Care of the Intact Penis
Much nonsense has been written about the special care required for an intact penis. Care advice can be summarised briefly:
1. Leave it alone.
(2. Leave it alone.)
(3. Leave it alone.)
(Very similar to the special care required by the ears and the eyes, really.)
A baby's penis should be washed like any other part of his body, gently. No effort should be made to retract his foreskin and wash inside. In New Zealand, nurses were once instructed to start trying to retract the foreskin from birth and ensure that it was fully retractable by the end of a week. This doubtless caused many problems, resulting in the "need" for circumcisions. This mentality persists in many places, and it may be necessary to make sure that any new person examining the baby (including nurses, nannies and grandparents) is not a "retractor".
[The pediatrician of a friend of mine told her] the only
thing she needs to take care of her son's foreskin is a ruler ... to
smack anyone's hand who tries to touch it! Not bad for Peoria,
December 26, 2007
From South Africa comes this breath of fresh air:
The normal foreskin in the young child.
To the editor:
In the Paediatric Casualty Department at the Johannesburg Hospital we frequently see children with torn foreskins caused by forcing the foreskin back over the glans penis. The damage is most often done by clinic sisters, but I regret to say that it is sometimes caused by general practitioners who seem to be unaware of the normal development of the foreskin.
The normal foreskin will in the normal course of events dilate sufficiently to slip over the head of the penis by 5 or 6 years of age. It does not require anyone's help to do this. The head of the penis does not require cleaning. Nature does the job very efficiently by means of natural secretions. The white material which collects under the foreskin is not dirt or pus but good healthy epithelial debris which will slowly but surely separate the adherent foreskin from the glans better than any nurse or doctor should do it.
It is a good rule that is a baby passes a good stream of urine without causing ballooning of the foreskin, then that foreskin is entirely normal.
Will nurses and doctors please take note?
Paediatric Casualty Department
Catzel P. The normal foreskin in the young child. SA Mediense Tysskrif [South African Medical Journal] 1982; 62:751.
To this should be added that "ballooning" is entirely normal too, though it can be alarming to mothers and others seeing it for the first time. (In fact it is a healthy way for the foreskin to separate from the glans and for the space inside the foreskin to be cleansed.) If the baby is not in pain and the flow of urine is free, there is still nothing to worry about.
The notion that boys need special hygiene merely repeats an old myth that
has led to much unnecessary genital tampering. Such a notion does not even
credit evolution. If boys ever did need such care, that line of hominids
never survived evolution as they would never have reproduced. Our primate
ancestors did not waste valuable food foraging time cleaning their
children's genitalia down at some river.
Penises are self-cleaning and have been for hundreds of thousands of
years. Urine is sterile, and the interior of the penis is washed at
each urination. The other secretions are are moisturizers and the
body's first-line of protection against pathogens. Its appearance,
just as it [is] in females, is no cause for alarm.
Many cases of UTI and other irritations and infections can be traced
directly to genital tampering, not to failure of hygiene.
The notion that boys need aggressive cleaning is an invented one,
which dates to the 1870's and was part of an advertising campaign for
circumcision. The notion does not exist outside the influence of
Parents do best if they practice 'benign neglect' and leave their
child's penis to develop on its own. The occasional bath is all the
hygiene the child needs.
John Geisheker, JD, LL.M.
Doctors Opposing Circumcision
John Geisheker writes from experiences such as this:
My name is J... D... and my son, C... C... (3), told me on 9/22/10
that it felt hot when he urinated. So on 9/23/10 I took him to his
primary care physician, Dr. Shaheen Khan of Madera Children’s Medical Group, in Madera CA. I asked them to test his urine for protein and all came back normal. The Dr. then came in and asked me to retract his foreskin and I said, “I have never pulled his foreskin back and don’t want to.”
Her response to me as she ROLLED back his foreskin was, “You do it like this, it should come all the way back so you can clean it.”
My son jumped back in pain and looked at his penis and said to me, “Mom, my Pee Pee looks funny and feels funny.”
I asked her why the skin did not go back over the head of his penis and she instructed me to take him home and put him in a warm bath and it will come back over the head on its own. I
did that, nothing happened. Later that day when I looked at his penis it had swelled up more than it was before. We went to bed assuming all would be well in the morning.
When we woke up on Friday morning, 9/24/10 it was even more swollen and now had some spots that had rubbed a sore on the raw
skin. So I immediately took him back to Dr. Khan and asked her to fix this problem she had created. So she gave me Keflex and said, “This should help take the infection away. Come back on Sunday, 9/27/10, to
make sure all is doing what it is supposed to.” I didn’t know any better so I did as I was told. I gave him his antibiotics on schedule and had him rest as much as a 3 year old will. I took him back first thing Sunday morning and saw Dr. Khan again.
When she looked at his penis she said, “Oh no, you need to take him to Valley Children’s Hospital now, the medicine is not working.” So that’s exactly what his dad and I did.
