Many parents had wanted the child circumcised in the newborn period but were talked out of it. Once a complication arises it is best to recommend circumcision. In this condition, the retracted foreskin cannot be returned to its normal position, covering the glans, due to preputial tightness. There is resultant lymphatic oedema, with swelling and distortion of the tissues. The key feature is that the whole glans is visible, which cannot happen in phimosis, when the glans is hidden under the very tight foreskin.
Treatment requires surgical referral.
It is only the rare co-operative child that allows you to gently compress the oedema and reduce the paraphimosis without an anaesthetic. Occasionally, EMLA cream will facilitate successful reduction. Usually elective circumcision is booked for 6 weeks, although occasionally the foreskin becomes stretched during the episode of paraphimosis and requires no further treatment. Textbooks say that hydroceles are a scrotal swelling that the examiner can easily get above. In practice, this is not always so, as the swelling can extend up towards the deep inguinal ring.