I typed this up last year for my doctor.
And I know that some of the links may have changed.
Jessica
PS, I forgot my manners and posted it forgetting to edit it for copyright.
Foreskin Retraction during well-child exam: Is it really necessary?
#1: What are you looking for that wouldn't show externally? If there is a problem a problem should be detected EXTERNALLY, such as external signs of infection or difficulty peeing. Statistically, problems of the foreskin are so rare that examination seems likely to be a waste of time and only perpetuates myths about the foreskin being problematic, unhygienic, or ‘needing’ circumcision.
#2. The AAP clearly states the foreskin should not be retracted. If done before it is ready it may “severely harm the penis and cause pain, bleeding and tears”.
#3: The glans should be considered INTERNAL till retractable. Today’s parents choosing intactness consider this and also know the AAP’s recommendation that the boy should be the first one to retract the foreskin. After retraction the boy/man can be asked to retract the foreskin himself for an exam, if necessary. With this distinction in mind, most parents would consider an internal examination to be unnecessary and invasive. Wouldn’t the same type of exam on a female child cause concern about the appropriateness??
#4 It is impossible for another person to determine how 'gentle' they are. For some boys even a gentle exam could cause a small tear. A small tear can lead to infection or further problems. In the past, most doctors told parents to gently retract the foreskin for cleaning and retracted the foreskin for examination. Perhaps, this is why American’s have seen an inordinate number of foreskin ‘problems’ when compared to intact cultures; another indicator that this practice needs to stop.
#5. Consider the American culture of circumcision when examining the issue… Not long ago the medical premise was that the foreskin needed to be circumcised, was problematic, unhygienic and required extra ‘attention’. Is the notion that there it is necessary to examine the foreskin a leftover from this era? It certainly seems plausible that retraction stemmed from these misconceptions and not from medical necessity.
#6 Anecdotal evidence or experiences from other parents:
In the last month alone, on a parenting forum that I am a member of there have been at least 7 posts about US doctors retracting the foreskin of a child. The experience of other parents has made me very concerned about this practice and makes me feel it is important to:
#1 protect my son from being retracted
#2 provide information to medical professionals
In all these cases there was no indication of a penis or foreskin problem, most children were in for a well-child exam and sometimes the physician insisted they were being gentle or did not consider what they did was retracting. Although injury from gentle retraction may be rare I believe all retraction to be unnecessary and ill advised. I’ve included a summary of these examples at the end of this information.
Medical Information:
AAP
“Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin.”
Source:
http://www.medem.com/search/article_..._typ=NAV_SERCH
The following sources of information were originally compiled by John Geisheker, J.D., LL.M., General Counsel, Ex.Director, DOC
Avery's Neonatology, (2005:1088) a medical text
“Because circumcision is so common in the United States, the natural history
of the preputial development has been lost, and one must depend on
observations made in countries in which circumcision is usually not
practiced.”
from Pediatrics, a reference text by Rudolph and Hoffman:
"The prepuce, [or] foreskin, is normally not retractile at birth. The ventral
surface of the foreskin is naturally fused to the glans of the penis. At age
6 years, 80 percent of boys still do not have a fully retractile foreskin. By
age 17 years, however, 97 to 99 percent of uncircumcised males have a fully
retractile foreskin. Natural separation between the glans and the ventral
surface of the foreskin occurs with the secretion of skin oils and desquamation
of epithelial cells, [or] smegma.”
From Roberton's Textbook of Neonatology:
“Forcible retraction in infancy tears the tissues of the tip of the foreskin
causing scarring, and is the commonest cause of genuine phimosis later in
life.”
Avery's Neonatology says:
'Forcible retraction of the foreskin tends to produce tears in the preputial
orifice resulting in scarring that may lead to pathologic [i.e., in this case,
iatrogenic, or physician-induced] phimosis.”
From Osborne's Pediatrics ...phimosis or paraphimosis is
“usually secondary to infection or trauma from trying to reduce a tight
foreskin” Moreover, they later state, “circumferential scarring of the
foreskin is not a normal condition and will generally not resolve.”
