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

[foreskin friendly]

Originally Posted by AleksFeodoraSnyder

This is a picture i found on Google, it looks very similiar to my son's penis also: http://www.steadyhealth.com/articles...e/phimosis.jpg

This is what his penis SHOULD look like at his young age...

Refer your Dr. to studies done by Oester (or Oster) & Kayaba
re: mean age for full retraction = 10.4 years old (after following hundreds, if
not thousands of intact boys)...

the strange looking membrane that you're referring to is just as a previous post said, very similar to the membrane that connects your nail to your finger.
It is the balano-preputial lamina... tell your doctor to do some continuing education regarding that membrane and the true time table that it normally takes to break down. It is ABSURD to expect that by 2 yrs old, all intact males should be fully reatractible, but that is a myth that continues through the American medical profession and one that ignorant Dr.'s use as a scare tactic to convince otherwise apprehensive parents to be agreeable with a circumcision. Completely unneccessary. I don't even believe that a true diagnosis of phimosis can be accurately given in someone who hasn't already gone through puberty!
Just remember, this membrane is a protective measure that the body has created to PREVENT problems from occuring. Don't mess with it and certainly DO NOT let any medical staff or day care providers mess with it!
That might be exactly the cause of the original problem to begin with!
Physiologically, the foreskin is fused to the glans penis and should remain that way until it naturally seperates on its own, in its own time.
Good luck and keep us updated! Good for you for coming here, following your intuition and preventing any furthur damage from possibly happening to your son!

p.s. - As your son's foreskin starts separating from the glans, you may see pools of smegma underneath the foreskin. DON'T try to manipulate them out from under the skin...they will work their way out in their own time...and with that be VERY leery of any Dr. that might suggest that those smegma pearls are infectious bacteria!! They aren't!

[Yulia_R]

Originally Posted by foreskin friendly

p.s. - As your son's foreskin starts separating from the glans, you may see pools of smegma underneath the foreskin. DON'T try to manipulate them out from under the skin...they will work their way out in their own time...and with that be VERY leery of any Dr. that might suggest that those smegma pearls are infectious bacteria!! They aren't!

Yep, during this the penis can be swollen and it can be painful for the boy to urinate (since urine pushes smegma built up toward the opening, creating micro-tears in adhesions on the way). It should resolve on its own within 48 hours. My son had this once and I just had him pee in a warm bath (with a bit of tea tree oil and backing soda in it) which made it less painful for him to urinate. Once the smegma built up was out, the swelling went down within few hours. He was balloning for some time after that (during the torn adhesions that smegma created) and in few months his foreskin completely re-attached to the glans. He is nearly 4 yo now and is not anywhere near being retractable. Which is totally normal.

[AleksFeodoraSnyder]

Originally Posted by Quirky

That picture looks totally normal to me. That's what baby penises are supposed to look like. The foreskin is supposed to be fused to the head (glans) of the penis, exactly like the fingernail is supposed to be fused to the nailbed of the finger.

I agree with the PP that your son sounds normal. What about getting a second opinion from a urologist?

Just FYI, the link between foreskins and UTIs has been disproven. In other words, intact boys are no more likely to get UTIs than circumcised boys. Nor is the foreskin likely to cause UTIs -- it's usually a problem with the kidneys and urethral system.

Cutting off the foreskin may make the boy MORE prone to UTIs by exposing the opening of the urethra to more bacteria.

Plus, one in ten circumcised boys will develop meatal stenosis as a result, where the urethral opening scars and narrows because of chafing. This does require painful surgery to correct.

Leave your son alone. Don't cut off his foreskin. That's 19th century medicine and won't do him any good, and will do him great harm.

Re: fused like a nail to the nailbed. My son's forskin is actually loose and not attached, it is however narrow at the tip. Does that make sense?

[latinalonestar]

Others have responded but I wanted to add that you can NOT diagnose phimosis in a child b/c the foreskin is normally not retractable until puberty. Only 50% of boys are retractable by age 10. This urologist is very foreskin-ignorant.

Must read article:
http://www.mothering.com/articles/ne...uncircson.html

As far as infection, did they do a culture? If not I bet there was no infection. Infections are very rare. Your son could have experienced some separation, which is a normal developmental phase that can be accompanied by redness, swelling, irritation, itching, smegma pearls, ballooning, etc. These are all normal. This process happens throughout childhood. This does not mean a boy is retractable b/c the opening still remains narrow.

This sticky is about normal separation:
http://www.mothering.com/discussions....php?t=764732?

As a boy goes through puberty, hormones will allow his opening to stretch. Essentially hormones do what your doctor is trying to do with the steroidal cream. If you use a steroidal cream, the foreskin will go back to being tight b/c your son does not yet have the hormones to sustain the open foreskin. His foreskin has absolutely NO reason to be open at this age. Retraction is something that comes with sexual maturity. Also, steroidal creams are dangerous to a child b/c they can thin the foreskin, making tearing likely. DON'T USE STEROIDAL CREAM.

