the presence of any underlying causes such as poor hygiene, forced retraction and recurring infections of the foreskin and glans penis. This is typically caused by Balanitis xerotica obliterans (BXO). BXO is cicatrizing skin condition which is similar to lichen sclerosis. BXO is also responsible for penile cancer in later stages of life.
PATHOPHYSIOLOGY
In physiological phimosis, the attempted retraction of foreskin results in constriction ring which is proximal to preputial orifice. In BXO it has sclerotic constricting band which is 1 to 2 cm proximal to distal end which whitish discoloration of peri meatal area and an erythematous area being a sign of developing disease.
CAUSES
- Poor Hygiene - This might be irritating and painful and try to clean thoroughly.
- Due to forceful retraction of foreskin over the glans penis which leads to microtears at preputial orifice and scarring.
- Balanoposthitis - Inflammation of foreskin along with glans penis.
- BXO (Balanitis xerotica obliterans) known as lichen sclerosus is a skin condition which affects male genitalia. A whitish ring is formed near the tip of the prepuce which prevents retraction.
- Who are on repeated catheterization.
- In elderly patients there is loss of elasticity and infrequent erections.
- Balanitis (inflammation of glans penis)
- Patient who is suffering from untreated diabetes which leads to residual glucose in urine leading to infection
SYMPTOMS
- Preputial pain
- Inability of glans to retract fully on the foreskin
- Irritation to skin
- Local infection
- Meatal opening is small
- Urinary retention
- There is presence of blood in the urine
- A bulge is seen at the tip of penis which gets accumulates during urination
- There is scarring of the foreskin and bleeding is seen
- Erection is painful
- Painful intercourse
- Pus is seen in balanoposthitis
SEVERITY OF PHIMOSIS
There is 6 grades of phimosis such as -
- Grade 0 fully retractability
- Grade 1 full retraction but tightness behind the glans
- Grade 2 partial exposure of the glans
- Grade 3 partial retraction with just visible meatus
- Grade 4 slight retraction nor glans neither meatus is visible
- Grade 5 no retraction
COMPLICATIONS
- Infected foreskin which leads to infection of the skin
- Paraphimosis is when foreskin gets hidden behind the glans which is due to forceful retraction and cannot cover the glans
- Retention of the urine
- Carcinoma of the penile
- Type 2 diabetes
- Narrowing of the penile opening
RISK FACTORS
- Urinary tract infections
- Forceful retraction of foreskin
- Infections of the foreskin
DIAGNOSIS
- Urine tests
- Blood tests
- Bacterial culture test
DIFFERENTIAL DIAGNOSIS
- Acute balanoposthitis
- Paraphimosis
- Dysuria
- Congenital megaprepuce
- Preputial adhesions
TREATMENT
Physiologic phimosis is common in males at the age of 10 years which doesn't require any intervention. Non retractile foreskin becomes retractable during puberty. If phimosis is seen in older and in adults it doesn't cause any severe problems so non surgical measures are effective.
NON SURGICAL
- Patient is advised to stop exacerbating masturbation techniques.
- Topical steroid creams such as betamethasone , cortisones are effective in treating phimosis and are considered before circumcision.
- Gentle stretching of the foreskin and skin is under tension by growing additional cells, if the opening is too small then flesh tunnels are used, the diameter can be increased until the foreskin can be retracted without difficulty.
SURGICAL
It can range from complete removal of the foreskin to minor operation.
PROGNOSIS
The most acute complication is paraphimosis, in this gland is swollen and painful, the foreskin is immobilized by swelling in a retracted position. Further it can be a risk factor of urinary retention and carcinoma of penis.
AYURVEDIC MANAGEMENT
In ayurveda phimosis is related to Nirudhpraksh. It is also known as nirudhmnai. Acharya Sushruta gave brief knowledge about this disease as it is mainly due to Atimardan (excessive rubbing), Peedan (pressing) and Abhighatadi (trauma) which causes vitiation of the vata doshas which get localized to glans (mani) and prepuce (shishangra twacha) which furthur produces adhesions causes obstructions in the passage of the urine, and sometimes characterized by thin stream of urine without excessive pain and glans cannot be exposed.
HERBS USEFUL FOR PHIMOSIS
1. ASHWAGANDHA
Ashwagandha (Withania somnifera) is a powerful gift of ayurveda used in the treatment of anxiety, muscle strength, and acts as an antioxidant. Ashwagandha is associated with male and its fertility and useful in females too. This herb is used to strengthen the uterus, ovaries and its ligament to prepare for pregnancy. It works as a powerful antioxidant (boosts up the immune system) and anti-inflammatory. Helps to improve the quality of ovum (egg), reduces the stress level and calms the mind and helps to manage hormonal disturbances.
