At birth, a boy's penis, including the shaft and the head (glans), is covered by a double fold of skin. This is called the foreskin. [No, the penis is not "covered" by the foreskin, the foreskin is an integral part of the penis, just as a car is not "covered" by its bodywork. Defining the foreskin as separate from the penis is part of the way circumcision is normalised.] Circumcision removes the foreskin over the glans. [ie, it removes all the foreskin] If a boy is not circumcised, his foreskin is left intact. [Or rather, his whole penis is. But bravo! This is the first time the AAP has used that word. There's hope yet they will get it.] During the first several years of life, the intact foreskin will naturally separate from the glans. This is called foreskin retraction. [Actually, it's called desquamation. It enables foreskin retraction. There are men whose foreskins have separated who have never retracted them.] This information has been developed by the American Academy of Pediatrics to explain foreskin retraction, smegma, and how to care for the uncircumcised penis.

What is foreskin retraction?

Foreskin retraction occurs when the foreskin can be pulled back away from the glans toward the abdomen. This process happens on its own. When it happens is different for every child. It may take a few days, weeks, months, or even years. [Or the foreskin may never become retractable.] This is normal. Most boys will be able to retract their foreskins by the time they are 18 years old. Some foreskins retract soon after birth. Separation can even occur before birth, but it is rare. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. Sometimes the foreskin will puff out, like a balloon, while a boy urinates. This is normal and is a sign that the foreskin and the glans have begun to separate from each other. [Bravo again! The normality of ballooning is seldom admitted. Ballooning is commoner in small boys than young men.] Foreskin retraction should never be forced. While the foreskin is still attached to the glans of the penis, do not try to pull it back, especially in an infant. Forcing the foreskin to retract before it is ready may harm the penis and cause pain, bleeding, and tears in the skin.

[This paragraph would be more coherent if events were put in sequence, as they are in this site's Care of the Intact Penis.]

What is smegma?

When the foreskin separates from the glans, skin cells are shed. This begins in childhood and continues through the teen years. New skin cells regularly replace the ones that are shed. Since this shedding takes place in a closed space - with the foreskin covering the glans - the shed skin cells work their way along the penis through the tip of the foreskin. These discarded skin cells may look like whitish lumps, resembling pearls, under the foreskin. These whitish lumps are called smegma. Specialized glands, called Tyson's Glands, located under the foreskin are largely inactive in childhood. [The very existence of Tyson's glands in humans is doubtful.] At puberty, Tyson's Glands produce an oily substance, which, when mixed with skin cells, make up adult smegma. Adult smegma serves as a protective lubricator for the glans [and the foreskin].

Diagrammatic Representation of the Inner and Outer Foreskin Layers.

Does my son's foreskin need special cleaning?

The uncircumcised penis is easy to keep clean. When your son is an infant, bathe or sponge him frequently and wash all body parts, including the genitals. You do not need to do any special cleansing, such as with cotton swabs or antiseptics. Simply wash the head of the penis and the inside fold of the foreskin with [mild!] soap and warm water. [Or rather, just wash the outside of the penis as a whole. The inner fold of the foreskin will look after itself.] Remember, do not try to forcibly retract the foreskin. You should watch your baby urinate to be sure that the hole in the foreskin is large enough to allow a normal stream. [You probably won't have much choice!] Consult your pediatrician if:

• the stream of urine is never heavier than a trickle
• your baby seems to have some discomfort while urinating.

If the foreskin becomes inflamed, a common cause is the fungus monilia, which can cause redness and itching. This can be easily treated with an antifungal cream. If the foreskin becomes considerably red or swollen, see your pediatrician. If your son's foreskin is fully retracted before puberty, an occasional retraction with cleansing beneath will do. [He can do it himself.] Once your son starts puberty, he should retract the foreskin and clean beneath it on a daily basis. It should become a part of your son's total body hygiene, just like shampooing his hair and brushing his teeth. Teach your son to clean his foreskin by:

• gently pulling it back away from the glans
• rinsing the glans and inside fold of the foreskin with [mild] soap and warm water
• [rinsing with water only]
• pulling the foreskin back over the head of the penis.

Caring for your son's uncircumcised penis requires no special action. Remember, foreskin retraction will occur naturally and should never be forced. Once boys begin to bathe themselves, they will need to wash their penis just as they do any other body part. [This excellent paragraph might have substituted for all the other worrisome advice before it.]

This information should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. [But beware if he recommends circumcision. Get a second opinion, making sure the doctor is not scalpel-happy, or an advocate of universal circumcision.]

© 2000 - American Academy of Pediatrics
[The original of this page is at http://www.aap.org/family/uncirc.htm.]