When we got to the emergency room the nurse took one look at my son and called the Urologist to come down immediately. When urologist Dr. Robert Kezirian walked in the room he said, “What happened to this little boy? Cole has a bad case of Paraphimosis and we need to fix this now.”
He told us they would be in to apply brown sugar of all things to his penis so that they would be able to manipulate the penis and push the head of his penis back through his foreskin. So after some Tylenol with codeine and a half hour of my son's penis wrapped in brown sugar the Dr. came in and with a horrified look on his face and said to my son, “Alright Buddy, sorry but we have to do this, but when we are done you will be all back to normal.”
So he commenced to pushing my son's penis back through his foreskin and just the sight of it made everyone in the room cringe as the urologist did this. Although in the end all is well, we went home a little swollen but it looked like a normal uncircumcised penis. The urologist told us to keep him on his antibiotics and ibuprofen for the swelling. My poor son is now traumatized and won’t even let me pull down his pants or look at his penis in fear I might touch it and hurt him again like “the Doctor did”.
Needless to say I will not be taking him back to Dr. Khan EVER again, not even for a common cold or a scrape on the knee. It just breaks my heart to see my fearless 3 year old now scared someone is going to hurt his “Pee Pee”. I wouldn’t want to see this happen to ANY other child. Please do what you can to get my story out to the medical public and the general public.
J... D..., A... C... & C... C...
The foreskin usually detaches itself from the glans and becomes retractable during babyhood and/or boyhood. The best person to discover this and encourage it is the boy himself. Again, Rule 1 applies.
As it becomes retractable, the boy should be encouraged to wash underneath it, using mild soap, if any (remember, smegma is Greek for "soap"). Stronger soaps are implicated in balanitis (irritation of the glans), and particular suspicion falls on bubble baths.
If they have not done so earlier, most intact young men learn to retract their foreskins as part of masturbation. (Attempts to enforce Rule 1 on them are misguided.)
Some men have foreskins that still do not retract, and they are happy to leave them that way. If you are not (if you want it to retract for intercourse, for example) it can be freed non-surgically using an ointment (betamethasone 0.05% - or 1% hydrocortisone cream, sold over the counter under the trade
name "Cortaid" or as a generic or economical store
brand - applied once or twice a day to the outside of the foreskin from the tip to about mid-glans for up to eight weeks), or surgically without circumcision. If you are in the US, this means looking for a foreskin-friendly urologist.
A Japanese firm, Turumaki Corp., offers a do-it-yourself foreskin stretcher, the "Glansie".
So when should I worry?
As with any other part of the body, seek help if there is pain, discharge, discoloration (bearing in mind that some redness of the tip of the foreskin is normal), bleeding or other change or unusual circumstance. Do not assume that any deviation from normality means circumcision will be required. It may be necessary to pick and choose your doctor to ensure that s/he does not have this mindset, and to seek a second opinion if s/he recommends circumcision. (Do not think you are abnormal for wanting to conserve the foreskin: what is abnormal is the view that it is dispensable and the wish to get rid of it.)
If the foreskin becomes inflamed (red and itching), a common cause is the fungus Monilia. This can be easily treated with an anti-fungal cream.
If the foreskin gets caught behind the glans (paraphimosis), a simple technique will free it: the area is lubricated and the glans is squeezed between clean fingers to make it small enough for the foreskin to come forward, a process similar to removing a ring from a swollen finger. It is very common for boys and men to be scheduled for circumcision after such an incident, but instead gentle tension over time, or betamethasone as above, is all that is needed, if the penis's owner is worried about it happening again. (See also the paraphimosis page.)
Sometimes (after an erection during sleep, for example) the foreskin remains behind the glans and becomes swollen with fluid ([o]edematous). Even this is nothing to worry about, though it can look alarming. Once the foreskin is returned to its usual position the swelling will go down.
If the foreskin gets caught in a zipper (as the glans also may), lubricate the area with anything oily and apply an ice cube to numb and shrink the trapped skin. (If that doesn't release it, sacrifice the zipper by cutting across it and pulling the teeth apart, or use wire cutters or pliers to open the slide by snipping or bending the tiny tabs that hold the top on. That will allow the back to fall off and release the teeth, which can then be separated.)
So when is circumcision indicated?
If there is recurrent infection or inflammation of the glans or foreskin, and everything else has been tried and failed, then it may be time to start thinking about circumcision, but it should be regarded as a desperate measure, like removing a frostbitten limb.
It is important to remember that routine circumcision has created a climate of worry about the foreskin and recourse to circumcision at the first opportunity. What is normal, and what conservative measures are available, are not nearly as well known as they should be.
(This site may not offer medical advice, but two paediatricians have checked this page.)
This page may also be downloaded as a Word document or in .pdf format (which requires Adobe Acrobat Reader ).
An article in Nurturing Online (offsite) also deals with this topic.
The illustration is the Zeus of Artemisium, more than 2450 years old, fished out of the sea in 1928, now in the Archaeological Museum, Athens, the first in a series of Intact Men in Art.