Next to the village school, Alif is playing cricket. He is a young child; he will turn six to seven years old next month. He’s been playing with his friends for quite a while.
The evening has come, and now his grandfather is taking him home. After arriving at the house, Alif sits down to wash his hands and face. After almost an hour and a half, his mother calls him to eat. After having dinner with everyone in the family, Alif falls asleep in the same room with his grandparents.
In the morning, Alif’s crying is heard; he is crying in great pain. his grandparents woke up to the sound of crying. They got up and found Alif crying with his hands on his genitals.
To find out why he is crying, his grandparents open Alif’s pants and find that his foreskin is missing, although Alif has not been circumcised yet. The circumcision happened suddenly without any bloodshed.
Everyone in the house wakes up. Alif is groaning in pain. Hearing the commotion, the sixty-year-old woman from the neighborhood comes over to see what happened there.
After hearing the incident and seeing Alif’s condition, the elderly woman immediately says, “Hey, this is the Prophetic circumcision! How lucky your boy is! Circumcision was done with the blessing of God. Give treats to all the people of the village in this happiness. I bring the news to everyone.”
The news of Alif’s miraculous circumcision spreads in all directions. Everyone is coming to see Alif and inquire about this unique circumcision.
Alif, exhausted from the intense pain, is now sleeping. What has happened to Alif? Is it some supernatural being that caused his circumcision, or is it something else?
Phimosis. Image Source
Several hundred kilometers away from the village. Sajikul is a first-year student at Dhaka National Medical College. Now he is in class, listening attentively to the professor’s lecture.
In class, they have been studying the anatomy of the penis. Today, the class is learning about phimosis and paraphimosis while studying developmental anomalies. Sajiqul asks the teacher about this and takes notes of several other facts.
As the class ends and he finishes summarizing the lecture notes. Let’s see Sajiqul’s notebook. Phimosis and paraphimosis are often confused in many cases, so he noted them separately. Now, let me explain the gist of what he understood.
In short, phimosis refers to a condition where the foreskin of the penis is too small and tight to pull the foreskin to the base of the penis, so it is retracted over the glans penis, which may prevent the complete exposure of the glans. This condition of the penis is called phimosis.
Alternatively, to put it simply, any natural male with a foreskin covering the front part of the penis, even if it stays covered like a hood, is also referred to as having phimosis.
In the case of any man, phimosis is not a complicated problem until symptoms appear. Usually, in children under the age of ten, who have not undergone circumcision, and even among adults who have not been circumcised, phimosis can also be observed. Problems may arise during urination for some, and if proper hygiene is not maintained, the chances of urinary tract infection increase.
The impact of phimosis is usually felt during urination or when experiencing sexual arousal, causing discomfort. Typically, the effect of Phimosis reduces as children grow older. However, if it does not improve or worsen with age, using a steroid cream per the specialist’s advice can help expand the foreskin within a few weeks.
Furthermore, circumcision is the ultimate solution to free oneself from the effects of phimosis.
Now, let’s talk about paraphimosis. Hearing the name, one might understand that it is a condition related to the male genitals. Let’s try to understand what paraphimosis is through an example.
At night, Rahul urinated; he was around fifteen years old. His foreskin was too tight to retract over the glans penis, indicating phimosis. Feeling curious while urinating, he wished to fully expose the glans penis by pulling back the foreskin. After trying for a while, he retracted the foreskin, but unfortunately, it got stuck behind the head of the penis (neck of penis). He couldn’t bring it back to its original position, no matter how hard he tried, and Rahul felt pain. He thought it might improve while sleeping, so he went to bed without informing anyone. Days passed, but the foreskin didn’t return to its previous state.
With the foreskin stuck behind the Neck of the Penis, the blood circulation was restricted, causing the glans penis to turn red. In some cases, the glans can also appear bluish. At the same time, the foreskin being stuck can create a balloon-like swelling due to the accumulation of pus and fluid around the glans. This condition in Rahul’s penis is essentially Paraphimosis.
This was a summary of Sajikul’s notes on phimosis and paraphimosis.
Paraphimosis. Image source
Five days later, Alif’s pain was increasing day by day. The foreskin around his glans penis was swollen, and the glans penis had turned reddish-blue. Alif can’t walk properly.
The family could not handle the situation correctly, and everyone was distraught. They couldn’t reach any decision on what to do.
Sajikul is going to his village home to fetch some necessary documents. He is in the car now. After reaching home, he heard about Alif’s condition. Upon hearing about prophetic circumcision, he had doubts, so she went to see Alif at his house.
Seeing the condition of Alif’s penis, Sajikul quickly understood that this was not a case of prophetic circumcision; it was paraphimosis.
Immediately, Sajikul informed Alif’s family members about the necessity of clinical treatment for paraphimosis.
Alif is now being taken to Sajikul’s medical college where his paraphimosis will be treated. To reduce the pain, ice is applied to Alif’s penis.
