I need advice - quick

[cristina63303]

Let me start by saying everyone in my family is intact and circumcision is not an option.

I have two intact sons (9 and 7) We moved to Miami from Germany 5 months ago. 9 yo retracts no problem. 7yo does not retract yet and I've never thought anything of it until recently.

It turns out the orifice in his prepuce has been shrinking to the point that he complains about pain when urinating. His urine stream was down to a thin thread a few days back and today it was only drops!!! I'm terrified to take him to the doctor here because I simply don't trust US doctors to be able to handle the situation without suggesting the c-word.

Again: circumcision is not an option.

When we arrived here back in August I took the kids to the ped (have known him for a long time, is my brother's ped, my brother has 3 intact sons and never had an issue). Still, I'm not completely at ease with his position on circ. He examined the boys and said 7yo has "phimosis". I knew better but still took his prescription for mometasone (just in case). I did not use it until recently when I started realizing there MAY be an issue after all. So for the past week or so I've been applying it to my son twice a day but I have not really seen improvement - the contrary is the case.

Is there anything I should / shouldn't be doing when applying it? Does anyone have experience with these creams? I tell my son to strech it himself because I know better that attempting any kind of retraction.

Can anyone give me some advice or please recommend a trustworthy INTACT FRIENDLY MD in Miami?

THANKS!!!

[MyBoysBlue]

At 7 years old my first thought it there is some swelling due to separation and I would take the wait and see approach. But if he is not able to pee except for drops then you really need to see someone, that is an emergency. Hopefully someone can suggest an intact friendly doc, soon. You can just state up front that Circ is not an option.

[Fellow Traveler]

Hmm down to a few drops would have me concerned too. There is a list of intact friendly doctors (member recommended) here:

http://www.mothering.com/discussions...5#post13479385

In addition NOCIRC maintains a list too so you could call them. They might know a pedi urologist in your area too. Contact info is on their website:

http://www.nocirc.org/contact.php

I don't have any experience with the cream, as I understand it, it should be quickly effective.

[tennisdude23]

I am not a doctor, but my first thought was bacterial infection. If he has difficulty urinating, then medical attention is certainly warranted. Although justified in some medical instances, circumcision is very rarely needed, especially at a young age, when the body is developing. There are plenty of other options to entertain first.

[glongley]

There could be some low grade yeast infection going on which would produce enough low-grade swelling to make the opening smaller. I have heard of adult men who had retractable foreskins and then went back to being non-retractable, and it turned out to be yeast. The foreskins went back to being retractable after the yeast was treated. You can try an over the counter 7 day yeast cream and see if it helps.

If it's not an infectious process, regular application of the steroid cream would seem to be a good idea to loosen the opening.

The pain with urination can be a pulling away of the inner foreskin from the glans with the pressure of voiding, or he may have some freshly separated areas underneath that sting when urine gets on them.

Agree that if he's not able to pass more than drops, he should be seen by a doc. Just hold your ground on circ not being an option, and do not let them forcibly retract him.

BTW, there are foreskin- conserving surgeries to release a problematic phimosis that do not involve circumcision. Look up "preputioplasty" at cirp.org.

Good luck and let us know how things are going.
Gillian

[Fellow Traveler]

Good thoughts on this. Though I think it's prepuceplasti isn't it?

[glongley]

Originally Posted by Fellow Traveler

Good thoughts on this. Though I think it's prepuceplasti isn't it?

Preputioplasty or prepuce plasty is how it's listed at cirp.org.

[cristina63303]

Thanks everyone!

DH explained to DS how to stretch the skin a bit and he's back to a stream of urine, albeit thin. He does urinate, it just takes him longer than it used to.

I had a long talk with someone who knows more about this topic than anyone else on the planet (you all know who she is... isn't she AMAZING???) who, like Gillian, suspects yeast and suggested acidophilus culture.

I'll implement tomorrow and keep you guys posted.

