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4-year old just diagnosed with phimosis today. Please help?

post #1 of 88
Thread Starter 
Hi. My four-year-old son Jack is intact and because of a bacterial infection in his penis that was diagnosed on New Year's Eve, we took him to a pediatric urologist today. He had an ultrasound and a VCUG done. (The VCUG was horrible. My baby was very brave.) Then we saw the urologist and (after being very respectful and thorough with answers to our questions) he said Jack had phimosis and recommended circumcision. He said most boys are able to fully retract their foreskin by his age, and his hasn't retracted at all. He described Jack's foreskin as very tight, and it would probably only get worse. He told us to think about it, gave us some steriod cream to put on his foreskin daily to see if it would soften the skin and start retracting it (meaning Jack would do the retracting himself, not us), and told us to come back in a month with a decision.

My husband and I put so, so much thought into whether or not to have a circumcision done on our son in the first place (we now have another son, and he is not circumcised either). But now that one bacterial infection has occured--with no definite answer as to what caused it--the urologist's case sounded compelling today. We just need help deciding what to do. I am so confused. We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2. Oh geez, I'm just desperate about what to do. Has anyone had a similar experience with their son? I would be so grateful to hear other stories and how they turned out. Thanks.
post #2 of 88
It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.
post #3 of 88
Quote:
Originally Posted by Friday13th View Post
It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.
Ditto.

Think about these two questions. If there was ONE bacterial infection with no known cause, why would you think it sounded compelling? Do we traditionally lop off the outer labia of girls when they have ONE bacterial infection?

I'd be willing he has an extremely high number of circumcision referrals. If it were me, I'd tell him no way and give him a paper with references on ages of retraction, what TRUE phimosis is, and the often unnecessary circ recommendations for so-called phimosis and why it's harmful.
post #4 of 88
Does your son still have the bacterial infection? I'm assuming not. If not, the Phimosis is not a negative condition rather just the 'state' of your son's penis. Some boys can retract at your son's age, others can't retract until puberty. 'Only get worse?' Worse meaning the opening will get tighter? The likelihood of that is rare. Just make sure you or your son rinses himself with plenty of water when bathing but my unprofessional opinion is you do not need a cream to force your son's foreskin to do something it will do in it's own good time. There is a rare condition called paraphimosis (spelling) where the foreskin retracts and becomes stuck, but this can usually be manually corrected and does not need to be corrected with circumscision. Sorry for any typo o's. I'm not wearing my glasses. I live in a state where none of the doctors or nurses seem to circumcise their kids so this encounter with the urologist seems kooky to me. I'd do some research and get another opinion. You might want to also make sure the soap you are bathing your child with is gentle and that you rinse well. Once the foreskin is retractable, rinsing with water should be all that is needed for cleaning. The penis usually takes care of itself as long if you don't fuss with it too much!! If your son does still have the infection, circumscision is still not the cure. Ditto to all the other replies. Great advice!
post #5 of 88
Go to www.cirp.org/library/normal. There is the truth about retractability. This doc is just plain ignorant. And what bacterial infection? Did he culture it? Bacterial infections are rare in intact boys. Usually any inflammation is due to contact with an irritating substance such as high pH in a pool or bubble bath soap. From what I have read in this group it can also be caused by separation of the foreskin from the glans. My sons did not retract fully until 8.5 and 11. Look at the chart in the Kayaba article at cirp.org. It shows how many boys are just like your son. This is NORMAL.
post #6 of 88
Circumcision for "phimosis" is a "billable proceedure." It is very easy for the urologist and very lucrative.

Being nonretractable is normal at 4 yo and harmless anyway.

Steroid creams are for older teenagers and adults who are bothered by phimosis and have already tried stretching excersises without results.

Do not return to this "Dr."
post #7 of 88
Also, how did the doctor diagnosis a bacterial infection - what was going on that made the ped think of a bacterial infection did he look and diagnose or did he use swabs.

my boy is 4 1/2 and partial retractable and the average child of most retraction to occur is 10-12 sometimes even older.

So far no one has found a foreskin educated doctor in utah yet!

