Phimosis? Foreskin Development & Normal Age for Retraction

[MotherNurture]

HE'S INTACT---DON'T RETRACT!

"As a consequence of misdiagnosis and confusion of normal developmental narrowessness and non-retractablity with pathological phimosis, many unnecessary circumcisions are performed."


What Is Foreskin Retraction?

Sometime during the first several years of your son's life, his foreskin, which covers the head of the penis, will separate from the glans. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months or years.

After the foreskin separates from the glans, it can be pulled back away from the glans toward the abdomen. This is called foreskin retraction.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin.

American Academy of Pediatrics (http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZRNBDTODD?_cat=1 08)


Retraction of the Foreskin

At birth, the foreskin is usually attached to the glans, very much as a fingernail is attached to a finger. By puberty, the penis will usually have completed its development, and the foreskin will have separated from the glans.8 This separation occurs in its own time; there is no set age by which the foreskin and glans must be separated. One wise doctor described the process thus, "The foreskin therefore can be likened to a rosebud which remains closed and muzzled. Like a rosebud, it will only blossom when the time is right. No one opens a rosebud to make it blossom."9

Even if the glans and foreskin separate naturally in infancy, the foreskin Ups can normally dilate only enough to allow the passage of urine. This ideal feature protects the glans from premature exposure to the external environment.

The penis develops naturally throughout childhood. Eventually, the child will, on his own, make the wondrous discovery that his foreskin will retract. There is no reason for parents, physicians, or other caregivers to manipulate a child's penis. The only person to retract a child's foreskin should be the child himself, when he has discovered that his foreskin is ready to retract.

Mothering Magazine:


The tightness of the foreskin is a safety mechanism that protects the glans and urethra from direct exposure to contaminants and germs. The tight foreskin also keeps the boy's glans warm, clean, and moist, and when he is an adult, it will give him pleasure. As long as your son can urinate, he is perfectly normal. There is no age by which a child's foreskin must be retractable. Do not let your doctor or anyone try to retract your child's foreskin. Optimal hygiene of the penis demands that the foreskin of infants and children be left alone.

Mothering Magazine:


Avoidance of premature retraction. Care-givers and healthcare providers must be careful to avoid premature retraction of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.3

The Development of Retractile Foreskin in the Child and Adolescent (http://doctorsopposingcircumcision.org/info/retraction.html)
A guidance for healthcare providers from Doctors Opposing Circumcision

Also available in a PDF leaflet (http://www.doctorsopposingcircumcision.org/pdf/retractileforeskinleaflet10-2005-dan.pdf).


Almost all boys are born with narrow non-retractile foreskin which are fused with the glans beneath. This is a normal developmental physiological condition and is not a cause for concern. Some parents needlessly worry that the opening is not large enough.

Retraction of the foreskin should never be forced. It will retract when it is ready. There is no "right" age for retraction to occur.

A narrow non-retractable prepuce in boys is within the normal range of development and usually causes no problems. The prepuce usually will spontaneously widen until complete retractability is obtained. About 50-60 percent of boys at age ten do not have fully retractable foreskins.16 This is normal.16 After puberty, the percentage of boys with full retractability rapidly increases spontaneously.16

If a narrow or non-retractile prepuce becomes a problem, a wide variety of conservative alternative treatments to circumcision are are now available. Circumcision is an outmoded, radical, traumatic, disproportionate, unnecessary surgery for a minor problem.

Normal development of the prepuce: Birth through age 18 (http://www.cirp.org/library/normal/)

See Also: Intact Care Agreement (http://www.mothersagainstcirc.org/care.htm)

More great info, from the Canadian Paediatric Society (http://www.cps.ca/english/statements/FN/fn96-01.htm):


In general, there is inadequate recognition of the long period before the natural separation of the prepuce and glans is complete.96 Some authors still refer to the presence of "adhesions," when, in fact, separation has not yet taken place; similarly, a nonretractible foreskin is still sometimes incorrectly diagnosed as phimosis.97

In a study by Rickwood and Walker98 involving 420 boys referred to their unit for possible circumcision, only 116 (28%) required the procedure. They found no true phimosis in boys younger than 5 years of age. Most of the patients had developmental nonretractability of the prepuce, and their preputial orifice, although somewhat narrow, was supple and unscarred. The authors compared this finding with data from the Mersey region of England, where phimosis was the most common indication for circumcision, accounting for 87% of the procedures, and where 390 of the 950 patients circumcised were younger than 5 years of age. They estimated that approximately two thirds of these circumcisions performed in the Mersey area were probably unnecessary.

The false diagnosis of "Phimosis" in young boys (http://www.circinfo.org/phimosis.html)

Conservative Contemporary Treatment of Phimosis (http://www.cirp.org/library/treatment/phimosis/)

Can foreskin problems be treated without circumcision? (http://www.norm-uk.org/circumcision_alternative_treatments.html)

The #1 rule for intact care is to leave it alone.

The first person to retract a boy's foreskin should be the boy himself.

Until then, just wipe it off like you would a finger or give it a swish of plain water in the bath.

Once he can retract it himself, all he needs to do is "RETRACT, RINSE, REPLACE" in the shower or bath.

HTHs,

Jen

[mum33]

great! thanks for the info! :thumbsup:

[MotherNurture]

A note about 'separation trauma':


Red, Swollen, or Inflammed Foreskin (by Frank)

Oh no! Your son has a very red, swollen or inflamed foreskin! Classic symptoms of a dread foreskin infection, right? Well, maybe but probably not. But, how do you know?

Often its not most of the time, it can be something called separation trauma that is a normal part of development in boys. The foreskin is exquisitely sensitive and very similar to the eyelids and lips. Just like a minor bump on the lip can cause it to get very red and swollen with what we call a .fat lip. the foreskin responds the same way to any physical insult. As the boy.s foreskin prepares for separation of the bond to the glans, it is not an even process with spots remaining adhered and areas around it fully released. With the boy pulling at it and with erections, these spots get pulled and slight tears in the inner mucosal foreskin or surface of the glans result and the response of the child.s body is redness or swelling. This redness or swelling can be significant and alarming but the situation is not serious. The symptoms will improve greatly or completely subside within 24 to 36 hours and everything will go back to normal just as a fat lip will. Watch your son for 24 hours from the first symptoms and if you see significant improvement, continue to watch

But, what if it is an actual infection? Simply, the symptoms will not subside within the 24 to 36 hour period. That is not something to be overly alarmed about as these infections are simply minor skin irritations and will cause no long term damage as long as they are treated promptly and treatment within a couple of days is well within the range of prompt treatment. The only thing to watch for is any restriction of the urine stream such as a weak stream or a fine thin stream. If this situation develops, immediate medical attention is needed.

