In an uncircumcised male, the head of the penis is covered by a sheath of skin known as the foreskin. Phimosis is a condition in which the foreskin is tightly stretched around the head of the penis and cannot be pulled back freely. Phimosis can occur naturally. For example, in boys younger than age 4, it is normally hard to pull back the foreskin. However, in older boys and men, phimosis often is triggered by an infection under the foreskin (balanitis) or by other medical conditions such as diabetes.
Paraphimosis occurs when a tight foreskin is pulled back behind the head of the penis and then becomes stuck. It cannot be placed forward again to its usual position covering the tip of the penis. This can cause swelling, pain and loss of blood flow to the tip of the penis. If the foreskin cannot be pushed back into its natural position, serious harm can occur.
Phimosis is usually painless. However, a very tight foreskin may interfere with urination or sexual function. In addition, phimosis may make it difficult for a man to clean under the foreskin, which can make infection of the skin more likely.
Paraphimosis usually results in painful swelling of the foreskin and head of the penis. Severe loss of blood flow to the head of the penis may be signaled by a deep purple color, which usually indicates a medical emergency.
Phimosis may be prevented by good hygiene. This includes fully pulling back the foreskin, so you can clean under it during bathing.
Paraphimosis can be prevented by carefully replacing the foreskin every time it is pulled back. If paraphimosis occurs, circumcision may be recommended to prevent it from happening again.
Phimosis without any symptoms does not require treatment. This is especially true in children. If a boy does not outgrow phimosis or there are problems with urination or hygiene, treatment with certain medicated creams, such as hydrocortisone, may be effective.
In some older boys and men with phimosis, good hygiene and prompt treatment of infections may be all that is needed to prevent problems. In other men, persistent symptoms occur, and corrective surgery (circumcision) needs to be done.
It is an emergency if paraphimosis occurs and the foreskin cannot be pushed back into its normal position. A physician may need to do an emergency procedure to create a slit in the foreskin, or do circumcision.
In most men, phimosis is not a serious problem and will not require treatment. However, it is not expected to improve on its own.
As noted above, paraphimosis is sometimes a medical emergency, and the penis may become permanently damaged if you do not seek immediate medical attention
Epididymitis is most common in young men ages 19 - 35. It is a major cause of hospital admissions in the military.
Epididymitis is usually caused by the spread of a bacterial infection from the urethra, prostate, or the bladder. The most common infections that cause this condition in young heterosexual men are gonorrhea andchlamydia. In children and older men,E. coli and similar infections are much more common. This is also true in homosexual men.
Mycobacterium tuberculosis (TB) can cause epididymitis. Other bacteria (such as Ureaplasma) may also cause the condition.
Another cause of epididymitis is the use of a medication called amiodarone, which prevents abnormal heart rhythms.
The following increase the risk for epididymitis:
Being uncircumcised
Recent surgery or a history of structural problems in the urinary tract
Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle area. The area becomes more and more sensitive to pressure.
Physical examination shows a red, tender, and sometimes swollen lump (mass) on the affected side of the scrotum. Tenderness is usually in a small area of the testicle where the epididymis is attached.
There may be enlarged lymph nodes in the groin area (inguinal nodes), and a discharge from the penis. A rectal examination may show an enlarged or tender prostate.
Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage)
Tests for chlamydia and gonorrhea
It is important to distinguish this condition from testicular torsion. Testicular torsion is an emergency and should be treated with surgery as soon as possible.
Your health care provider will prescribe medications to treat the infection. Sexually-transmitted infections require specific antibiotics. Your sexual partners should also be treated. You may need pain medications and anti-inflammatory medications.
The treatment for epididymitis caused by the medication amiodarone is a lower dose or change in the medication.
Bed rest, while elevating the scrotum and applying ice packs to the area, is recommended. It is very important to have a follow-up visit with your health care provider to find out whether the infection has gone away completely.
Epididymitis usually gets better with antibiotic treatment. There usually is no reduction in sexual or reproductive abilities. However, the condition may return.
If not treated, or in some other cases, the condition can become long-term (chronic). In chronic cases, there is usually no swelling, but there is pain.
Call your health care provider if you develop symptoms of epididymitis. Go to the emergency room or call the local emergency number if you have severe testicle pain suddenly or after an injury.
You can prevent complications from epididymitis by getting diagnosed early, and by treating any infections.
Your doctor may prescribe antibiotics before a surgery that increases the risk for epididymitis. Practicing safe sex (having intercourse with only one partner at a time, using condoms) may help prevent epididymitis caused by sexually-transmitted diseases.
Structures of the throat include the esophagus, trachea, epiglottis and tonsils.
The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness. Sometimes the airway can get blocked.
The most common form of laryngitis is an infection caused by a virus, such as cold or flu viruses. It may also be caused by:
A physical exam can find whether hoarseness is caused by a respiratory tract infection.
Patients with hoarseness that lasts more than a month (especially smokers) will need to see an ear, nose, and throat doctor (otolaryngologist) for tests of the throat and upper airway.
Common laryngitis is often caused by a virus, therefore antibiotics likely will not help. Your health care provider will make this decision.
Resting your voice helps to reduce inflammation of the vocal cords. A humidifier may soothe the scratchy feeling that comes with laryngitis. Decongestants and pain medicines may relieve the symptoms of an upper respiratory infection.