Alif is now lying on the operating theater bed. Associate Professor Dr. Rosario will perform the treatment. Professor Rosario entered the operation theater and observed Alif’s penis, deciding on circumcision.
An analgesic injection was initially given to Alif, and he feels no pain now.
Then he made several punctures in the foreskin, which was swollen with pus and fluid on the neck. Then gently pressing the foreskin with the hand so that the fluid can drain through the hole.
Within a few minutes, all the fluid in the swollen foreskin was drained. Now the doctor is gently holding the foreskin and trying to bring it to the tip of the penis. Slowly bringing the entire foreskin to the tip of the penis, the glans penis is now inside the foreskin.
To complete the circumcision, he pulled the foreskin and stretched it a little more, and the stretched foreskin was then tightly tied with a surgical thread.
Now, the circumcision stapler has been inserted into Alif’s penis to the glans-penis. Professor Rosario applies pressure to the stapler trigger and slowly moves the stapler, turning it around the entire foreskin, cutting the foreskin together, and stitching it together.
Circumcision is complete. Professor is bandaging Alif’s penis. Professor Rosario has given Alif a sleeping injection, so now Alif is falling asleep.
Now let’s explore the reasons behind the development of paraphimosis in the penis.
Paraphimosis is not only observed in individuals who have undergone circumcision or any type of foreskin removal. It is not true that everyone who has not undergone circumcision will develop Paraphimosis.
Here are some reasons for Paraphimosis:
1. If someone pulls back their foreskin too forcefully over the glans penis and the foreskin gets stuck behind the glans or neck of the penis, paraphimosis can occur. During sexual intercourse, the foreskin might get pulled back and trapped behind the glans.
2. Failure to keep the area inside the penis or the glans clean can lead to infections, which may cause the foreskin to swell and lead to Paraphimosis. Also, any external injury to the penis or the sting of an insect on the glans can cause the foreskin to swell and result in Paraphimosis.
3. In some cases, long-term complications due to diabetes can cause chronic problems with the penis and foreskin, including paraphimosis.
4. Paraphimosis can occur even if the circumcision or cutting procedure is not done according to the proper rules. In rural areas, circumcision is often performed by untrained individuals, and instead of adequately stitching the foreskin, a piece of burnt cloth is used as a bandage. Tightly wrapped cloth around the penis causes a sac of pus and fluid around the neck of the penis. This condition is known as post-circumcision paraphimosis. So, even after circumcision, paraphimosis can still occur if proper medical care is not provided.
Any of the above-mentioned reasons can lead to paraphimosis in an individual.
Now, let’s discuss some ways in which individuals who have not undergone circumcision can prevent paraphimosis:
1. After urination, the penis should be adequately cleaned to prevent urine retention, which may lead to infections.
2. During sexual intercourse, ensure the foreskin is not pulled back behind the glans penis or trapped below it.
3. Avoid keeping the foreskin pulled back over the glans for extended periods. In some clinical tests of the penis, the foreskin may be pulled back, and in such cases, it should be ensured that after the test is done, the foreskin is returned to its natural position.
Now, let’s discuss a relevant topic. What if Alif did not receive further clinical treatment? Would Paraphimosis reduce on its own?
The answer is no. In Paraphimosis, due to the pressure on the foreskin, blood circulation can be restricted, leading to necrosis (tissue death) and potential gangrene in severe cases. The severity depends on the tightness of the individual’s foreskin. As Alif is a child, his foreskin is not as tight as an adult’s, so the risk of necrosis was lower.
However, if adults have Paraphimosis and do not receive prompt clinical treatment, the penis could be at risk of gangrene. In such cases, even circumcision won’t provide relief, and specific parts of the penis may need to be removed to prevent further spreading.
Now, let’s find out the exact reason for Alif’s paraphimosis. Let’s travel back using a time machine and observe what happened that night.
On a serene night, the sound of insects is audible outside. Everyone in Alif’s house is asleep, including his grandparents. Alif is trying to sleep but feels restless.
Sometimes, in between, Alif tries to take the foreskin of his penis to the base of his penis. He manages to pull the foreskin to the middle of the glans penis, but trying to pull it further causes discomfort, so he falls asleep.
Even during sleep, he fidgets and makes some movements. Before falling asleep, Alif forgets to bring his foreskin back to the front of the penis, and now it remains in the middle of the glans penis.
As he moves around restlessly during sleep, the friction between the foreskin and the pants causes the foreskin to get trapped behind the glans penis.
Usually, during circumcision, when there is no foreskin, and the glans penis is exposed, in this case, the foreskin is stuck to the penis neck and the glans penis is exposed, causing paraphimosis.
As a result, Alif’s family and the 60-year-old lady thought that some miraculous entity had been circumcised overnight, called Prophetic circumcision.
But now we know it is not the case. Rather than jumping on a case of a supernatural event causing any physiological or mental changes, we must think carefully and consult with professional doctors.