If it does turn out to be an actual infection, insist that the doctor take samples for a culture. This is the only way to assure that the pathogen (bacteria or fungal) is accurately identified and the only way that you can be assured that the proper medication is prescribed. When the doctor takes samples for a culture, he/she will swab the end of your son.s penis with two cotton tip swabs, one for bacteria and one for fungals. (yeast) It will take two to three days for the results of the test to return and the doctor will probably give you a prescription for a medication based on a visual examination of the symptoms but you should call the doctor about 3 days later to make sure that the medication is effective on the particular pathogen. If not, you will be given a new prescription that is effective.

With the proper medication, you will see results within a couple of days. However, even with a culture, not all medications are effective all of the time and if you do not see a complete abatement of the symptoms within five days, call the physician for an alternate treatment. Although the symptoms disappear quickly, the prescription will probably instruct treatment for 10 days or so. Be sure to administer the prescription for the full time. Although the symptoms may be gone in two or three days, some of the pathogens may remain that can flare up again if the treatment is ended.

Frank

I grant free and unfettered permission to post this (Red, Swollen or Inflamed Foreskin?) any where on the internet ~Frankly Speaking~

http://www.changa.org/circumcision/

[popular]

I was told my son had "Phimosis" and would need to be circumcised. He was 3 at the time!
Of course I got a second opinion.

Thanks for posting all this info. There are still some doctors out there who don't know this stuff!

[02maddi]

I also have just been told my son age 3 has 'phimosis' after months of pain swelling and some infections. We have been told he should be circumcised and now we are very confused as to what to do and where to turn....my DH just goes with what the Dr's say and I dont want to put my DS thru needless surgery after reading pro's and con's of circ's...i am more confused than ever..
What to do ???
Need a second opinoion any DR's good ones in Brisbane

[forbetoel]

Great thread, as the mother of 4 boys and the eldest being 8 and a half and his foreskin is still not retracting, this is a great peice of info. :thumbsup:

[MotherNurture]

I also have just been told my son age 3 has 'phimosis' after months of pain swelling and some infections. We have been told he should be circumcised and now we are very confused as to what to do and where to turn....my DH just goes with what the Dr's say and I dont want to put my DS thru needless surgery after reading pro's and con's of circ's...i am more confused than ever..
What to do ???
Need a second opinoion any DR's good ones in Brisbane

Your 3 year old being non-retractable is totally NORMAL. If he can pee fine, there's no urgency for surgical intervention. By the time he reaches puberty, hormones will have helped separate the foreskin from the glans (head) and the skin will be more elastic and stretchy and he should be able to retract comfortably. Again, as long as he can pee alright there's no pressing medical reason to amputate a normal part of his penile anatomy.

If the phimosis does persist post-puberty, it's curable in 80%+ of cases with a few weeks application of a topical steroid cream called betamethasone. Surgery is only very, very rarely necessary and even then, the tip of the foreskin can usually be dilated (opened up) as opposed to being cut off. IMO, you should be very wary of a doctor diagnosing phimosis in a toddler, let alone one who suggests circumcision or worse, presents it as your only option.

Get second and third opinions if you're concerned; hopefully you'll find a foreskin friendly and knowledgable doctor.

:hugs:

Jen

[sam's mum]

DH and MIL gave me a lot of pressure to circ DS because DH had been circed due to phimosis.

I just kept saying that they don't even circ for phimosis anymore and eventually they gave up. :smiliedance:

[our little treasures]

Well done Sams mum!!

[mysonroger]

great info.

[Ys_Woman]

Well tomorrow we see the surgeon again after he flayed open master 7's penis last September to alleviate the infection brewing in there. If all looks well he will close it all up next month and make it look tidy. Phimosis may be treatable but when it turns to BXO and the urine is trapped in there it becomes ugly.
I had my baby in December and it is a boy, so I will be getting the surgeon to have a quick look tomorrow to see if there is anything out of the ordinary. I couldn't bear to have another son suffer when a small operation to remove a tiny piece of skin can circumvent all that.
I am praying that all goes well.

Amy:)

[sam's mum]

Well tomorrow we see the surgeon again after he flayed open master 7's penis last September to alleviate the infection brewing in there. If all looks well he will close it all up next month and make it look tidy. Phimosis may be treatable but when it turns to BXO and the urine is trapped in there it becomes ugly.
I had my baby in December and it is a boy, so I will be getting the surgeon to have a quick look tomorrow to see if there is anything out of the ordinary. I couldn't bear to have another son suffer when a small operation to remove a tiny piece of skin can circumvent all that.
I am praying that all goes well.

Amy:)


:hugs: good luck, I hope that it is all ok

[MotherNurture]

I couldn't bear to have another son suffer when a small operation to remove a tiny piece of skin can circumvent all that.

It's a lot more than a "tiny piece of skin" and circumcision certainly doesn't prevent all penile problems.
In fact, it causes many.

Only 1% of boys ever require circumcision for medical reasons; conversely, if you circumcise your son routinely during infancy you're guaranteeing him the risks of the initial surgery and anesthesia (including hemorrhage, infection, and death) and you're also sensitizing him to future pain, giving him a 70% risk of penile adhesions, a 10% risk of meatal stenosis, and a 1% chance of requiring a circumcision revision.

He's also losing a valuable, sensitive, and functional part of his sexual anatomy. Circumcision removes up to half of the skin on a male's penis, including 2-4 feet of blood vessels, 240 feet of nerves, and 10-20,000 specialized nerve endings. It also damages or removes the male g-spot (the frenulum) completely.

IMO, intact genitals are a basic human right...regardless of gender.