I keep thinking about the fact that I'm SO CLEAR on this and would never consider circumcision. Now, most people are not quite there and how many in our situation have been chopped? Horrible. Unnecessary. It is really frustrating to have to be afraid of doctors... precisely the people who should be in charge of helping us!!!

[tutucrazy]

Originally Posted by cristina63303

Thanks everyone!

DH explained to DS how to stretch the skin a bit and he's back to a stream of urine, albeit thin. He does urinate, it just takes him longer than it used to.

I had a long talk with someone who knows more about this topic than anyone else on the planet (you all know who she is... isn't she AMAZING???) who, like Gillian, suspects yeast and suggested acidophilus culture.

I'll implement tomorrow and keep you guys posted.

I keep thinking about the fact that I'm SO CLEAR on this and would never consider circumcision. Now, most people are not quite there and how many in our situation have been chopped? Horrible. Unnecessary. It is really frustrating to have to be afraid of doctors... precisely the people who should be in charge of helping us!!!

This happened to my son when his foreskin had a yeast infection. It can also happen if there is any swelling during separation process. The foreskin opening will not shrink unless there is a wound that healed it closed. Like if he tore the opening and it healed closed. This would be rare and I would suspect separation inflammation or yeast inflammation to be much more likely. Here is a little thread I wrote about my son's experience:

http://www.mothering.com/discussions...ting+urination

[Ron_Low]

Originally Posted by cristina63303

It turns out the orifice in his prepuce has been shrinking to the point that he complains about pain when urinating. His urine stream was down to a thin thread a few days back and today it was only drops!!! I'm terrified to take him to the doctor here because I simply don't trust US doctors to be able to handle the situation without suggesting the c-word.

Again: circumcision is not an option.

Ballooning of the foreskin during urination can be a startling sensation if you're not used to it but it wouldn't usually be described as pain if everything was working right.

He's probably not too young to do manual preputial sphincter stretching for himself with a tool like the Glansie.

[eepster]

Originally Posted by cristina63303

I keep thinking about the fact that I'm SO CLEAR on this and would never consider circumcision. Now, most people are not quite there and how many in our situation have been chopped? Horrible. Unnecessary. It is really frustrating to have to be afraid of doctors... precisely the people who should be in charge of helping us!!!

It really is a sad state of affairs, when one clearly needs medical help, but fears to seek it b/c of the institutionalized ignorance of the US medical community.

Can you call your old Dr from Germany?

[proudmomof4]

Even with a doc from Germany you'd have to make sure he knows his stuff. Germany doesn't do RIC but still - some docs seem to think that circumcision is the only option with phimosis.

As a side thought, I'm always a bit surprised to read about "separation issues". That seems to be such a common topic here, yet I've never seen it discussed in German sources (where intact boys are the norm).

[brant31]

My immediate reaction to your original post was "does it hurt him to touch or squeeze the end of his foreskin, or is the issue just the narrowing?"

The reason I ask is that if he's not tender there when he's not trying to urinate, and not obviously red/inflamed, it most probably is not a bacterial infection. As Gillian and others have noted, it easily could be yeast which is corrected by getting his pH balance right and re-colonizing. Has he been eating a lot of sweets just prior to this?

The second thing I wondered was whether he stretches his foreskin. Not like a restoring adult, obviously, but most boys like to absentmindedly pull their foreskins forward. This natural reflex has the advantages of helping along the natural separation of foreskin and glans, and keeping the acroposthion loose and away from the glans. An overhanging foreskin is less likely to be tight than one whose opening continually presses up against the glans. To use just a few words from a well-circulated letter to The Lancet (a leading medical journal): "What looks like a pin point opening at 7 months will become a wide channel of communication at 17." In other words, it's not at all unusual for some boys to experience very narrow preputial openings at some time before or during puberty.

Nevertheless, be alert to other possibilities and especially keep an eye out for the signs of bacterial or simple yeast infections. Home remedies are fine for many conditions, but a doctor's visit may be indicated.

[mntnmom]

If you do go to a doc, insist they do a culture. It may take a while to come back, but if the cause isn't immediately obvious it may save time and prevent unnecessary antibiotics etc.
I knew a 6yr old here, whose German mom was convinced to have him, and his new baby brother circ'd for phimosis. I don't know if the doc was German or American, but sadly it does happen here too.

