Phimosis

[Rockprincess]

Hello, I am looking for some information and advice. My son Alasdair has a fairly severe infection in his penis. I am feeling horrible about it because thinking back I realize it probably started a month ago when he was having trouble getting to the bathroom in time, but when it improved I brushed it off. Anyway, yesterday at bedtime I noticed it was quite red and this morning it was leaking pus Obviously we went to the doctor asap.

As it turns out, the infection is a result of phimosis, which is when the foreskin is too tight at the opening to retract over the glans. I'm not surprised by this, really, because twice as an infact his doctor had to do a minor procedure to widen the opening for him. As an infant it's not a huge issue because the unretracted foreskin can't harbour bacteria. Now however the foreskin has retracted (my doctor checked at his 3 year visit and it was tight but possible), but the opening has closed tighter again, so it is now impossible to actually clean under his foreskin properly.

We're going back in a week to check that the infection is gone, but it's almost certain we'll be referred to a pediatric urologist at that point. My Doctor advised me that the usual treatment for phimosis is circumcision. While of course I will do what is necessary for my son's health, I was told that some people here may have information about things to try before taking that step. I would be grateful for any advice or experience you have to share. Thank you!

[kiara7]

How old is he?

[Rockprincess]

He is 3.5

[kiara7]

Nak.

You will get great advice here.

There is no need for him to be retractable at 3.5 years old. It is completely normal for boys not to be retractable until much later (10, 12, 15). Your doctor has no business checking anything and performing any procedures. What did he do, btw?

There is no need to clean under foreskin at 3.5 either. The opening closed because that is what it is supposed to do. Once separation starts naturally, it will widen, but if it's manually retracted, stretched, etc. - the opening will tighten back.

How was this infection diagnosed?

Other posters will give you more info, I'm sure, but most likely these issues are a direct result of the doctor messing with things that don't need his "help".

[Rockprincess]

I think I must have been unclear. At Dair's 3 year appointment my Dr checked whether the foreskin was retractable. She very gently pulled, and it retracted - obviously it had naturally loosened by that point. Since then no one but Dair has touched it.

It is now 7 months later and Dair has developed an infection. It was diagnosed by the yellow pus oozing from it. His entire penis is inflamed and there is a lot of pus. He is on antibiotic to get rid of the infection.

The reason the doctor mentioned circumcision is because in Dair's case the foreskin can and has retracted but the opening is not large enough for the glans to pass through and therefore there is no way to properly clean the glans. This is the source of the current infection.

I do not think my doctor is to blame here. I am not looking to place blame. I am looking for ways to help my son.

edited to add: Dair's foreskin balloons when he pees and always has - I know this is an additional point of concern.

[CallMeMommy]

It doesn't need to be cleaned. There's absolutely no reason to be retracting his foreskin. The glans is a self-cleaning organ. Has she cultured the pus coming out? Is she even sure it's pus? The only legitimate reasons for circumcision are gangrene, cancer, frostbite, and severe injury.

[Rockprincess]

It is pus. There is a ton of it, there is no question. He has a raging fever. I am not questioning the existence of infection, and if you saw my child you would not either.

Once the foreskin has retracted, cleaning the glans and under the foreskin is indeed required. Mild soap and water are ususally all that is required. As I indicated above, my son's foreskin has NATURALLY retracted already and bacteria can therefore be harboured between the glans and foreskin. And obviously is, at the moment.

Please could you calm down and stop being so aggressive with me. I am not about to circumcize my child without making sure it is the last resort. Someone told me that people here had some good information about other possible therapies and that is what I am hoping to hear about.

[CallMeMommy]

It does sound like an infection, and if it is, antibiotic is the only therapy needed.

I don't think anyone (myself included) is meaning to sound aggressive, we just get exasperated with lack of education with health care providers. You'd be surprised how many times someone has said their doctor misdiagnosed smegma as pus, or gave an antibiotic for a yeast infection. In your case I'd get an antibiotic to clear up the infection and then, if you're confident he's completely retractile, have him retract and swish the glans in water every time he takes a bath (no soap!).

[eepster]

Sorry to be brusk, but need to go pickup DS from school.

Since your sure it's an infection, then I would worry it was caused by the retraction that the Dr did at the 3 yo checkup.