Jen

[naiwen]

DS's foreskin retracts almost by itself and he is only 1, when he touches it or I wipe it, it moves right back. Will this increase his risk of infections?

[Jessie V]

When I was pregnant with my son I gave DH the choice as to whether or not we had him circumcised. I dont have a penis and felt completely unqualified to make that decision! DH said that he wanted him left how he was born, a decision I agreed with.
My little boy will be 5 years old in November and will be circumcised in 3 weeks. He was diagnosed with severe phimosis at 2 years old. We have tried all different sorts of creams and treatments since we found out what was causing him to scream and cry everytime he needed to do a wee, which nearly broke my heart to hear. Nothing else has worked so against public opinion (and perhaps my own) we are finally having him circumcised.

[Nan]

Only 1% of boys ever require circumcision for medical reasons; conversely, if you circumcise your son routinely during infancy you're guaranteeing him the risks of the initial surgery and anesthesia (including hemorrhage, infection, and death) and you're also sensitizing him to future pain, giving him a 70% risk of penile adhesions, a 10% risk of meatal stenosis, and a 1% chance of requiring a circumcision revision.

He's also losing a valuable, sensitive, and functional part of his sexual anatomy. Circumcision removes up to half of the skin on a male's penis, including 2-4 feet of blood vessels, 240 feet of nerves, and 10-20,000 specialized nerve endings. It also damages or removes the male g-spot (the frenulum) completely.
I'm sorry.....I am very grateful for informative threads like this, but comments like the above make people whose son's must have surgery feel absolutely terrified. I find the above comments unnecessary for a public forum and best suited to a private message.
Can't we just respect the fact that Amy's son needs to have surgery because his willy got infected and wee got blocked? I know that a lot of circ's are done unnecessarily but sometimes they have to be done as a last resort.

My son has to have surgery on his willy in January because physiologically it has developed abnormally. The procedure is way more involved than a circ, so comments like the above scare the cr@p out of me and others, I'm sure.

[Jessie V]

comments like the above scare the cr@p out of me and others, I'm sure.

:iagree:
I'm also petrified at what my little man must go through, I have been getting similiar sort of comments from my 'darling' MIL. :hair:
She believes that we (Dh & I) are putting our son through unnecessary surgery and has outlined every horror story she has been able to find (of which of course the worst happened to a friend of a friend of hers) We lost our little girl in feb 2007 and really don't need to hear all the sh@t she has t say now. We are only doing this as it has become the last resort for our boy.

[~Emmylou~]

Great info :thumbsup:

It's so important that this information gets out there - because circumcision was so prevalent for so long there are alot of parents out there who's first encounter with an uncirced male is their own son....me included.

All males in my family (including my younger brother) are circed, as is DH and all the men in his family. Circing DS was never an option for us, but I was still quite in the dark as far as knowledge went on what is normal.

I'm so grateful for posts like this because it's true, many caregivers don't have a clue about normal retraction either so that makes it even more important that mothers are informed :)

[proudmama]

fantstic info - i was doin my own research but obviously not well as i got no where near this good of info - thank you sooo much and by the looks of the post there are a lot of happy mums out there now having read this

you have really put my mind at ease:hugs:

[Ys_Woman]

I have concerns that the information presented on this sticky is one sided and suggests that phimosis does not require treatment by circumcision. Circumcision is a DEFINITE option, after all other avenues of treatment have been exhausted: like stretching exercises and steroidal creams etc.
Defer to the specialist's opinion, better yet- ask him what his own view of circ generally is (ours was anti-circ so it meant a lot when he suggested ds1 required it); get a second opinion if you aren't comfortable, but if you are told that circumcision is the only option then perhaps it is.
Just don't discount it.

Amy

[Paulb]

I have concerns that the information presented on this sticky is one sided and suggests that phimosis does not require treatment by circumcision. Circumcision is a DEFINITE option, after all other avenues of treatment have been exhausted: like stretching exercises and steroidal creams etc.

Let me focus this discussion at that point by stating one thing very clearly. Phimosis - and note: Phimosis - does not "require" treatment by circumcision if indeed, at all. It is as simple as that.

Now, we are talking here about children, are we not? Granted that, phimosis as a "condition" in itself is really particularly rare. It would be characterised by an extremely fine urine stream resulting in a voiding time of a minute or more (actually more than 30 seconds is probably excessive, but one has to provide leeway). In fact, other conditions (urethral valves to be precise) can cause much the same appearance.

Generally, it would also result in extreme "ballooning" where the foreskin inflates with the "backlog" of urine, though this might not happen if the foreskin had not separated from the glans, which latter is however quite unlikely in this particular context. But the "also" remains important here, since "ballooning" is in itself a perfectly normal phenomenon when the foreskin has separated, since a normal foreskin and even a retractable one, may be quite snugly closed. (In fact, such a situation is the least likely to experience problems.)

Unless the foreskin is so tight as to restrict voiding, phimosis per se is not a condition to be treated at all in childhood. Certain articles (http://www.mja.com.au/public/issues/178_04_170203/dew10610_fm.html) distinguish the "normal" or "physiological" tight foreskin from "pathological phimosis", but even this (latter) does not constitute an indication for circumcision.

So let us cut to the chase - if "phimosis" is actually not something that requires "treatment", what's all the fuss about? Well, it turns out that we are discussing a quite distinct phenomenon, that of "infections" under the foreskin causing pain, bleeding and sometimes, a discharge. And it has been ably pointed out by Frank (http://www.bubhub.com.au/community/forums/showthread.php?p=1212862#post1212862), that a significant proportion of these are in fact, nothing more than a variant of the normal process of separation of the foreskin from the glans. Such incidents will be relatively mild and short-lived but may be recurrent as different points on the foreskin separate. Such bleeding as may be involved will (generally) be coincident with the first complaint of pain on urination while successive urinations will be less uncomfortable.

Actual episodes of inflammation or infection will on the other hand be seen to persist and escalate and bleeding and/ or discharge would be a late sign. Clearly inflammation and infection do occur, so how are we to deal with this very real problem?

Well, the first and most important thing is to adopt the mind-set that there must be a cause for inflammation or infection. Two things in particular do not constitute a cause for a problem, and these are the foreskin, and urine. I point this out with a view to purposely "shake" people's focus in viewing the foreskin as a sort of "disease" in itself, or something prone to disease.

