During the childhood years, a parent may notice a change in appearance of their son’s foreskin and be concerned that something is wrong or be concerned that he should be able to retract by a certain age. None of these are cause for alarm and in most cases, the best thing to do is nothing at all.
How Can Problems of the Foreskin be Avoided
Most foreskin problems can be avoided with proper care of the intact penis. During the first few years of life, the inside fold of a male’s foreskin is normally attached to the glans. The separation of these two structures occurs naturally over time – a process that should never be hurried. The foreskin is usually retractable by 18 years of age.
The first person to retract a child’s foreskin should be the child himself. Forcing the foreskin back can be painful and can cause problems, such as infection, adhesions and/or acquired phimosis. Parents must be diligent in protecting their son from premature foreskin retraction by caretakers and health care providers.
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, also 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 foreskin must be retractable. Don’t let your doctor or anyone try to retract your son’s foreskin. Optimal hygiene demands that the foreskin of infants and children be left alone. Premature retraction rips the foreskin of the penis open and causes your child extreme pain. There is no legitimate medical justification for retraction. The child’s discomfort is proof of that.
How The Foreskin Protects Against UTI (urinary tract infection)
The foreskin contains muscle fibers arranged in a whirl to form a sphincter at the tip of the foreskin. The sphincter holds the foreskin protectively closed except when the child urinates and the pressure of the urine stream forces the sphincter open, allowing outflow of the urine. Then the sphincter closes again to prevent entry of foreign matter. The sphincter of the foreskin keeps contaminants away from the urethra and is added protection against UTI.
Foreskin Getting Tighter, No Longer Retracts
Sometimes in childhood, a previously retractable foreskin will become resistant to retraction for reasons that are unrelated to impending puberty. In these cases, the opening of the foreskin may look chapped and sting when your son urinates. This is not an indication for surgery any more than chapped lips. This is just the foreskin doing its job. If the foreskin were not there, the glans and urinary opening would become chapped instead. Chapping is most often caused by overly chlorinated swimming pools, harsh soap, bubble baths or a diet that is too high in sugar, all of which destroy the natural balance of skin bacteria and should be avoided if chapping occurs. The foreskin becomes resistant to retraction until a natural and healthy bacterial balance is restored.
Foreskin is Red, Inflamed, Itching and Uncomfortable
When the tip of the foreskin is red, it is protecting the glans and urinary opening (meatus). The cause must be determined. Causes include infrequent nappy changes, bubble baths, chlorinated water (swimming pools), soap on the foreskin, harsh soap on nappies or underwear, antibiotics and concentrated urine from dehydration.
Drinking water, soaking in soap-free bath water, bacterial replacement therapy (liquid Acidophilus culture both ingested and applied to the foreskin 4-6 times a day), and air will all help healing.
White Lumps Under The Foreskin
During the period when the foreskin is undergoing the slow process of detaching itself from the glans, sloughed skin cells (smegma) may collect into small pockets of white pearls. As the foreskin proceeds with detachment, the body will do its job and those pearls will pass out of the foreskin all by themselves. These collected pockets of cells are nothing to worry about, they are simply an indication that the natural process of detachment is occurring.
Sprays When Urinating
In almost every intact boy, the urine stream flows out of the urinary opening in the glans and through the foreskin in a neat stream. During the process of penile growth and development, some boys go through a period where the urine stream is diffused. Undoubtedly, many of these boys take great delight in this phase, while mothers understandably find it less amusing. If your boy has entered a spraying phase, simply instruct him to retract his foreskin enough to expose the meatus when he urinates. He will soon outgrow this phase.
Foreskin Balloons When Urinating
Ballooning of the foreskin during urination is a normal and temporary condition in some boys. It is not uncomfortable and is usually a great delight for little boys. Ballooning comes as a surprise only to those adults who have no experience with this phase of penile development. It certainly does not cause kidney damage as it has nothing to do with the kidneys. Ballooning disappears as the foreskin and glans separate and the opening of the foreskin increases in diameter. It requires no treatment.
Foreskin Caught In Zipper
There have been rare cases where a boy has accidentally caught part of the skin of his penis in the zipper of his trousers. This is painful and can cause a lot of bleeding. Cutting off the foreskin however, is illogical in this situation. By cutting across the bottom of the zipper with scissors, the zipper can easily be opened to release the penile tissue
Phimosis is often used as a diagnosis when a doctor does not understand that the child’s foreskin is supposed to be long, narrow, attached to the glans and resistant to retraction. Some doctors prescribe steroid creams for phimosis, but this is unnecessary in children, since the foreskin does not need to be retracted in young boys. The hormones of puberty will do the same thing at the appropriate time that a steroid cream is doing prematurely. In adults who have a foreskin that is securely attached to the glans or a foreskin with such a narrow opening that the glans cannot easily pass through it, steroid creams are a conservative therapy. This is if the adult wants a foreskin that fully retracts. Many males don’t, preferring a foreskin that remains securely over the glans. It is purely a matter of personal choice, one that only each male can decide for himself.
Balanitis Xerotica Obliterans (BXO)
This is recognizable by a whitish ring of tissue at the tip of the foreskin, which constricts and prevents retraction. This is an uncommon condition affecting no more than 1% of boys under 15 years of age. It is confirmed by biopsy. Conservative treatment by a physician for BXO with 1% Clotrimazole and 1% Hydrocortizone cream mixed together and applied three times a day is usually effective. This treatment should be tried, as should more potent steroid creams if necessary, before surgery is considered. Just as we do not amputate the labia of females with BXO or the glans of circumcised boys with BXO, it is logical that we should not amputate the foreskin of intact boys with BXO.
Foreskin is Stuck Behind the Glans (Paraphimosis)
Paraphimosis is caused by premature retraction of the foreskin and it getting stuck behind the glans. The foreskin then acts as a tourniquet and blood gets trapped in the glans, causing it to swell. Squeezing blood out of the glans and using the thumbs to push the glans back inside the foreskin will bring the foreskin forward again. If needed, applying ice or the injection of hyaluronidase by a physician will reduce swelling.
Why Is Genital Integrity Important
Every human being is born with a foreskin. In females, it protects the glans clitoris; in males, it protects the glans penis. The foreskin is an essential part of human sexual anatomy and has numerous protective, sensory and sexual functions. The genitals of children, like every other part of their body, should be protected and cared for conservatively. Respecting a child’s right to keep his genitals intact is in the child’s best interest..
Answers to your questions about avoiding circumcision after the neonatal period.
– Article: Protect Your Uncircumcised Son.