As a sole practitioner with my own Los Angeles-based holistic house call veterinary practice, I work a lot of long and unusual hours. I'm highly available to my clients nearly all day and into the night. As a result, short naps are often needed to keep up my better brain function and energetic state.
Recently, I was just about to take an afternoon power nap when a text from a client came through with an attached picture. As I did not want to have an unanswered message dwelling on my brain and affect my sleep, I picked up the phone and laughed out loud when I saw the photo and associated text.
My client sent me an image of her fluffy, white male Shih Tzu-Poodle (a Shihpoo?) mix lying on his side, which exposed his belly and a little, pink surprise: the glans penis extruding from his prepuce (foreskin-like sheath that covers the penis).
The text inquired: "Why is it still peeking out? What should I do?"
Having faced this issue many times in emergency practice, especially while doing emergency work, I recognize that this clinical presentation can alarm the pet owner and potentially escalate to a more severe health issue if not properly addressed.
Paraphimosis is the medical term for this condition. Mirriam Webster defines the term’s components as follows:
Para — beside, alongside of, beyond, or aside from
Phimosis — tightness or constriction of the orifice of the foreskin arising either congenitally or postnatally (as from balanoposthitis) and preventing retraction of the foreskin over the glans
When it comes down to it, paraphimosis occurs when the glans penis is unable to be properly retracted within the foreskin (prepuce).
Is Paraphimosis a Serious Health Concern?
The condition becomes more serious when irritation and dryness occur on the surface of the penis after the glans has protruded for minutes to hours (to days?) and comes into contact with environmental surfaces (the ground, carpets, etc.).
Additionally, edema (swelling) will occur as a result of restriction of blood flow back from the head of the penis. This further prevents the glans from retracting and restricts the proper flow of urine through the urethra, which leads to bladder enlargement and discomfort.
How Is Paraphimosis Resolved?
Resolving paraphimosis can be relatively simple or complex, depending on the length of time that the problem occurs and the amount of irritation, trauma, and swelling occurring in the glans penis.
An owner can apply some lubricant (personal, sterile surgical, moisturizing lotion, other) to the glans penis and gently try to press it back into the prepuce (or slide the prepuce forward over the glans).
If hair from the prepuce is sticking to the glans and preventing proper repositioning, then electric trimmers can be used to carefully trim away the hair. Scissors are not recommended, but they can be used if trimmers are not available, the scissor operator can work with confidence to cut only the hair (and not skin), and the animal can be properly restrained.
Additionally, a highly-osmotic solution, like 50% dextrose solution, can be applied to the surface to promote the movement of liquid out of the penis. On a more severe scenario, the prepuce tissue may need to be surgically cut to create a larger opening for the penis to be retraced.
It’s most ideal that a trained veterinary professional performs the treatment beyond the owner’s ability to lubricate and readily replace the penis to its natural position.
Can Paraphimosis Be Prevented?
One of my top paraphimosis prevention tips is to keep the hair at the tip of the prepuce cut short. This reduces the likelihood that hair will stick to the penis to prevent it from properly retracting into the prepuce.
It pains me to see a dog return from being groomed sporting a fresh haircut and an artistically-styled frond of hair at the tip of the prepuce (like a Merkin … Google it). Not only does this increase the likelihood that paraphimosis will occur, but the collection of urine, environmental debris, white blood cells, bacteria, and other substances can contribute to urinary issues, including infection, that ascends into the urinary tract from the outside world.
Additionally, prevent your male dog from humping other dogs, your mother-in-law’s leg, and his favorite stuffed animal.
Fortunately, my client’s dog’s paraphimosis was resolved the DIY (Do It Yourself) way with a gentle, lubricated push. From now on the hair is being trimmed shorter, so I hope his manhood stays put in its proper place.
Dr. Patrick Mahaney