So what about these arguments of the "last resort"? Well, the last resort must needs follow the first resort, then the second and so forth. Only when all these fail, might one consider the "last" resort.


Circumcision removes up to half of the skin on a male's penis

Let's look at the foreskin, a piece of skin - actually comprising between half and two-thirds of warning: link to photos of a penis>>>the skin of the penis (http://www.foreskin.org/3zones-c.htm), or at least that is the amount usually removed in circumcision. Let me make an observation - healthy skin is not prone to infection or inflammation; these follow after injury, and generally speaking, a substantial injury which may include penetration or incision, burning (by heat or caustic chemical), abrasion and blistering, chafing or bruising. There are also certain viral infections which either enter via a minuscule injury (herpes simplex) or lodge in the skin following systemic infection (varicella-Zoster), but we hope that herpes simplex is not relevant to this discussion.

Is the foreskin in any regards a unique part of the skin? Well, in terms of susceptibility to the above, no. So, what or where should we look for reasons for infection or inflammation? Since it folds over on itself, or over the glans, then it could be considered a flexure such as the groin, the (inside) elbow or knee folds, the armpits, the neck and any folds of fat. And indeed if we consider these places, any competent General Practitioner (Family Physician) or paediatrician would immediately recognise these as the common and characteristic sites of infantile (atopic) eczema (http://dermnetnz.org/dermatitis/dermatitis.html) or seborrhoeic dermatitis (http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html), and they should make such a connection as these are the outright most common skin problems in childhood.

While we would be loath to refer to skin affected by these conditions as "diseased", a common factor in those conditions is a combination of various irritants and indeed, sufficiently noxious irritants may alone suffice to cause an irritant dermatitis. All of these dermatitis (inflammation) variants may in turn be complicated by secondary infection.

Reference to the above links reveals a particularly common irritant: soap. This injures the skin by removing the natural oils which keep the skin "plastic" - that is, flexible - resulting in a "dry" appearance and the development and propagation of fissures or "cracks" in the skin. Such fissures are self-propagating as the skin is necessarily weakened at the location of the fissure, and that part is then subject to more flexing than adjacent skin. Soap penetrating such fissures then becomes a direct irritant in its own right.

Flexures are necessarily more subject to this process as firstly, they are flexures; the zones where folding and unfolding of the skin is maximal, and secondly as they naturally tend to "catch" soap and other irritants, and these are not so readily flushed away again during washing.

Again (and as the links indicate), bathing becomes a problem as it involves sitting (or lying) in water which becomes soapy during washing, and necessarily leaves a residue on leaving the bath as there is no rinsing process. Showering on the other hand, allows whatever soap that may be used, to be washed away fully.

The worst possible exposure to a soap, is the practice of bathing in a solution of dishwashing detergent, marketed under the euphemism "bubble bath". (Remember Madge (http://au.youtube.com/watch?v=_bEkq7JCbik)?) This (generic) product is predicated on its "surfactant" properties, that is, its ability to penetrate into capillary spaces and separate oily deposits so that it will tend to enter potential spaces such as flexures, under eyelids and of course, under the foreskin where it becomes virtually impossible to remove.

My personal suspicion is that those who claim to have "tried everything" have not had explained to them the most fundamental steps (options?) of avoiding or settling foreskin irritations such as never using "bubble baths", not using soap when the child will subsequently be sitting in bathwater contaminated with soap, instead showering and ensuring soap is not applied near the tip of the penis, not attempting to or permitting the boy to retract when soap (or other contaminant) is present (though having him retract whilst showering in clean water is OK) and not applying "antiseptic" or "antibiotic" to the foreskin (antifungals are probably OK in most cases. A letter I recently received from an ophthalmologist is rather pertinent here, concluding that the lady to whom it referred, was clearly allergic to the commonly used ophthalmic antibiotic and a mild irritation had consequently become much worse when that antibiotic was used).


... the infection brewing in there. ... when it turns to BXO and the urine is trapped in there it becomes ugly.

There is a certain proclivity to blame the presence of urine for irritations and/ or infection. We know that inadequate cleaning away of urine, particularly in nappies, is a cause of nappy rash but of course we also know that this is due to contamination with bowel bacteria. Napkin dermatitis is in fact characterised by "burning" (ammoniacal) of the areas exposed to the nappy, while the flexures are "spared" - less likely to be affected.

One such susceptible area is the tip of the foreskin or if this has been sacrificed, the meatus of the glans - meatal stenosis is a common consequence of circumcision and directly to be expected if a circumcision is performed on the basis of such irritation. Inflammation of these areas may also be indicative of an irritant dermatitis, where the moisture leaches out an irritant from the clothing (such as detergent or enzyme residue). I note a post here where a mother describes an ulcerated area on the tip of the foreskin, sticking to clothing and using non-stick dressings for this reason - I prefer to recommend liberal (albeit messy) use of Zinc and Castor Oil (unscented) cream to both protect from irritants and avoid exudate sticking the irritated area to clothing.

If urine itself were a problem, then this would affect the urethra itself and would be even more evident in little girls who have significant flexural areas in the vulva and indeed, vagina, to trap urine. In fact they do suffer a comparable incidence of vulval irritations from the same causes above; the use of soap, bubble baths etc., but of course (and paradoxically) surgery to remove the urine-entrapping labia is never mooted!

Contamination with bowel bacteria really only occurs where there is a mechanism for its introduction such as by deliberate retraction (as is understood to be responsible for the reports of "studies" finding a higher incidence of UTIs in intact infant boys but always proportional to the extent to which forcible retraction was advised to parents in the area of the study), especially if this occurs during bathing in soapy bathwater which not only contains the bacteria from the anal region, but (the soap which) interferes with the anti-bacterial defences of the foreskin.


DS's foreskin retracts almost by itself and he is only 1, when he touches it or I wipe it, it moves right back. Will this increase his risk of infections?

This post went unanswered, but from the above, it should be clear that the problem is not the foreskin or how it behaves, but how it is treated, where "treated" is not a medical term.

