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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Paraphimosis: Pet Emergency or Owner Embarrassment?

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

Image: tenten10 / via Shutterstock

Comments  10

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  • Google
    06/11/2013 06:30pm

    I Googled "Merkin" and was a bit surprised. Who knew things like this existed and who knew I'd learn about it on a pet blog!

    It mystifies me why a groomer would leave a bunch of fur around a critter's private parts for just the reasons you mentioned. That surely can't be healthy and if this problem arises, it must be really REALLY uncomfortable.

    I've had more than one cat's backside shaved when they don't keep themselves clean. I call it a "potty strip".

    That aside, it's good to know your client was able to get the problem corrected. Happy endings are always good, regardless of the source of the problem.

  • 06/15/2013 01:23am

    Glad to hear that I could introduce you to the phenomenon that is the "merkin".
    Yes, I'm always amazed when I see a large frond of hair attached to a male dog's prepuce!
    I am a big advocate of the "sanitary clip" for both dogs and cats around the anus, penis, and vulva. There are so many occasions when urine, feces, or other discharge accumulates on the hair and irritates the skin, thereby causing inflammation and infection. Sanitary clips for all!
    Thank you for your comments!
    Dr. PM

  • Persistent Erection
    06/13/2013 07:19pm

    Over the years I have seen two cases of paraphimosis caused by the intact male dog having an erection and then the prepuce acting like a rubber band around the base of the penis, not allowing it to "deflate" properly. The dogs didn't have a problem unless they had an erection so I'm not sure if the preputial opening was too small or not.

    I had read that applying ice to the engorged penis would constrict the blood vessels and reduce the size of the penis quickly. From experience, I would warn you that it must not be comfortable to the dog to apply ice to his penis because I was bitten once when I did it.

    Be careful. Muzzle the dog in some way before ice application. It does work so that the penis "deflates" and can retract into the prepuce quickly. However, if the penis is traumatized in any way, the dog should be seen by a veterinarian as soon as possible.

  • 06/13/2013 07:22pm

    I forgot to include my name...

    Dr. Bob Turrou
    http://practicalveterinarytips.com

  • 06/15/2013 01:27am

    Thank you Dr. Bob!
    Great to have a fellow veterinarian sharing his experience on this particular topic. I've never seen it occur in an intact animal, yet I speculate that the dogs' mating drive and inevitably more frequent excitation/engorgement would create plenty of opportunities for the glans penis to get stuck outside of the sheath.
    Note to self: No ice to be applied to the glans penis. I've done the 50 % Dextrose solution trick and it has worked (along with NSAIDs or steroids, sedation, etc.).
    Thank you for also suggesting to other readers that a muzzle should be placed!
    I hope to see you again back on my PetMD page.
    Dr. PM
    www.PatrickMahaney.com

  • ThingsWeNeverHearAbout
    06/14/2013 09:26pm

    When our family moved to Acapulco for a few years, we brought our animal children with us also. One of them was a rather large Samoyed named Boyo.

    One day, as Boyo was walking across the dining-room I noticed some drops of blood on the tiles. Upon inspection, I discovered it was coming from somewhere around his penis area. I immediately rushed him to the vet.

    Acapulco can be a very hot place and flies abound. It seems one of them had decided to lay eggs under the (warm and moist) prepuce and horror of horrors, it was full of maggots. I almost fainted.

    The vet then explained to me what I had to do and, believe me, it wasn't fun for either of us. With a bucket of boiling hot water beside me, and a pair of tweezers, I had to retract the prepuce, pull them out with the tweezers and put them in the bucket of hot water.

    Boyo, on his back, was an 'angel' through all this...even counting the odd time I missed (that must have been extremely painful for him), there'd be a small groan from this 'almost Polar Bear'.

    Seemed like it took forever, but I was finally certain I had them all...cleaned Boyo up and applied the medication the vet gave me.

    I wasn't at all concerned that he would bite me through all this, I was concerned that he'd lick me to death saying 'thanks' the days following!

    Anyone else ever had an experience like this???

  • 06/15/2013 01:32am

    Steph,
    Thank you for sharing your story.
    Pulling maggots out of an animal certainly one of the most unpleasant experiences any veterinarian or technician must endure in clinical practice.
    Removing them from the prepuce or penis is certainly something that is especially off-putting (especially for we men).
    Hopefully, Boyo will have this site closely monitored with the hair clipped short and kept clean to prevent any accumulation of material that could permit the growth of insect larvae!
    I hope to see you back again on my PetMD page.
    Dr. PM
    www.PatrickMahaney.com

  • backyardwolf
    12/11/2013 12:53pm

    I am fostering Greyson, an adorable little 4.6 pound chihuahua that we rescued. This poor little guy has gone through two surgeries now because his penis continues to peek out. Now I have just returned from the vet again today and was informed that he will just have to live with it, use ky jelly daily and watch for swelling. I was basically told that his penis is just too long for his sheath. Is this really possible??
    Before he was neutered it stayed in, except when excited, just like any normal dog. But after being neutered it stayed out. We just assumed it would go in when the pain from the neuter went away, but it didn't. Then it did get swollen and that was when he had his first surgery. After that first surgery he healed for 7 weeks with no change at all, just sported a new scar that ran alongside his penis. Then the vet operated again and that new scar was on his belly in front of his penis. Now today it is two months later after his second surgery and he still sticks out. Most of the time it sticks out about 1/2 inch but at times it sits out at 3/4 inch or even more. (On a four and a half pound chihuahua!)
    I don't know how to explain to potential adopters what his future may hold. Mostly because I really don't know what will happen. Do I need to warn them about possible lifelong issues? Is a tube of Ky jelly really the answer? Is it going to swell up again? If so how often? Is he going to need surgery over and over again? Is there really nothing else we can do for him?
    Other than his peek-a-boo penis, Greyson is very healthy 18 month old neutered chihuahua. He is a happy go lucky dog and definitely Mr. Personality. This little guy thinks everybody is his best friend! His hair is extremely short and he really does leave his penis alone, only occasionally licks it clean after going potty. Everything else about his penis is normal. He passes urine normal. He has normal erections when he gets excited. Then when he calms back down it goes back in, almost.
    This poor dog has gone through three surgeries in the last eight months. I thought I was doing what was best for him, but now I am not so sure. If you have any ideas or any thoughts that may be of help to him they would be greatly appreciated. I want to be certain that I did all I could for this special little boy before I adopt him out.

  • 02/12/2014 06:49pm

    My 13 year old min pin has paraphimosis and I have been lubricating his penis every other day and pushing it back in. It annoys and hurts him. Since it kept coming out, I took him to my vet and he said it is simply his age and that muscle is too relaxed now. He is scheduled for outpatient surgery one week from today. They will be sewing his sheath opening so that it has a smaller opening. This way, it shouldn't come out anymore.

  • paraphimosis yorkie
    04/02/2014 01:13pm

    Your article was the most helpful and a thorough discussion on this problem. My yorkie, unfortunately, has this condition daily. It looks just like the poodle picture you posted. So, at the end of the day, I either have to put it back in myself with lubricant or my vet told me to put a little hemorrhoidal cream on it. But since he licks it off, I have to put a bandana around the area until it has soaked in.

    I don't want to deal with this daily. It does go back into the prepuce, but I have to keep an eye on it constantly. The hair is trimmed short in that area. We do allow him to be outside with us for at least an hour/day. We live on 10 acres of short grass prairie. He gets a bath at least once/week.

    What else can we do? I do not want any kind of surgery. Thank you.


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