Paraphimosis is the inability to completely reduce the penis into the preputial cavity.
Paraphimosis most commonly occurs in dogs after manual semen collection and less commonly after coitus. The skin at the preputial orifice becomes inverted, trapping the extruded penis and impairing venous drainage and detumescence.
Paraphimosis is uncommon in cats, as semen collection in cats is usually done under anesthesia or by chemical stimulation.
Other causes of paraphimosis include a small preputial opening (see paraphimosis image), priapism, foreign objects around the penis, a constricting band of hair at the preputial orifice (feline), or trauma.
Paraphimosis can be differentiated from the following conditions on the basis of physical examination: priapism (persistent erection without sexual stimulation); congenitally short prepuce with secondary penile exposure; penile neoplasia; and penile hematoma.
Courtesy of Dr. Autumn Davidson.
Paraphimosis warrants veterinary intervention if it does not resolve quickly on its own. The exposed penis rapidly becomes edematous, because its venous drainage is compromised. With continued exposure, the mucosa becomes dry and painful. Self-trauma exacerbates the condition.
If recognized early, before severe edema and pain develop, paraphimosis is more easily treated. Treatment begins with gentle cleansing and liberal lubrication of the exposed penis. The penis is then repositioned inside the prepuce by first sliding the prepuce proximally, extruding the penis further. This everts the skin at the preputial orifice; usually, the prepuce then slides easily over the penis.
Edema resolves promptly once circulation is restored.
Persistent cases of paraphimosis may benefit from cool compresses, lubrication, or sedation with acepromazine and should be evaluated for the presence of priapism if refractory (best done using penile ultrasonography). Note that acepromazine has been reported to cause persistent penile erection in horses; however, in the author‘s experience, acepromazine administered at 0.005-0.03 mg/kg, IM or SC or slow IV, is helpful in dogs because it induces sedation and mild hypotension, facilitating manipulation of the penis back into the prepuce.
Courtesy of Dr. Autumn Davidson.
If the everted prepuce does not slide over the edematous, exposed penis, a cool compress may be applied with gentle digital pressure to act as a pressure bandage. A temporary purse string suture can be placed to keep the penis inside the prepuce.
Sedation is helpful if the patient is in pain. When paraphimosis is due to other causes or is of longer duration, sedation or general anesthesia may be required.
The preputial skin may need to be incised to allow for thorough examination of the preputial cavity, removal of restricting material, and relief of venous obstruction. The penis is then replaced in the preputial cavity, and the incision is closed. If the urethra has been damaged, temporary placement of a closed-system indwelling urinary catheter may be needed to prevent stricture formation.
Chronic cases may require preputial orifice revision (see preputial orifice revision image) or advancement.
For More Information
Lavely JA. Priapism in dogs. Top Companion Anim Med. 2009;24(2):49-54.
MacPhail CM. Paraphimosis. In: Fossum TW, ed. Small Animal Surgery. 4th ed. Elsevier Mosby; 2013:848-853.
Zamirbekova N, Parlak K, Satıcı İ, et al. Surgical treatment of paraphimosis in dogs: 4 cases. Eurasian J Vet Sci. 2024;40(1):41-46.
Also see pet owner content on reproductive disorders of male dogs and male cats.