[reAllytee]

My personal suspicion is that those who claim to have "tried everything" have not had explained to them the most fundamental steps (options?) of avoiding or settling foreskin irritations such as never using "bubble baths", not using soap when the child will subsequently be sitting in bathwater contaminated with soap, instead showering and ensuring soap is not applied near the tip of the penis, not attempting to or permitting the boy to retract when soap (or other contaminant) is present (though having him retract whilst showering in clean water is OK) and not applying "antiseptic" or "antibiotic" to the foreskin (antifungals are probably OK in most cases. A letter I recently received from an ophthalmologist is rather pertinent here, concluding that the lady to whom it referred, was clearly allergic to the commonly used ophthalmic antibiotic and a mild irritation had consequently become much worse when that antibiotic was used).

See that would be an assumption.

I can tell you I did try EVERYTHING.



There is a certain proclivity to blame the presence of urine for irritations and/ or infection. We know that inadequate cleaning away of urine, particularly in nappies, is a cause of nappy rash but of course we also know that this is due to contamination with bowel bacteria. Napkin dermatitis is in fact characterised by "burning" (ammoniacal) of the areas exposed to the nappy, while the flexures are "spared" - less likely to be affected.

One such susceptible area is the tip of the foreskin or if this has been sacrificed, the meatus of the glans - meatal stenosis is a common consequence of circumcision and directly to be expected if a circumcision is performed on the basis of such irritation. Inflammation of these areas may also be indicative of an irritant dermatitis, where the moisture leaches out an irritant from the clothing (such as detergent or enzyme residue). I note a post here where a mother describes an ulcerated area on the tip of the foreskin, sticking to clothing and using non-stick dressings for this reason - I prefer to recommend liberal (albeit messy) use of Zinc and Castor Oil (unscented) cream to both protect from irritants and avoid exudate sticking the irritated area to clothing.

My son has bowel issues that mean his bowel movemnts are highly acidic which leads to a nasty nappy rash even when I am changing him within minutes of him passing the movement.

I cut out all soap from his baths as well as alternating between cloth & disposables because we use cloth so thought it may have been an irritant from those even though I am of the thought disposables have more irritants. I also tried various washing powders & then changed to a natural alternative called Soap Nuts. I was also rinsing his nappies 4 times after their being washed to be 'sure.

I used loads of Zinc & Castor oil ... As well as all other various natural creams to help. I tried all magical potions doctors gave me the only one that 'helps' the ulcers is the Orabase we use under the Zinc but that too was not always helpful.

It got to the point where I had a screaming 4mth old crying 'Mama' everytime I changed his nappy he was in such agony.

So yes I DID try everything & it didnt work so circ'ing was the final step.

Now obviously my son still has bowel issues but his penis now copes much better without having gunk trapped under it & I am hoping that with time the scars that have been produced by all of this will fade because I really worry about how he will feel looking at the scars from his issues rather than the circ'ing.

Assumptions are never good.

[cmfbaker]

Hi
My son is 3 and started having great pains when he had to pee. I thought it might be a bladder infection, but it turned out to be phimosis. (The hole where the pee comes out was too small) The GP gave me a steroid creme to apply twice a day for 8 weeks, and he soon got better. Now the hole is a normal size, and all we have to do is retract the foreskin a couple of times/week to stop it from going back to being too tight. SO no surgery, no more pain and a happy 3 year old!

[Jessie V]

cmfbaker I am so happy that your little man was able to avoid surgery for his problem :) I wish mine could also have found relief from the creams we were prescribed, we tried so many for so long and unfortunately none worked for us :(


I must say though that even with such a touchy subject there hasnt been the nasty comments and disputes that I had anticipated :)

[JohnC]

cmfbaker I am so happy that your little man was able to avoid surgery for his problem :) I wish mine could also have found relief from the creams we were prescribed, we tried so many for so long and unfortunately none worked for us :(


I must say though that even with such a touchy subject there hasnt been the nasty comments and disputes that I had anticipated :)
For about 1-2% of boys (in total, by age 15) circumcision is an appropriate treatment option, mainly because of underlying lichen schlerosus causing genuine pathological phimosis.

The only thing I would add is that if any parent finds themselves in that situation they should first seek a referral to a paediatric urologist, if they haven't done so already. It's a sad fact that many doctors are still fairly ignorant about foreskin issues, so a truly expert opinion is a wise investment.

[julietv8]

Whilst I don't believe in routine circumcision (my son is not) I think in some cases it can be medically necessary. For the mum's who are struggling with this decision I wish you the very best. I think as parents we all just do the best we can, it doesn't really help when people get judgmental over it.

[forbetoel]

Whilst I don't believe in routine circumcision (my son is not) I think in some cases it can be medically necessary. For the mum's who are struggling with this decision I wish you the very best. I think as parents we all just do the best we can, it doesn't really help when people get judgmental over it.

:iagree: And as an anti RIC (not anti-circ) I would hope that no-one would judge a mother who had her son circumcised on medical advice.

BUT- I think this thread is very valuable for those mothers who are going down the path of a medical needed circumcision for their son. I think it is vitally important that parents do know that there are lots of other avenues that often work before talk of a circumsicsion is really necessary.

I know I once believed that if your sons foreskin had not retracted by the age of 4 that he would need a circumcision.:eek:
How many others still believe this outdated information?

BTW I don't judge any parent who has opted for RIC, what good is there in that.

I will however remain vigilant in getting the correct information out there for future mum and dads of little boys. :)

[Fi123]

Hello my husband and I have been trying to conceive for 3 years now. My husband has had adult phimosis and has never been able to retract his foreskin. This has made sex very painful for him as the friction causes tension to the foreskin forcing it back. He has had the paraphimosis in which the foreskin was forced back and resulted in swelling and oedema of the area. Sex would have been impossible for us had it not been for condoms (to hold the foreskin intact) and lubricant (to prevent friction). Eventually he opted for a circumcision due to the fact that we have not been able to conceive as yet and have just discovered preseed (a fertiliy friendly lubricant) but thats another story. I would urge all parents to circumcise their children to avoid this complication in adult life. Adult circumcsion is a very painful operation, not that it isnt painful to a child but to make the decison in adult life was a very hard one. Their have been many sexual issues for my husband who never felt like 'a man' until now. Good luck to all. XOXOX

[WorkingClassMum]

I would urge all parents to circumcise their children to avoid this complication in adult life.