At this point all your son's penis needs to do is pee. Less than 3% of men are not retractable after puberty, so it is not likely that this will happen to your son unless he has scarring from forcible retraction. Just the fact that your doctor was trying to retract him tells us that he doesn't know about the foreskin and is not respecting it's natural developmental process.

Here are some more links you should read:

Development of a retractable foreskin in a child or adolescent:
http://www.doctorsopposingcircumcisi...kinleaflet.pdf

Avoiding circumcision after the neonatal period:
http://www.nocirc.org/publish/pamphlet7.html

The ONLY medical reasons for circ are frostbite, malignancy, gangrene, or serious trauma. Your son is perfectly normal.

[Yulia_R]

Originally Posted by AleksFeodoraSnyder

Re: fused like a nail to the nailbed. My son's forskin is actually loose and not attached, it is however narrow at the tip. Does that make sense?

yes, it does make sense. It means that the process of separation has already started. It may take years till it's completed. The opening usually loosens up the last (which makes sense if you think about it).

[Tinijocaro]

Yes, urologists have a "magic number" that all kids should retract by, but that just isn't reality. I have two boys, one retracted by 4, the other,not until he was about 12. No issues at all.

Of course your ds has phimosis, all boys have it until they are retractable.

Is the bacterial infection cleared up?

Originally Posted by JacksonsMom

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.

[chaoticzenmom]

It seems to me that if the steroid cream was working, then the hormones of puberty will work, kwim? If the cream was enough to enlarge the opening, then the scar tissue must not be very tough.

I hope somewhere in here, you're getting some helpful info.

[robertandenith]

Originally Posted by Tinijocaro

Yes, urologists have a "magic number" that all kids should retract by, but that just isn't reality.

yes, it's like saying that all girls will have their first period by their 10th year, THEY ALL SHOULD!

[eepster]

Originally Posted by AleksFeodoraSnyder

Re: fused like a nail to the nailbed. My son's forskin is actually loose and not attached, it is however narrow at the tip. Does that make sense?

The natural adhession has broken down, either b/c you DS is an early bloomer or b/c the daycare workers have been forcibly retracting him. Either way, the sphincter at the end is simply still naturally tight when you DS isn't peeing. As long as it's enough for pee (which being a liquid can fit through a pretty small opening) to come out it is not a problem.

Take you DS diaper off and let him play somewhere easy to clean up, then watch him. When he starts to pee, you will see the sphincter relax.

It is likely ballon for a few moments since he sounds partially seperated, this is pefectly natural and harmless. It may spray in a funny direction, this will happen b/c the opening of the foreskin and the meatus don't line up, again this is natural and harmless. He may pinch the tip with his fingers or stick one inside to make the pees go in a very strong steam, this isn't natural, but when DS was 20 mo he thought it was hysterically funny, and it's mostly harmless.

[enstar780]

Originally Posted by JacksonsMom

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.

UTIs are actually fairly rare on boys so this is an unusual situation. Girls actually receive UTIs 50 times more often than boys however we do not use this as a reason to push circumcision of them. Similar treatments used for girls also apply here as well. The foreskin does not have anything to do with this situation. The UTI most likely has an internal cause and there are many reasons that can happen. As well, a 4 year olds foreskin does not need to retract, the time at which childre become retractable varies, it may happen when they are 12. If the foreskin has not seperated from the glans yet it definitely should not be retracted.

[MCatLvrMom2A&X]

Unless you have seen him retract there is no way to know if it is still fused to the glans. It looks loose from the outside because the skin is made to be loose.

Like everyone has said if he can pee then there is nothing wrong with him. Pin hole size is normal while not urinating just like the anal sphincter it will relax to allow urine out then close tight to keep germs out.

Normal intact penis side by side: http://www.cirp.org/library/hygiene/...e1/figure3.jpg

Hate this picture on the right because someone is doing a MAJOR : but the one on the left is a normal intact penis the foreskin is fused to the glans in the left picture. You cant even see the opening on it because of the overhang and the hole is that small.

[AleksFeodoraSnyder]

Originally Posted by Sancta

Check this out: http://www.mja.com.au/public/issues/...w10610_fm.html

Includes photos.

ETA: I didn't read the article so I have no idea what it says. I only found the pics.... also, I agree that if he's peeing fine then leave it alone. And one more thing - I've also read that cases of true phimosis are just not found in the under 5 age group. So unless your son is a super rare case, I'd think he didn't have "true" phimosis. And lots of kids who do have true phimosis likely have it because they have had their penises manipulated and scar tissue has resulted.

After looking at the above photos in the attachment; both my husband and feel like our son's penis looks more like the far bottom right photograph. We will definately get a second opinion now. But it really appears that the "poof" at the end isn't there, I guess i didn't remember what it looked like, when i was at work yesterday.