2. SHILAJIT
Shilajit ( Asphaltum punjabinum) is a dark sticky mineral substance which has powerful rejuvenating properties and helps to support the immune system of the body, acting as an anti aging. It initiates detoxification and removes the excess kapha which helps to maintain healthy weight, promotes healthy health to lungs and respiratory tract. Helps to maintain energy, vitality and provides tone to the reproductive system.
3. GOKSHURA
Gokshura ( Tribulus terrestris) is an ancient herb used mainly for bodybuilding, relieves disease of the urogenital system and acts as an aphrodisiac. It helps to improve muscle strength, acts as a diuretic which cleanses the urinary system and has lithotriptic activity. Gokshura helps to increase the libido in both men and women, promotes sperm production and ovulation. It acts as an anti-inflammatory property and is used in the treatment of anti obesity.
4. TURMERIC
Turmeric ( Curcuma longa) is used in the treatment of diabetes and mainly balances tridoshas of the body. It acts as a blood purifier which is commonly used in the treatment of atherosclerosis, removes the toxins from the vessels and expels extra kapha and medha from the body. It has an anti-inflammatory property which is helpful to rejuvenate skin tone, act as antibacterial and as antioxidants.
HERBAL REMEDIES BY PLANET AYURVEDA FOR PHIMOSIS
Planet Ayurveda is a famous herbal pharmaceutical company that deals with the production of herbal products and various remedies for treating various kinds of ailments without causing any side effects to the patient. All the formulations prepared by planet Ayurveda are 100% pure which is made from plant extracts. For the treatment of phimosis planet ayurveda provided many herbal remedies which provides great relief to patients.
PRODUCTS LIST
- MALE SUPPORT FORMULA
- ATIRASADI CHURNA
- JATYADI OIL
- TRIBULL OIL
PRODUCTS DESCRIPTION
1. Male Support Formula
Male support capsules are polyherbal capsules formulated by planet ayurveda using ingredients such as Ashwagandha ( Withania somnifera), Shilajit ( Black bitumen), Gokshura ( Tribulus terrestris). These capsules act as the best aphrodisiac which helps to promote and strengthen the male reproductive organ. It helps to increase the flow of blood to penis and enhances the fast removal of toxins which helps to prevent infection and inflammation. Helps to remove the obstruction of urine due to phimosis.
Dosage: 1-2 capsules twice daily with plain water after meals.
2. Atirasadi Churna
Atirasadi Churna is a polyherbal churna which is formulated by planet ayurveda using ingredients such as Safed Musli ( Chlorophytum borivilianum), Shatavari ( Asparagus racemosus), Akarkara ( Anacyclus pyrethrum), Varahi Kand ( Dioscorea tuberosa) and many more. This churna helps to improve male reproductive system and is effective in premature ejaculation and in erectile dysfunction. This churna helps to pacify the vata dosha, balances pitta dosha and nourishes kapha dosha.
Dosage: 1 teaspoon with plain water after meals.
3. Jatyadi Tailam
This is classical herbal oil which is formulated by planet ayurveda using ingredient such as Chameli ( Jasminum officinale), Patola patra ( Stereospermum chelonoides), Katuki ( Picrorhiza kurroa) and many more. It has penetrating property which helps to heal the deep seated wounds and in non healing wounds. It helps to restore the normal color and reduces the sensation of the affected area.
4. Tribull Oil
This is herbal oil formulation prepared by planet ayurveda using various ingredients such as Cutsaraiya ( Barleria prionitis), Khurasani ajwain ( Hyoscyamus niger), Jaiphal ( Myristica fragrans), Maalkangni ( Celastrus paniculatus) and many more. This is very helpful in male reproductive system, maintains the proper circulation for penis, it maintains the erectile dysfunction and disease known as peyronie.
Method Of Application: Jatyadi oil is mixed with Tribull Oil and is applied over the affected area and massages it gently daily.
Contact Planet Ayurveda Support Team to provide you the costing/ordering and delivery information at - [email protected] or Call at 0172-521-4040 (India), +91-172-521-4040 (Outside India) or Whatsapp at (+91) 842-749-4030.
CONCLUSION
Phimosis is a condition in which the foreskin is too tight to be pulled back over the head or glans of the penis. It is the part of mae reproductive organ which is located outside the body, external organs include penis, scrotum, testicles. The internal organs include vas deferens, prostate and urethra. The main hormones which are involved are follicle stimulating hormone (FSH), Luteinizing hormone (LH). A balloon-like swelling is seen under the foreskin which occurs during urination. The main complication arriving due to this condition is scarring which is due to balanitis and balanitis xerotica obliterans (BXO). As we discussed there many herbal remedies which are formulated by planet ayurveda and it provided great relief to patients without causing any side effects.