Hun, I am sorry your DH suffered so badly, but on this one case senario I would not recomend that all baby boys get circumsized.

I would never recommend that all little girls get their appendix out 'cos two of my sisters both had burst appendix, one nearly died and the other had her fertility compromised.

I have not had my two kids tonsils removed cos I had tonsilitis.

Again I am sorry it took your DH so long to get his situation remedied - it should have been looked into during his late childhood and teens.

[Hootenanny]

Lots of good info in the op, I know the importance of not forcing retraction of the foreskin but it's good to have a reminder sometimes.
To the previous poster it is unfortunate for your partner but for every story of an uncircumcised man with difficulties there are hundreds who are fine. I hope he can reach a resolution, no one should have to be in pain unnecessarily.

[jade24]

OMG I feel sick to my stomach after reading the original post.

Two years ago I was told my son had a tight foreskin (he was being examined after not peeing for over 24 hours) and I was referred to a paed. I was then told, that yes, it was tighter than normal, but should do alright and to bring him back for steroid cream if he complained of pain. Fast forward 2 years, to yesterday.
DS is now 5 1/2 years old and he told me that it was stinging when he went to the toilet, so I took him straight to the dr's. The dr examined him and spent a couple of minutes forcefully retracting DS's penis as far back as it would go :no: He said DS has an infection and his foreskin is 'stuck' halfway. He gave him antibiotics and a cream to apply twice a day, and said I was too retract the foreskin and apply it :( I did it last night, but couldn't really get it retracted, so gave up. Then this morning we tried and poor DS was in tears and now his willy looks red and looks like it has tiny tears in it :crying: I decided right then that I would be leaving well alone and getting a second opinion, but after reading this I am beside myself. I can't believe I allowed the doctor to do that and I can't believe I tried to do it myself. Now I am concerned that damage has been done and I am in complete confusion as to what to do.

Do I go and see a paed, or a urologist?? Is it possible that my poor little man has been damaged 'down there'? I feel so horrified that this has happened and only wish I'd looked this up before rushing him off to the dr's :gloomy:

[bumMum]

sorry i can't read through 30 posts on this as most of them probably won't answer my question.
shouldn't the foreskin be able to retract by the time the boy is sexually active? several men in my family have had a lot of trouble with their foreskins (don't ask me why i know this).. and I was just wondering. my son is 2 and uncirced but I am curious as this article seems to imply that it is almost never necessary to circ but I would think if the child is in pain and the penis gets swollen and even bleeds a little something is wrong and surgery may be needed.

[MimiGrace]

jade24 :hugs::hugs: don't feel guilty. i think a lot of parents aren't aware of issues surrounding the foreskin because its only in the last few years that people have stopped routinuely circumcising the majority of boys.
i think your best option is to get him in to see a urologist - because they are going to have a lot better understanding of what your son needs than a GP. :hugs:


youngnotdumb - i think the point the article was making, that most foreskin problems are actually caused by people forcibly retracting the foreskin before it detaches from the glands (which can happen anywhere from about 2-14). Of course there can be naturally occuring problems with the foreskin - but the same can be said for most body parts, and we don't routinuely amputate them JIC.

[leajones22]

What do you do when your 19month old's foreskin doesn't retract and has had issues with a very aggravated tip. We have seen a doctor who looked not touched and prescribed anitbiotics for infection and steroid creams. The creams caused my son to scream everytime they were applied after the first 2 days. So we stopped them. Now the problem is now that the infection has cleared up it is obvious to any one who changes his nappy that he has scar tissue at the end of his penis. Neither myself or anyone else has ever tried to retract his foreskin.

My worry is that he is going to need a circ due to the presence of this scar tissue.

Also as another note, yes years ago it was routine to do this and that was then but now little boys are being precribed steroid creams for issues with the foreskin, aren't these going to cause problems in the future?

[Achelois]

What do you do when your 19month old's foreskin doesn't retract and has had issues with a very aggravated tip. We have seen a doctor who looked not touched and prescribed anitbiotics for infection and steroid creams. The creams caused my son to scream everytime they were applied after the first 2 days. So we stopped them. Now the problem is now that the infection has cleared up it is obvious to any one who changes his nappy that he has scar tissue at the end of his penis. Neither myself or anyone else has ever tried to retract his foreskin.


Lea, if the doctor hasn't tried to retract his foreskin, then how does he know it doesn't retract? I'd be concerned about this & would seek a second opinion. A 19 month old's foreskin needn't be retractable, and usually isn't. All he has to be able to do is pee. If there are outward signs of irritation, these can be treated topically like they would be with a girl.

There's an article on natural retractability here: http://www.doctorsopposingcircumcision.org/info/retraction.html If your son has a non retractile foreskin during puberty, and it's causing him problems (not all non retractile foreskins are problematic or painful) he can either choose to stretch it or opt for preputioplasty, which removes the phimotic ring rather than the whole foreskin. Surgery is rarely needed, though. My partner is one of the few men with adult phimosis and it has never bothered him - he never knew his was any different.

[RobW]

My partner is one of the few men with adult phimosis and it has never bothered him - he never knew his was any different.

Your partner is not one of the few unfortunately. There are up to 10% of men whose foreskin is tight with or without a short frenulum, who, when erect cannot fully retract the foreskin properly. A perfectly functioning foreskin is able to be pulled back so that the penis looks as if it were circumcised. Bunching up of the foreskin behind the glans is not ideal and any degree of difficulty attaining complete retraction is abnormal. Many of these men have issues with painful retraction, "ouchy" overly sensitive glans-- they have a classic thin skiined wet look, with a deep purple /red coloration of the glans and often the opening of the foreskin is a much redder color than the rest of the penile skin. This is not "normal" either- though it is common.

Phimosis is associated with increased tears, infections and penile carcinoma- not to mention the greater opportunities of passing on the HP virus to the female partner!

The most difficult part of having any rational discussion about circumcision is that the anti's come spring-loaded with all the answers about why a foreskin must be kept at all costs. There is, thus, an assumption (erroneus though it is) that the natural state must, by all evolutionary concepts, be the PERFECT state.