From the American Academy of Pediatrics:
“..foreskin retraction should NEVER be forced. Until separation occurs, do
NOT try to pull the foreskin back - especially an infant's. Forcing the
foreskin to retract before it is ready may severely harm the penis and cause
pain, bleeding and tears in the skin. " (From the American Academy of Pediatrics
bulletin, "Care of the Uncircumcised Penis").
Other Information
“The tightness of the foreskin is a safety mechanism that protects the glans and urethra from direct exposure to contaminants and germs. The tight foreskin also keeps the boy's glans warm, clean, and moist, and when he is an adult, it will give him pleasure. As long as your son can urinate, he is perfectly normal. There is no age by which a child's foreskin must be retractable. Do not let your doctor or anyone try to retract your child's foreskin. Optimal hygiene of the penis demands that the foreskin of infants and children be left alone. Premature retraction rips the skin of the penis open and causes your child extreme pain. There is no legitimate medical justification for retraction. The child's discomfort is proof of that.”
Protect Your Uncircumcised Son: Expert Medical Advice for Parents
By Paul M. Fleiss
Mothering Issue 103, November/December 103
http://www.mothering.com/articles/ne...uncircson.html
Is any special care required for my intact son?
Your son's natural penis needs no special care. During the first few years of life, the inside fold of his foreskin is attached to his glans, very much the way the eyelids of a newborn kitten are sealed closed. The tissue that connects these two surfaces dissolves naturally over time -- a process that should never be hurried. The foreskin should never be retracted by force….
(please follow this link, more useful information was listed, too long for me to include w/o violating copyright)
Source:
Mothering.com
Ask the Experts: Marilyn Milos
http://www.mothering.com/sections/ex...l#special-care
“Avoidance of premature retraction.
Care-givers and healthcare providers must be careful to avoid premature retraction of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.3”
Source:
Doctors Opposing Circumcison
http://www.doctorsopposingcircumcisi...etraction.html
Examples from an Online Forum
In the last month on a parenting forum that I am a member of there have been at least 7 posts about US doctors retracting the foreskin of a child. In all these cases there was no indication of a penis or foreskin problem, most children were in for a well-child exam. -One example was a 2 year old that needed to have surgery for a hernia.
Though some of the examples are extreme, for example, certainly the surgeon had no business even examining the foreskin, about half of the examples are of doctors who would consider they were gently retracting the foreskin. In some examples, the doctor did not even consider the action to be ‘retraction’. While many parents may tolerate a gentle examination the consensus seems to be that it is unnecessary and ill advised. Furthermore, more and more parents consider this a violation of the child’s body, bordering on sexual assault. The logic being that a parallel exam on a female child would cause outrage and almost universal be considered unacceptable.
The forum has over 22,000 active members and I simply did a basic search of posts in July and August. There may have been other examples that came up that I did not find, but these are typical example that are posted. Of course, I understand the nature of online forums and that I cannot truly verify these cases are true. I would just like to present some examples that show the parents perspectives and in some cases the misinformation that doctors use to defend this practice.
The number of examples of retraction has prompted me to be diligent about protecting my son from misinformed caretakers, family members, and even medical professionals. Although injury from gentle retraction may be rare I believe retraction to be unnecessary and ill advised. I first assumed that circumcision was something that was necessary so I do understand the blinders that cultural norms place on us. In the past we have justified the violation of our sons genitals by claiming medical problems, hygiene issues, and the quick easy almost painless fix being circumcision. Now that more is known about circumcision, more parents are choosing to leave their son intact. However, much of the misinformation still lingers and the norms that we usually expect around genital integrity seem to be missing when it comes to this issue, and I think this is one of them.
After this I included a summary of the recent retraction incidents as I had found them... I kept them anonymous, but I don't feel right posting them here now as people might be able to tell who they were- and although I believe almost all would want to stop this from happening I didn't have the time to contact each individual to receive proper permissions.... as for the mother who's son was circumcised during the surgery, she did want her experience to be shared to prevent it from happening. Some examples were very extreme and others were ones that probably ended fine.