For one bacterial infection with a diagnosis of phimosis i think the doctor wants to get his yacht payment.
post #8 of 88
neither of my boys are retractable..they are aged 4 and 2. The urologist is trying to make money out of you by soliciting and unnecessary procedure.
post #9 of 88
Quote:
Originally Posted by JacksonsMom View Post
Hi. My four-year-old son Jack is intact and because of a bacterial infection in his penis that was diagnosed on New Year's Eve, we took him to a pediatric urologist today. He had an ultrasound and a VCUG done. (The VCUG was horrible. My baby was very brave.) Then we saw the urologist and (after being very respectful and thorough with answers to our questions) he said Jack had phimosis and recommended circumcision. He said most boys are able to fully retract their foreskin by his age, and his hasn't retracted at all. He described Jack's foreskin as very tight, and it would probably only get worse. He told us to think about it, gave us some steriod cream to put on his foreskin daily to see if it would soften the skin and start retracting it (meaning Jack would do the retracting himself, not us), and told us to come back in a month with a decision.

My husband and I put so, so much thought into whether or not to have a circumcision done on our son in the first place (we now have another son, and he is not circumcised either). But now that one bacterial infection has occured--with no definite answer as to what caused it--the urologist's case sounded compelling today. We just need help deciding what to do. I am so confused. We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2. Oh geez, I'm just desperate about what to do. Has anyone had a similar experience with their son? I would be so grateful to hear other stories and how they turned out. Thanks.
I agree with the previous posters. You are right, the doctor is wrong. There are a couple of questions that have been asked but I'll repeat that we need to know.
  • How was the original infection diagnosed? By sight or did he do a culture?
  • How was it treated?
  • Does he currently have an infection? Or has it been successfully treated.

With regard the diagnoses of phimosis the most important question is simply
  • Can your son urinate properly? That is to say is there good 'flow'. Ballooning is normal just FYI.

At your son's age not many boys will be retractable, as has been said by other posters the average age is about 11. You can read quite a bit about the normal development at this site:

http://www.cirp.org/library/normal/

You might want to read a bit more about phimosis here:

http://www.cirp.org/library/treatment/phimosis/

Now I want to underscore that it is very unlikely that your son has a condition that requires circumcision. Circumcision is only necessary in cases where there is significant trauma or scarring of the foreskin and even then it might not be necessary. There is a less invasive option known as prepuceplasty that can be used in place of circumcision, you can read a bit about that here: http://www.biomedcentral.com/1471-2490/8/6 But I want to reiterate that the need even for that is rare.

I think your son is probably just fine and if there isn't any obvious problem (like really obstructed urine flow) I would not bother.
post #10 of 88
What every one else said the Dr. just dosnt know what he is talking about. Do you really want to risk your ds's life going under GA and watch him suffer over the next weeks for no reason? Of course not.

Why did he have a VCUG done by the way? Did you make sure no retraction happened during the test?

My ds is the same age yours is and he is no where near retractable and it is 100% normal.

Do not use that cream it is meant for teenagers and adults who can do stretching exercises to go with it.

A thread you may find helpful now and in the future http://www.mothering.com/discussions...d.php?t=764732
post #11 of 88
Well, my older son wasn't retractable at 4 and was retractable at 7. My younger son is partially retractable at 4, about the same amount he has been since he was about 2. Eventually he'll be retractable, too. My brother says he started getting retractable by 9 and was fully retractable by 13. He's now in his mid-twenty's and has no problems with his genitals.

Boys become retractable at different ages. It's perfectly normal for a 4 year old to be completely non-retractable. I would see if you can find a recommendation for a foreskin-friendly doctor in your area and get a second opinion. Phimosis is perfectly normal for a 4 year old.
post #12 of 88
Please don't believe the doctor that your son should be retractable by now, or that he has phimosis. I was told the same garbage about my 15-MONTH old son by a pediatric urologist who wanted him circumcised. He later told us that his opinion about the foreskin is "the sooner you get rid of it, the better"

Your instincts are guiding you correctly here, mama. Don't let the doctor hurt your son!
post #13 of 88
I am speechless...

No, I'm not. Your son had one suspected bacterial infection and a VCUG was done? And an ultrasound too? Tell me that this was a persistant and recurrent infection. It wasn't just one infection, right?

I have only met one boy child who was retractile by age 4. Many, MANY boys do not become retractile until they reach puberty. My oldest is 6 and not retractile. He still has a tight phimotic ring, but it is loosening as he gets older. 4 is not at all unusual. Many, MANY babies are born with a tight phimotic ring. Unless it is getting progressively tighter and is causing him pain and discomfort, it's normal.