Too bad that penile issues basically only occur in the uncircumcised!

Given that every study to date shows that in general men circumcised as adults report nothing but positive outcomes in ALMOST all cases, this should make the intactivists sit back and perhaps reconsider their inflexible opinion-- I note here that in post after post that it is the circumcised men who are much more likely to be neutral when it comes to the question of their sons being circumcised -OR NOT! How refreshing, because that is not the stance of the anti's by a long shot.

For the parents agonising over the too early foreskin retraction and the issues that it causes-- and it does, take heart that IF your child needs circumcising he actually ends up with a more sexually functional penis with NO maintenance problems from there on out. So stop agonizing about the terrible thing you/your doctor did. The absolute worst thing that could happen would be a circumcision-- and that is clearly not a bad thing.

While there has been a slight drop off of routine circumcision in the USA, there is now a trend back up-- educated, native born Americans, not on welfare, have a circumcision rate of over 90%. That many on welfare are not circumcised is not because they didn't want it but that it wasn't paid for by Medicaid. As usual the poor or immigrants miss out. I notice similar trending in Australia though why Queensland has a 50% rate and Tasmania has a 5% rate, who knows?

[moggy]

Hi Rob,
I fully support circumcision for those with medical problems as you describe.
However, the figures you give on circumcision rates in Australia are not correct.
There were 295,738 births in Australia in calendar year 2009. (ABS website.) I assumed 51% of these were male (there are slightly more males births than female births). You can then go to the Aust. Government medicare website and look for item 30653. Here you will find figures for infant circumcision. My calculations for the % circumcised in calendar year 2009 are :

Australia 13.3%
NSW 18.1%
Qld 16.7%
SA 14.85%
Vic 7.7%
ACT 7.1%
WA 6.8%
NT 2.3%
Tas 1.3%

I would be interested in where your figures for the US come from. The notion that 50% are circumcised in Queensland/Brisbane is rubbish. Sounds like wishing thinking from the likes of Prof. Morris or Dr. Russell.

[Father]

Here you will find figures for infant circumcision.

Yes you will. These figures, though, are only those procedures that were claimed through medicare. So the actual figures will obviously be higher.
As an example, I did not claim the circumcision of my first boy on Medicare. He was done at Circumwise in Victoria. For some reason, we could not claim. And considering that circumcisions are the only thing that Circumwise do, then there would be a hell of alot more boys being circumcised in Victoria than the medicare figures would indicate. I did claim it for our second boy though (different state).

[MotherNurture]

Too bad that penile issues basically only occur in the uncircumcised!

This statement is blatantly false, even if you were just to consider the issue of meatal stenosis which almost exclusively a complication of circumcision and occurs in 10% of cut boys.

[ElizaDoLittle]

:)bump:)

OP has some great info, thank you!

[ickynicky3]

thanks for this info, I just aske my sister about my sons boy bits yesterday as I wasn't sure whether it was normal the skin didn't come back, she wasn't sure either and was worried as her boy is 4yrs and still hasnt retracted I will show her this post so she won't have to worry any more thanks guys :)

[ICanDream]

My son suffers from phimosis as well (5yo), we've done the cream etc but it often retightens after a while so we just repeat the process. One thing that bothers us and him is that he can't pee in a straight line so to speak, when he start to pee it kind of goes at a right angle and he ends up missing and peeing on the floor. Is this a normal thing with phimosis? Anyone know if this stops or what we can do to help him - we've suggested sitting but as you can imagine that's not a popular option for a little boy (so I was told anyway) :laughing:

[Kimberleygal1]

Yes you will. These figures, though, are only those procedures that were claimed through medicare. So the actual figures will obviously be higher.
As an example, I did not claim the circumcision of my first boy on Medicare. He was done at Circumwise in Victoria. For some reason, we could not claim. And considering that circumcisions are the only thing that Circumwise do, then there would be a hell of alot more boys being circumcised in Victoria than the medicare figures would indicate. I did claim it for our second boy though (different state).

I think also that the figures of procedures done in public hospitals may not be included in the stats.

Reading this thread highlights some of the reasons dh and I chose to circ our boys. I'm glad we don't have the issue of having to pull back foreskins and be worrying about how it should or shouldn't look nor do our ds's have to be fiddling with their bits keeping it clean etc. My 2 nephews were the only 2 boys in our families not circ'd but due to the discomfort and pain of their tight foreskins they were both done when they were 6yrs old which was surgery, pain they will remember and recovery time. Also having worked in a childrens hospital the amount of boys having to have the procedure done due to repeated infection was high.

[Lovemyfam]

I think also that the figures of procedures done in public hospitals may not be included in the stats.

Reading this thread highlights some of the reasons dh and I chose to circ our boys. I'm glad we don't have the issue of having to pull back foreskins and be worrying about how it should or shouldn't look nor do our ds's have to be fiddling with their bits keeping it clean etc. My 2 nephews were the only 2 boys in our families not circ'd but due to the discomfort and pain of their tight foreskins they were both done when they were 6yrs old which was surgery, pain they will remember and recovery time. Also having worked in a childrens hospital the amount of boys having to have the procedure done due to repeated infection was high.

You should never have to pull it back, I have never pulled my sons back nor has he, he has never had an infection or anything he doesnt have to "fiddle" with it to clean it there is only one reason to have to fiddle with a intact penis and its not to clean it. :) :rolleyes:

I think this is a perfect example of people being told the wrong things, a uncirc'd penis is no harder to care for then a circ'd penis, only difference is you dont have a healing period where you have to vasaline it up and clean dried blood like with a circ'd penis so they actually are less work. :D

[Achelois]

My son suffers from phimosis as well (5yo), we've done the cream etc but it often retightens after a while so we just repeat the process. One thing that bothers us and him is that he can't pee in a straight line so to speak, when he start to pee it kind of goes at a right angle and he ends up missing and peeing on the floor. Is this a normal thing with phimosis? Anyone know if this stops or what we can do to help him - we've suggested sitting but as you can imagine that's not a popular option for a little boy (so I was told anyway) :laughing:

Basically, a five-year-old can't be diagnosed with phimosis. I'm not sure how you'd even know whether he was retractable or not at that age, let alone be treating it, since only he should be retracting it, and the average age for first retraction is 10.4 years (http://www.doctorsopposingcircumcision.org/info/retraction.html). No foreskin opens on its own. It gradually loosens due to puberty hormones and manipulation by the boy himself due to self exploration and masturbation. Retraction is, after all, only necessary for sex. During natural separation, the urine stream may be affected and 'ballooning' may occur, all of which is completely normal. It will correct itself once separation is complete. (http://www.cirp.org/library/normal/) Many small boys sit down to urinate, or you could try putting a coloured ping pong ball in the toilet for him to aim at.