[eepster]

Originally Posted by AleksFeodoraSnyder

After looking at the above photos in the attachment; both my husband and feel like our son's penis looks more like the far bottom right photograph. We will definately get a second opinion now. But it really appears that the "poof" at the end isn't there, I guess i didn't remember what it looked like, when i was at work yesterday.

Penises are very variable from one moment to the next. When it's very cold, they get loose and wrinkly. When they are erect they look tight and smooth.

When the Dr showed you what he wanted you to see, he probably was pulling the foreskin taught so that it looked tighter than it really was, and the poof at the end was flattened out.

[AleksFeodoraSnyder]

When i changed his diaper today, there was no "poof"

[KBecks]

I don't know the answer, but I wish you and your boys the best. Don't hesitate getting a 2nd opinion before committing to a decision to circ.

[eepster]

Originally Posted by AleksFeodoraSnyder

When i changed his diaper today, there was no "poof"

Was he erect?

DS's flattens out when he is.

[eepster]

Let's look at this from a different angle. Comparing both scenarios:



You get him circumcised

• At best he under goes a painful procedure, looses part of his penis, and looses sensitivity
• He will be traumatised by the need to change the dressings
• He may been confused about is body immage b/c at this point it is fairly formed
• He is exposed to general anestethic (if the Dr is half way civilized)
• He may have one of the many, many possible side effects/risks associated with circ which includes: excessive bleeding; infection; degloving; nicking the glans; amputating the glans; burns from a cauterizer; meatal stenosis; opening the ureathra; adhessions; death
• He gets another UTI and it goes untreated b/c it tends to be less symptomatic in circ'd boys

You do not circumcise him:

• nothing happen, he is fine and he keeps all his parts
• he gets another UTI, and you treat it with antibiotics
• He really does have true phimosis, at the point it becomes an actual problem he has it treated with a less dramatic procedure such as a dorsal slit, or one of the many other options.

Which scenario is better, less risky, etc.

[Owlpainter]

Do not feel bad! I have learned so much from this thread. I had no idea about phimosis and might have made the terrible mistake of circumcision for my intact son if I had encountered this doctor. I feel like an island sometimes when it came to the decision of not circumcising my boy(he'll be two next month)there is so much ignorance on this issue amongst my own peer group and family. It's like they are desperate to have an excuse to cut my poor kid, and then when you have the medical community siding with them...it's really tough. Very smart decision to advise this board. I will remember this in the future...This is my first post!

[Devaskyla]

It sounds like you're describing a perfectly normal infant foreskin. Here's some other image links.
http://www.parentingweb.com/art/infant.GIF (drawing)
http://www.clareloprinzi.com/images/Circumcision2.jpg (photo)

[Ask a man]

I stumbled onto this while using Google to do some research. And while I am impressed by the number of sources cited and the lengthy posts, I feel the need to say some things here since I actually have a penis attached to me. Many of the previous posts seem very opinionated.

To the person who is having trouble with the doctor,

Yes definitely get a second opinion. if you only have one child and he is a male, then preferably go to a male doctor. i mean no offense towards women. But you are definitely not penis experts and a male doctor will in most cases, though not all will have more sensitivity when handling this condition. (very fine female doctors exist, and very inexperienced male doctors exist as well) I am in no way meaning to be biased. But let's face it men have more experience with the organ being discussed here. Also I never went to a pediatrician as a child. I went to a very fine family physician. I never understood why people go to pediatricians. I would suggest maybe even talking to a Urologist. edit: No I would definitely see a Urologist or maybe even two. Remember your young man's penis is going to be one of the most important things in his life. Don't let just anybody mess it up or damage it.

To those discussing the retracting of foreskin,

I am in no way an expert on this subject seeing as how I was circumcised as a child. It seems that many people who do not support circumcision have little knowledge of circumcised male genitals while people who support circumcision have little knowledge of uncircumcised male genitals. Only opinions. Really it's not about hygiene or tradition, children get circumcised because most people don't actually think about the matter, they just do what a physician or their peers suggest or their family members had performed.

However my foreskin seems to have grown back and I can tell you that you must keep it clean. Some of you are suggesting that retracting of the foreskin should only happen after puberty or by the child himself. This can not be correct can it? How will you keep it clean? Smegma?

Also some people commented about some pubic hairs on one of the photos discussed in the thread. If the image you all are referring to is this one:

http://www.steadyhealth.com/4542/Image/phimosis.jpg

I don't think that is pubic hair(s). Here is most likely what happened: The picture was probably taken with an actual camera before digital cameras were around. There may have even been dust etc on the lens. Then the film was developed and a picture was printed. Some time later, that actual photograph was scanned and uploaded to the internet. There may have been dust on the scanner or the surface of the original photograph may have been scratched. Having one solitary pubic hair that thick, long, and dark would be unusual.

Again, I mean no disrespect. But no one here should believe that they already know everything about this matter. And please ask your husband if available or another man whom you trust for help with this.