Cracks in the foreskin in men and children

The foreskin is the fold of skin that covers the glans of the penis outside of sexual arousal. During an erection, she shifts to the base, exposing her. It happens that the skin lobe is damaged, causing redness, swelling, and then cracks, giving men a lot of discomfort and suffering.

Epidemiology

According to statistics, 9 out of 10 boys have problems associated with the inability to abduct the foreskin. In adult men, phimosis, to a lesser or greater extent, occurs in approximately 14% of those who see a urologist. [1]

Balanoposthitis is recorded in 3% of male representatives. [2]

Causes of the cracks in the foreskin

Cracking of the foreskin occurs for several reasons. Here are the most common ones:

• phimosis or narrowing of the foreskin  - is  divided into physiological (age-related) and pathological. Most boys under the age of 16 have a congenital problem with head exposure; [3]
• balanoposthitis -  inflammation of the head and foreskin. In adults, it is provoked by infection, inflammatory dermatoses, allergies, precancerous skin conditions. Children are most often infected with conditionally pathogenic flora, which is constantly present in the body;  [4]
• mechanical injury. [5], [6]

Risk factors

There are factors that increase the risk of cracking:

• improper care of the genital area (smegma accumulates between the head and the foreskin, becoming infected with untimely hygiene);
• using detergents that provoke irritation;
• diabetes mellitus, which reduces the body's immune defenses.

Pathogenesis

The mechanism of narrowing of the foreskin is not completely clear, but it is associated with a lack of connective tissue arising from a genetic predisposition. During puberty, sometimes there is a mismatch between the development of the head and the skin, which forms a ring around it.

The pathogenesis of inflammation is the same, regardless of its localization: under the influence of a pathogenic stimulus, the cells and tissues of the organ are destroyed, exudate is released, then there is a productive stage of tissue restoration. Frequent relapses thin the skin, making it vulnerable to the slightest physical impact.

Symptoms of the cracks in the foreskin

Cracks occur on the inner side of the dermal leaf. They are both small, inconspicuous, not causing painful sensations, and large, which cannot be overlooked.

The first signs that give out the presence of pathology are pain that pursues when moving the foreskin, urinating, intercourse and forcing a visual examination of the organ. Here redness, cracks, edema are found.

• Cracks in the foreskin with diabetes

Often, hyperemia of the glans penis is a tip to the endocrinologist about diabetes mellitus, since sugar is excreted with urine, its residues settle on the skin, being a breeding ground for bacteria and fungi to multiply. [7]

This is how a pathological process arises, leading to cracks, and sometimes ulcers and erosions, which are difficult for a weakened immune system to cope with. Scarring of the wounds leads to a narrowing of the openings of the foreskin - phimosis.

Crack in the foreskin of a child

In almost all young boys, the foreskin completely covers the head and this should not bother the parents until they complain of pain and see the red tip of the penis.

With the growth of the child, starting from about 3 years old, the skin folds gradually stretch, the head begins to be exposed. A crack in the foreskin of a child may appear if hygiene rules are not followed. During bathing, the groin area must be washed with soap and rinsed with clean water, without exposing the head, and wash with liquid baby soap.

Complications and consequences

Fissures in the foreskin often lead to rough scarring, which narrows the rim around the head of the penis and leads to difficulty in urinating or its complete retention, interfering with intercourse. Clamping of the head is fraught with edema, congestive hyperaemia, sometimes even tissue necrosis.

Getting into the cracks of purulent exudate is dangerous for the development of cancer. [8],   When balanoposthitis often develop lymphangitis  -  inflammation of the lymphatic vessels of the penis and then bubonadenitis. 

Diagnostics of the cracks in the foreskin

A urologist diagnoses a crack in the foreskin by performing a visual examination, specifying certain details for concomitant diseases, whether there were problems with exposing the head before, whether there were  sexually transmitted infections .

To clarify the diagnosis, a smear is taken for culture,  analysis for syphilis , herpes, glucose levels. An allergist consultation may be scheduled.

Differential diagnosis

Differentiation of the disease leading to the formation of cracks is very important, since the treatment regimen depends on it. It occurs between STIs, phimosis, balanoposthitis, diabetes mellitus and other pathologies that can lead to defects in the foreskin.

Treatment of the cracks in the foreskin

In addition to tactics aimed at treating the underlying problem, local therapy is used, which is as follows:

• proper daily hygienic care, including warm baths of decoctions of anti-inflammatory and antiseptic medicinal herbs;
• restriction in sexual intercourse, refusal to masturbate;
• wearing swimming trunks made of natural fabrics;
• applying healing ointments.

With balanoposthitis, it is possible to take antibiotics inside. In case of detection of genital infections or human papillomavirus, long and serious therapy is required.

Medicines

The main means for healing cracks in the foreskin are ointments

Based on antifungal, anti-inflammatory, antibacterial components. After washing with warm water and drying, you can resort to applying the following preparations:

• bivacin is a combined antibiotic that has a destructive effect on most gram-positive and gram-negative bacteria. Packaged in a tube with ointment and an aerosol can. The ointment is applied in a thin layer to the affected surface, the balloon is shaken and sprayed from a distance of 20 cm. The multiplicity of the procedure is 2-3 times a day. Skin contact may cause pain and burning sensation. The drug can cause an allergic reaction, so a preliminary test must be done;
• triderm is an ointment that combines 3 components: anti-inflammatory, anti-fungal and antibacterial. Application to the penis is carried out by light rubbing twice a day: in the morning and in the evening. The duration of use should not exceed one week. The drug is not recommended for children, due to the lack of trials in this age group;
• cortomycetin is an ointment that combines an antibiotic and corticosteroids. Can be applied not only to adults, but also to children over 2 years old. Apply twice a day to the skin. Able to cause burning, dryness, itching, hypersensitivity reactions;
• levomekol  - promotes healing, has an antimicrobial effect, accelerates cell regeneration. Can be used from 3 years of age, lubricating cracks for 4-5 days;
• bepanten 5% is a reparant ointment, its use does not lead to overdrying of the skin, you can use it after applying corticosteroids. Creates a greasy protective coat. Suitable even for the smallest. It is applied once a day or several times, if necessary. Virtually no side effects.

Vitamins

The development of inflammation of the skin of the head and the inner layer of the foreskin, leading to the formation of cracks, is facilitated by a lack of vitamins C, B2, B6, PP and others. Therefore, it is important to saturate your diet with foods containing them, periodically drink vitamin complexes.

Physiotherapy treatment

Of the entire arsenal of physiotherapeutic methods, in the case of cracks in the foreskin, baths with a decoction of chamomile, plantain, elderberry flowers, echinacea, motherwort are suitable. They, unlike a solution of potassium permanganate, do not dry the skin and do not lead to rough scarring.

Surgery

Surgical intervention is carried out with phimosis. Such an operation is called  circumcision  and is a circumcision of the foreskin. In other cases, only conservative treatment is used. [9], [10]

Prevention

The main preventive measures to prevent the formation of cracks in the foreskin are daily hygiene using mild hypoallergenic soap solutions, passing annual examinations by a venereologist, urologist to identify problems.

In diabetes mellitus, it is important to keep your blood glucose level under constant control. It is also necessary to apply protection against genital infections during contact with a woman, to avoid traumatic effects on the head of the penis.

For children, parents should not use force to open the head of the penis. The child should be able to retract the foreskin himself to that distance until it causes discomfort.

Forecast

Timely access to a doctor and treatment of problems makes the prognosis of the disease favorable.