A painful, swollen penis was the presenting complaint of an 11-year-old boy. The swelling erupted 1 to 2 hours before the photograph was taken, when the child had attempted to retract the foreskin.
The child had paraphimosis, a condition that develops when a phimotic prepuce is retracted behind the coronal sulcus and becomes incarcerated. This causes lymphatic and venous stasis distal to the corona, with resulting edema and painful swelling of the prepuce. The constricting band proximal to the swelling is diagnostic.
Paraphimosis is a medical emergency, since it may lead to arterial compromise and necrosis of the tip of the penis if the incarcerated prepuce is not released early. Treatment consists of manual reduction of the prepuce with appropriate lubrication. If the technique is unsuccessful, a dorsal preputial slit may be required. Circumcision should be performed at a later date.