Natural Treatment Is The Best Possible Way To Cure Phimosis
Physical examination is often of great importance in clarifying suspected etiologies. Start with a general examination, and keep in mind some of the vascular, endocrinological, and neurological causes of ED. Assess the degree of androgen-ization checking for body hair and any evidence of gynecomastia. Examine the genitalia carefully for any abnormalities. Check whether the foreskin can be retracted, and look for conditions such as phimosis or balanitis. Deep palpation of the penis can reveal fibrotic thickening (Peyronie's plaques) in a proportion of men presenting to sexual dysfunction clinics. Cremasteric and bulbocavernous reflexes should be elicited as well as saddle sensation and deep tendon reflexes of the legs. The size and consistency of the testicles should be assessed. If urinary symptoms are present, rectal sphincter tone and prostatic examination are necessary. Cardiovascular risk assessment should be undertaken see Appendix and Jackson et al. (17) .
Squamous cell carcinoma of penis this is relatively rare in the UK ( 1 of carcinomas in men vs. 10-20 in Asia, Africa, South America) affecting ages 40-70 years. It is particularly rare with early circumcision (at birth). There is an association with paraphimosis, phimosis, HPV 16, Most tumours arise from the glans or inner foreskin near the coronal sulcus as a slow-growing, irregular mass. Patients occasionally present with inguinal nodal metastases and occult penile cancer due to severe phimosis or a very small primary tumour. Metastases to inguinal lymph nodes, lung, liver or bone occur and are present in 15 of cases at diagnosis. Lymph nodes may be enlarged at clinical presentation due to infection alone.
Mortality rates for SJS range from 5 to 10 and increase to 30 to 40 for cases of TEN. Most patients die of sepsis or pulmonary involvement. SJS and TEN can produce significant ocular sequelae, including severe visual loss in a significant number of patients, requiring intensive involvement of an ophthalmologist. Residual skin discoloration, persistent erosions of the mucous membranes, phimosis, abnormal nail regrowth, and synechiae of the genital mucosae can also occur.
Balanitis xerotica obliterans (BXO) this is the male equivalent of lichen sclerosus et atroph-icus of vulva. It may cause narrowing of the urethral meatus or phimosis. There is a weak association with carcinoma of the foreskin. The gross appearances are that of grey-white foci of atrophy in the foreskin or perimeatal glans. Balanoposthitis infection of the glans and foreskin, usually due to candida, anaerobes, gardnerella or pyogenic bacteria. It is common in uncircumcised newborns or uncircumcised men with poor hygiene and accumulation of smegma and due to the propensity of pathogenic bacteria to adhere to the mucosal surface of foreskin. It causes phimosis.
Circumcision specimens consisting of the foreskin are removed more often in the context of benign penile conditions (BXO, Zoon's, phimosis and paraphimosis). Occasionally a small cancer is removed in this fashion and margins in this case will be important. These are dealt with below.