Paraphimosis in Dogs: When the Penis Won't Go Back In

Paraphimosis is when a dog's penis comes out of the sheath (prepuce) and can't go back in.¹ It most often happens after arousal, mating or semen collection, or when hair at the sheath opening rolls inward and traps the penis.^1,2 The exposed tissue swells quickly and dries out, and without treatment it can be badly damaged, so it's an emergency.^1,3 If your dog's penis hasn't gone back in within about 20 to 30 minutes, call your vet. If it has been out for an hour or more, or looks dark, dry or very swollen, go to an emergency vet now.^4,5,2

What's Normal

It's normal for the pink tip of the penis to show briefly when a dog is excited or aroused, and for it to slide back within minutes.⁴ Paraphimosis is when it stays out. See dog penis problems for other conditions.

Causes

• Arousal, mating or semen collection: the most common trigger, especially after manual semen collection.^1,2
• A hair ring: hair around the sheath opening rolls inward or wraps around the penis like a band.^2,7,3
• A small sheath opening or a short or weak sheath.^1,6
• Injury, including a broken penile bone, or a string, rubber band or other object around the penis.^2,9
• Scar tissue from earlier surgery near the sheath.³
• Nerve or muscle problems, infection, inflammation and tumors.^2,6

It's more common in intact males because of sexual activity.² Neutering reduces the behaviors that can trigger it, but it doesn't fix an anatomical problem such as a small opening or short sheath.^4,9

Why It's an Emergency

When the penis stays outside, the sheath opening acts like a rubber band and blocks blood draining back out, so the penis swells, which makes it even harder to go back in.^1,3 The surface dries out and becomes painful, and licking makes it worse.^1,9 Without treatment, the tissue can ulcerate and die, and the urethra can become blocked. In severe, late cases, part of the penis may need to be removed.^1,9,4 Sources give different time windows, from about 20 minutes to 2 hours, but all agree that earlier treatment is easier and more successful.^4,5,2,1

Safe First Aid on the Way to the Vet

Only try first aid if your dog is calm, the tissue is still pink and moist, and the swelling is mild. A dog in pain may bite, so if he won't let you near, just keep him from licking and go.^4,2

1. Gently rinse the penis with lukewarm or cool water to remove dirt and hair.^4,2
2. Coat it generously with a plain, water-based lubricant with no added ingredients.^4,5
3. Look at the base for a ring of hair, string or debris. Ease away hair only if it comes free easily. Don't cut anything near the penis.^2,5
4. If the tissue is soft, you can try once to gently slide the sheath forward over the penis. Never push or force it.^2,4
5. Whether or not it goes back, keep the tissue moist with a clean, damp cloth and lubricant, stop licking with a cone, and take him to the vet.^5,2

What not to do: don't force the penis back, scrub it, or use products with additives. Don't wait to see if it fixes itself, and don't allow mating.^5,4,2 Some vets prefer that owners not try to replace it at all, so if you can reach your vet by phone, follow their advice.⁵ See a vet even if it goes back in, to check for damage and prevent it happening again.²

How Vets Treat It

• Sedation and pain relief, then cleaning, clipping the hair and generous lubrication.^1,2
• Removing any hair ring or foreign material.^1,2
• Reducing swelling with cool compresses, gentle pressure or a concentrated sugar solution, then sliding the sheath back over the penis.^1,2,9
• A temporary stitch around the sheath opening to stop it slipping out again.^1,2
• Surgery to enlarge a tight opening, especially if blood flow is compromised, and a urinary catheter if the urethra is damaged.^1,3
• Recurring cases: surgery to lengthen the sheath or anchor the penis (phallopexy). In one small case series, phallopexy worked in all three dogs treated.^6,3,10
• Aftercare: a cone, plus pain relief, anti-inflammatories and antibiotics as prescribed.²

Prognosis

The outlook is very good if it's recognized and treated early.^7,2 It's more guarded if the tissue was badly damaged or the cause is serious, such as a tumor.⁴ It can come back, especially if there's an anatomical cause.⁹

Prevention

• Keep the hair around the sheath opening trimmed, and check the area during grooming and baths.^2,4
• In breeding dogs, use lubricant before breeding or collection, and check that the penis goes back in afterward.²
• Redirect excessive humping.^4,9
• Brush out burrs and grass seeds after outdoor play.⁴
• Ask about surgery if your dog has a narrow opening or short sheath.^6,3 See reproductive health in dogs.

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