Give him the antibiotics, but make sure no further retracting is done till your DS chooses to himself. Wash in plain water, no soap, no bubble bath, just swish.

Make sure his fingernails are clean and short, so if he sticks them in there (yeah, boys do this ) they don't cause damage.

[tennisdude23]

You absolutely do not have to clean under the foreskin. Smegma, for example, is a natural self-cleaning lubricant. It does not cause infections. What causes infections is if you try to force the foreskin back to forcibly clean down there. That's a big no,no. The only person that should be doing that is your son. There is also no such thing as a "too tight opening." The only time the opening would be too tight if it would constrict urination. Phimosis cannot be also diagnosed in a 3 year old child. Your doctor is misinformed. If your son's glans cannot fully go through the opening; that's perfectly normal and is normal until late teens. The average age of complete retraction is 10-11 years old, with some kids not being able to do it until early adulthood. Again, all normal. I am sure people here will give better advice on the infection business than I can; however if you have urgent questions, please feel free to contact Doctors Against Circumcision (DOC). I am sure they will give excellent advice without having your son undergo something as radical as a circumcision for what's probably a none-existant problem.

[Tinijocaro]

Ballooning is also completely normal, it doesn't lead to problems. All it means is that the foreskin has detached from the glans, but the opening is small enough to create pressure inside the foreskin. My older boy ballooned until he was 12 and became fully retractable.

[bremen]

Originally Posted by eepster

Since your sure it's an infection, then I would worry it was caused by the retraction that the Dr did at the 3 yo checkup.

the op said the check up was 7 months ago. i highly doubt that the retraction at the check up so long ago is to blame.

[MyBoysBlue]

We get frustrated with doctors damaging our baby boys. You mentioned that your son had a procedure twice to widen the opening. That is a huge mistake that could cause future problems like phimosis. If he was able to pee there was no need to do this.

Here is a link that might help. It has a "Prepuce “Problems” and How to Care for Them" You'll have to scroll down a bit.

http://www.doctorsopposingcircumcisi...iansguide.html

[kiara7]

Originally Posted by Rockprincess

edited to add: Dair's foreskin balloons when he pees and always has - I know this is an additional point of concern.

Didn't mean to upset you. Just get frustrated with doctors.

Ballooning is a normal process. Nothing to be concerned about. It will resolve in its own time. The only thing your son needs his penis to do is pee right now.

Since you're giving him antibiotics, make sure you give him a good probiotic too, so that he doesn't get a yeast infection.

[Fellow Traveler]

I want to reply later tonight when I have time. I just want to point out that we do get a lot of people who are told one thing by the doctor and it turns out to be another so don't take offense by a particular comment. I want to also quickly mention that there are alternative treatments to circumcision that are often skipped which I'll bring up later. (or perhaps someone else will).

[mommyminer]

I agree with what everyone has said above. I'm sorry your dr has grossly misinformed you about phimosis. I encourage you to do some of your own research on this issue and bring the research to your dr.

"twice as an infact his doctor had to do a minor procedure to widen the opening for him" This shocks me (well not really considering what I've heard Dr's do)! There was no need to widen the opening unless his urine wasn't coming out.

The antibiotics should be working within 24 hrs. If not, I'd encourage you to have your dr culture the pus to find the appropriate antibiotic. I hope your little man feels better soon.

[l_olive]

I'm sorry, but this whole situation is just full of, what I would consider to be, TERRIBLE medical advice and misinformation. And I know that I probably sound angry, but please know that's directed at your health care provider (HCP), not at you.

Originally Posted by Rockprincess

Hello, I am looking for some information and advice. My son Alasdair has a fairly severe infection in his penis. I am feeling horrible about it because thinking back I realize it probably started a month ago when he was having trouble getting to the bathroom in time, but when it improved I brushed it off.

What leads you to believe that a 3.5 year old not making it to the bathroom in time has anything to do with his foreskin? There are lots of children, both boys and girls, intact and cut, who have difficulty with this.

Originally Posted by Rockprincess

Anyway, yesterday at bedtime I noticed it was quite red and this morning it was leaking pus Obviously we went to the doctor asap.

Many boys experience symptoms very much like this is described as a normal and natural part of the separation process. Since you've gone on to say in subsequent posts that he has a raging fever, it is quite possible that it was indeed an infection, but without a culture, there's no way to know that for sure.