I don't know why, but I am still shocked at such ignorance from the medical community.
post #14 of 88
Quote:
Originally Posted by JacksonsMom View Post
... We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2.
I'm so sorry you're going through this and I hope your son is feeling better. I can't speak from personal experience as my son was retractable by about 2.5 yrs and he's never had any infections. But like many have said, becoming fully retractable can happen at any time and it's not uncommon for boys to be non-retractable until older boyhood or teen years. Your urologist is wrong. Please know that doctors in the US make profit for every surgery they perform. You understand what I'm saying, right? He could say "Boys AND girls get infections all the time and we don't always know why so we just treat it and take a wait and see approach. If your son has multiple infections or still isn't retracting by age 18 then come see me again. We can talk about circumcision or non-surgical options then". He could say that, but then he would not make any money off of your son's circumcision and the one or two post-surgical follow up visits, would he??? I'm sorry to sound cynical about it but I really don't think one infection is reason for surgery. If nothing else, know that your son not retracting is completely normal at age 4 and it would be wise to seek a second opinion with a foreskin-friendly doctor if you you feel like you should go ahead with the surgery.
In countries where intact is the norm and physicians themselves are likely to have an intact penis, circumcision for childhood non-retraction and one infection is practically unheard of.

Good luck to you and your son!
post #15 of 88
Thread Starter 
I want to THANK ALL OF YOU for your information, advice, and stories about your own sons. My husband and I read through all of them again and again. Just to answer a few recurring questions:

How was the original infection diagnosed? By sight or did he do a culture?

Jack's pediatrician did a culture--there was a puslike substance coming from his penis and she cultured it. It was positive for bacteria. She did say that was very rare to see a bacterial infection at Jack's age, and she mentioned STD's. (AAAH, red flag). The only time Jack isn't with one of us is when he is at preschool three times a week, two hours a day. No babysitters, no daycare, never. We trust his preschool teacher, and know that Jack would have told us about any unusual or uncomfortable experiences. But the red flag was still waving for us, of course...

How was it treated?

Antibiotics cleared up the infection within a couple of days. He has not had any trouble since that time.

Why did you do a VCUG after just one bacterial infection?

Because we didn't know any better, I guess. And we were scared. We can't go back in time and undo it, it's done. Everything was normal, so I guess all that other "stuff" that could be going wrong was ruled out. (Trying to look for the silver lining.)

I loved the comment that no one has found a foreskin-friendly doctor in Utah yet. I am not surprised. We haven't found another intact boy yet! (Except for Jack's brother, Charlie, 10 months.) It's kind of disheartening to realize that we don't have a lot of support around here, but we have an abundance of ignorance. But we both so appreciate you all taking the time to answer our questions with your real-life stories and experience and knowledge. We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
post #16 of 88
Quote:
Originally Posted by JacksonsMom View Post
I want to THANK ALL OF YOU for your

I loved the comment that no one has found a foreskin-friendly doctor in Utah yet. I am not surprised. We haven't found another intact boy yet! (Except for Jack's brother, Charlie, 10 months.) It's kind of disheartening to realize that we don't have a lot of support around here, but we have an abundance of ignorance. But we both so appreciate you all taking the time to answer our questions with your real-life stories and experience and knowledge. We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
You're very welcome. I hope you'll stick around and contribute. If you have more questions feel free to ask. And Utah is one of the states that dropped medicaid coverage for circumcision so there may be more boys than you realize who aren't, just perhaps not in your circle of friends.
post #17 of 88
Please share this knowledge with the urologist who incorrectly diagnosed your 4 your old son Jack with "phimosis" and who recommended circumcision! This doctor will give similar diagnoses in the future and many trusting parents will only agree to his recommendation of unnecessary, harmful amputative surgery. I have a hard time comprehending how this occurs in our country at such an alarming rate in the 21st century.
Bless both you and your husband for doing your research and asking questions to protect your boys.
post #18 of 88
seriously, the urologist is so wrong it's scary. and i realize it's over but why on earth did they put him through a vcug? that's to check for kidney reflux and would only be indicated if he were having recurrent UTIs. weird!

You should provide this to the urologist:

http://www.doctorsopposingcircumcisi...etraction.html

It's possible you could save other boys from unnecessary circumcisions.
post #19 of 88
Quote:
Originally Posted by JacksonsMom View Post
We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
Good for you mama! Please stick around Mothering and help other parents with your son's story. I was in your exact shoes two years ago and owe so much to this board! If you want to do more reading, here is my *big sigh of relief* thread, which also links to my original "please help!" thread. The people here are simply awesome. :
post #20 of 88
It was not your fault that the VCUG was done. Not at all!

Just FYI, most of the time, doing any sort of external culture of a penis is practically useless. IF the swab touches his skin, it will grow bacteria whether there is an infection or not. This is because the skin is normally covered in bacteria. A culture of the penis isn't going to tell them anything usefull.
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