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

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
A guidance for healthcare providers from Doctors Opposing Circumcision

Also available in a PDF leaflet.

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

See Also: Intact Care Agreement

More great info, from the Canadian Paediatric Society:

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

Conservative Contemporary Treatment of Phimosis

Can foreskin problems be treated without circumcision?

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!

[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.

[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.



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.

[our little treasures]

Well done Sams mum!!

[mysonroger]

great info.