Originally Posted by Rockprincess

As it turns out, the infection is a result of phimosis, which is when the foreskin is too tight at the opening to retract over the glans.

Almost all boys have a tight foreskin which is too tight at the opening to retract over the glans, and the average age of natural retraction is around 10 years old. A HCP who says that a 3.5 year old boy should be retractile is completely mistaken and woefully ignorant.

Originally Posted by Rockprincess

I'm not surprised by this, really, because twice as an infact his doctor had to do a minor procedure to widen the opening for him. As an infant it's not a huge issue because the unretracted foreskin can't harbour bacteria.

What in the world did your HCP do to your infant son, and more importantly, WHY???

Originally Posted by Rockprincess

Now however the foreskin has retracted (my doctor checked at his 3 year visit and it was tight but possible), but the opening has closed tighter again, so it is now impossible to actually clean under his foreskin properly.

If your HCP said it was still tight, then your son was forcibly and prematurely retracted. Of course his foreskin has reverted to its previous state -- it's called healing.

Originally Posted by Rockprincess

We're going back in a week to check that the infection is gone, but it's almost certain we'll be referred to a pediatric urologist at that point. My Doctor advised me that the usual treatment for phimosis is circumcision. While of course I will do what is necessary for my son's health, I was told that some people here may have information about things to try before taking that step. I would be grateful for any advice or experience you have to share. Thank you!

Your son doesn't have a phimosis problem and doesn't need to be circumcised. He may, or may not have had an infection which can be easily treated with antibiotics. Please be aware, though, that a course of antibiotics can often lead to a yeast problem which can also cause redness and swelling -- just like it does in females.

Please read a lot. Here are two great places to start.

Mothering Article on How to Protect your Uncircumcised Son, by Dr. Paul Fleiss

http://www.mothering.com/articles/ne...uncircson.html

The American Academy of Pediatrics Care of the Uncircumcised Penis

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

[l_olive]

Originally Posted by Rockprincess

Someone told me that people here had some good information about other possible therapies and that is what I am hoping to hear about.

But please hear that what we're saying and the articles that you can find linked to in this thread and the stickies is that your son doesn't need any kind of "therapy" because he doesn't have a problem beyond a possible, and simply treated, infection.

To me, what it sounds like, is that your over-zealous HCP needs to leave his poor penis alone. Maybe you might think about asking your HCP how exactly s/he would treat the exact same type of infection in a female child?

[Rockprincess]

I am listening to what you are saying, and I agree that I need to do more research before making any decisions. I will also talk to the pediatric urologist in depth before I make any decisions.

I do disagree with some of the information some of you are giving however. The widening as an infant was performed because the restriction was so great it caused problems with his urination. The ballooning was not momentary and normal, it was very exaggerated and the urine left the foreskin balloon at a much slower rate than it entered from the urethra. This is a big problem, it can cause repeated UTIs.

I think perhaps we are coming to this issue from different places. I live in Alberta, Canada, where routine infant circumcision is less than 18%. My doctors are very familiar with uncircumcized penises and how to care for them appropriately. My doctor did not say "An infection! You will circumcize him immediately!" he said "Come back when the infection is treated. If there is still a problem we will refer you to the urologist. You should know that sometimes the medical indication for this problem is circumcision."

I am looking for ways to reduce my son's risk of infection in the future. I believe his continued ballooning along with the detached foreskin and narrow opening leave him vulnerable to infection, and I'd like to reduce that without surgery if possible.

Just to address this:

What leads you to believe that a 3.5 year old not making it to the bathroom in time has anything to do with his foreskin? There are lots of boys, both intact and cut, who have difficulty with this.

I don't think it has anything to do with his foreskin, I think it has to do with an undetected UTI. My son has been totally potty trained for over a year, and a month ago he started having accidents about twice a day. I thought about UTI at the time, but the accidents only lasted a few days, so I put it out of my mind. That's all.

[MyBoysBlue]

I'm in Alberta too. Being in Canada doesn't protect you from misinformed doctors. I was sent to a urologist with my first son. Luckily he was informed enough to tell me that my doc wasted our and his time by referring us as there was no problem at all. So if your lucky you will get a urologist that is as informed. Just be up front that you will not entertain talk of circumcision.