score “one” for the home
Anytime a man can do something nice for another, it’s a good feeling. Anytime a man can do something to save another man’s penis from rotting and falling off, that’s a special feeling.
I saw a patient who was complaining of a “swollen penis”. There are about a million jokes I or you could throw in here, so let’s everyone pause for a minute, think about your favorite “swollen penis” joke and insert here
So I took a look at this patient’s penis and it took all of my restraint to keep from saying “DAAAMMMNNNN”. This patient had what is called a paraphimosis. For those of you who aren’t familiar (hopefully there aren’t too many of you who are familiar), a paraphimosis is when the foreskin of an uncircumcised man is pushed back too far, gets stuck and acts like a rubber band around the penis preventing return of venous blood from the head of the penis (“the glans” for the sake of making this sound somewhat doctorly)–note that arterial blood continues to pump into the glans because arterial pressure is usually high enough to overcome the restraint of the paraphimosis. So with continued arterial inflow and obstructed venous outflow, it’s not hard to imagine that one ends up with vascular congestion and swelling distal to the paraphimosis, which makes it even more painful and harder to fix (pull the foreskin back over the glans). If a paraphimosis goes unfixed it can become a urologic emergency since once the pressure in the glans grows very high from the congestion and swelling, eventually arterial blood can no longer enter and the glans necroses from lack of blood supply. I.e., the head of the penis rots off. Not a good thing.
Anyway, this dude’s penis was majorly swollen (like in the picture). We contemplated calling urology but the decision was made that I should try to reduce it first. The objective in reducing a paraphimosis is to somehow reduce the swelling in the glans so that the foreskin can be pulled back over and therefore eliminate the rubberband-effect. Unfortunately, when you look online at how these things are reduced, they often get bloody–many times involving a tear or cut in the foreskin to accomodate it over the glans. I was hoping to avoid this. Using a combination of thought and guy-knowledge, here’s what I did.
I wrapped my patient’s penis with an ACE bandage. Starting from the top and working downwards, wrapping it quite tight in order to use the constant pressure from the bandage to push the pooling blood past the foreskin but leaving the base of the penis uncovered. Once wrapped, I went over it once more with another ACE, this time a little more tightly. Then I summoned a little thing that all men know as shrinkage. I grabbed a couple of ice packs and had my patient hold them on his penis for about 30 minutes.
When I took the ice packs off, unwrapped the bandages, I was able to pull my patient’s foreskin back over and he felt much better. Interestingly, so did I. I came out of the patient’s room and everyone heard the good news, and it was like something else. Let’s just say there were a lot of high-fiving going on. Yup, as my attending (also a guy) said, “score ‘one’ for the home team”. You said it brother.