[Achelois]

I think also that the figures of procedures done in public hospitals may not be included in the stats.

Reading this thread highlights some of the reasons dh and I chose to circ our boys. I'm glad we don't have the issue of having to pull back foreskins and be worrying about how it should or shouldn't look nor do our ds's have to be fiddling with their bits keeping it clean etc. My 2 nephews were the only 2 boys in our families not circ'd but due to the discomfort and pain of their tight foreskins they were both done when they were 6yrs old which was surgery, pain they will remember and recovery time. Also having worked in a childrens hospital the amount of boys having to have the procedure done due to repeated infection was high.

It's because of the belief among medical professionals like yourself that retraction of infants and young children is necessary that you're seeing boys with infections and problematic tight foreskins. Premature retraction by someone other than the boy himself leads to infections and scarring. Many doctors in the USA see the foreskin as a disease and prescribe circumcision as a first treatment option, often for normal stages of development that don't even require treatment. I can assure you, as someone with numerous close family members working in the medical profession in a mostly intact country, we do not have the problems that you're talking about.

[mummykitty]

Subscribing :) jic I ever need it ;)

[Kimberleygal1]

You should never have to pull it back, I have never pulled my sons back nor has he, he has never had an infection or anything he doesnt have to "fiddle" with it to clean it there is only one reason to have to fiddle with a intact penis and its not to clean it. :) :rolleyes:

I think this is a perfect example of people being told the wrong things, a uncirc'd penis is no harder to care for then a circ'd penis, only difference is you dont have a healing period where you have to vasaline it up and clean dried blood like with a circ'd penis so they actually are less work. :D

A lot of boys do fiddle though and pull the foreskin back which is probably a normal instinct so could obviously be doing harm. Good friends of ours have 3 boys, all of which often stay over and always fiddle when in the bath.

[Father]

Basically, a five-year-old can't be diagnosed with phimosis.

During natural separation, the urine stream may be affected and 'ballooning' may occur, all of which is completely normal.

Yes you can.

Does the ballooning cause pain? Pain is NOT normal.

I would recommend that parents should not take this sort of advice from unknown people on the internet. "Don't worry Mum, I know your son is in pain, but it is normal. Much better to close your eyes and hope it goes away on it's own.... even if it takes a decade." This sort of attitude can be very dangerous, and cruel.
If in doubt, go see a doctor.

[Lovemyfam]

A lot of boys do fiddle though and pull the foreskin back which is probably a normal instinct so could obviously be doing harm. Good friends of ours have 3 boys, all of which often stay over and always fiddle when in the bath.
A boy fiddling with himself wont usually hurt him, he isnt going to keep going if it hurts, a nurse, dr or parent "forcing" it back will hurt and cause problems.


Yes you can.

Does the ballooning cause pain? Pain is NOT normal.

I would recommend that parents should not take this sort of advice from unknown people on the internet. "Don't worry Mum, I know your son is in pain, but it is normal. Much better to close your eyes and hope it goes away on it's own.... even if it takes a decade." This sort of attitude can be very dangerous, and cruel.
If in doubt, go see a doctor.

:rolleyes: Drs are not the be all end all and parents need to realize that they are human they can make mistakes

[ICanDream]

I agree Drs are not the be all and end all but I do believe we have to take some of what they say on board DS has had recurrent bouts of balanitis which is what led the Paediatrician to believe that he has a mild case of phimosis and that is what causes the mild ballooning and the fact that he's wees at a right angle - it is not normal the way he pees even for an uncirc'd penis - as much as it may sound odd we have discussed it with other parents of uncirc'd boys and they don't have the same issues.

Can I just add we are not looking to get him circ'd, just looking for ways that we can help him mainly pee in the right direction so that when he gets to school next year he isn't the kid that's known as the one that pees on the floor. He doesn't need a pingpong ball in the toilet, he's 5, he knows how to aim, he has no control over this from what we can tell.

Achelois, have you tried to tell a 5yo to sit down and pee - he's not an idiot - he knows his friends don't have to sit down to pee and he doesn't want to have to do it and be different.

[firsttimeparents]

Our ds 27 months has had 5 infections in 6 weeks and we went to see a pediatric urologist who said that ds has this and we are to retract the foreskin and put steroid cream on it in the hope that it opens up. We are due back to see him early Jan for a follow up! I feel terrible for doing it, but I don't see any other option! Makes me sick to think I am damaging him, but I hate seeing him in pain and discomfort :(

[Lovemyfam]

Our ds 27 months has had 5 infections in 6 weeks and we went to see a pediatric urologist who said that ds has this and we are to retract the foreskin and put steroid cream on it in the hope that it opens up. We are due back to see him early Jan for a follow up! I feel terrible for doing it, but I don't see any other option! Makes me sick to think I am damaging him, but I hate seeing him in pain and discomfort :(

Please go to a foreskin friendly dr for a second opinion

[eviestar]

Thankyou so much for the great info! We are expecting a little man in Feb and find things like this so helpful. I would never circ my son unless absolutely medically necessary and will be printing this info out for future reference.

[firsttimeparents]

How do I know who is a foreskin friendly doctor?

[Lovemyfam]

How do I know who is a foreskin friendly doctor?

Well you can always call around to the drs and ask them about things like do they know how to properly care for intact boys, how they feel about not vaccinating, and how they feel about skipping the well baby visits (that is for me what I ask) kinda like an interview.

[mummykitty]

Ask them their thoughts on circumcision even if they try to be neutral and medical generally a bias shows through :)