[cristina63303]

So, 5 months on, DS's infection is long gone and the crisis is over. HOWEVER, the balanitis left him with a very narrow preputial opening and significant ballooning.

Since there's no pain, I'm not immediately concerned, but I did take him to his old German ped two weeks ago. To my surprise he said "I wish I could tell you otherwise, but his foreskin is quite scarred and I honestly don't think it will be resolved without surgery. The tight ring is a scar and it will eventually need to be removed" Imagine my shock! He then said it did not have to be a full circumcision, but that only the scarred skin would eventually need to be removed, no rush, though.

Since I only had one day in Germany (I had just landed from USA and went straight to his office from the airport) he referred me to the children's surgery department at one of the best hospitals in the city. We drove straight there (talk about jetlag)

It was a very interesting meeting: we saw a female doctor and a male doctor. The male doctor said something to the effect of "what's that nonsense of a partial circumcision, just take the whole thing off". I BALKED. He left.

Now alone with the female doctor she said to me that the surgeons there call her and a few other female colleagues "the anti-circ clan" and she said she could not promise anything because it was indeed very scarred, but that she would not make any decision before trying the topical steroid treatment and gave me a prescription for the cream.

I've been trying to read everything I find on the topic, but as it tends to be the case with anything related to circumcision, it's difficult to trust advice, studies, etc.

DS is very disciplined about the treatment and both he and I are adamant that there's no need to cut anything off. I'm, however, still concerned because we still live in the US and I still don't trust anyone in the medical community about this issue.

I guess there really is no rush and he's ok with the ballooning. Just today he said to me that he's using the ballooning to help the skin stretch! I'm just very much afraid that this will cause him to have another balanitis which will further damage his foreskin.

And here's where you all come in: any advice on preventing this?

The theory and the explanation as to why the doctors believe the only solution is to cut is that, according to them, scarred tissue is not as elastic and will simply not stretch so he'll never be able to retract.

Now, I happen to have a scar on my face (dog bite) that I got at age 4. Well, it DID stretch and it grew with my face. So there.

Again: all you dear experts, any thoughts?

Please don't take this the wrong way: I can't believe that a group of strangers in an online forum inspires all the trust in the world on the topic of the genital integrity of my son and that almost no one I have met in person in the medical community comes close.

THANKS SO MUCH!!!

[MCatLvrMom2A&X]

His stretching is great. It very well may help the scar tissue to break down and resolve the issue without any other help. I personally still wouldnt do the cream at his age I would wait till he is in full on puberty before trying it.

I would encourage him to keep up the stretching as much as possible being sure to remind him to be gentle with things and not retract it farther than it will easily go because it could get stuck behind the glans if he pushes to hard. Oh and make sure he uses clean hands as well so there is no risk of infection.

[PuppyFluffer]

I think you wait and see. Scar tissue does indeed stretch some. It lacks the elasticity of non scarred skin, but it does indeed stretch some.
Retraction is a sexual function. The function of the penis currently is to allow the passage of urine. If that is being accomplished, I'd carry on without a worry.
As for the prevention of infection, I'd make sure his diet is healthy whole foods and little to no refined sugar and flour. An imbalance in our natural bacterial/yeast colony can cause the overgrowth of yeast and yeast feed on sugars.
It's interesting to me that the families who research things like vaccination and circumcision and decline these invasive things for their children are often the parents who focus on actively building health for them as opposed to assuming they are protected and feeding them processed refined foods. I think the path of education creates healthier people overall (in general).

[PlainandTall]

Cristina- There is a surgical cut called z-plasty ... it's actually a generic term for a way to expand flesh- I'm sure if you google it you can find a diagram- but basically- you make a cut longitudinally.... and then sew the edges together "wrong" so that the stitches wind up latitudinal... it's a way of taking the tension out of a ring of scar tissue without actually removing anything.

I'm glad your son has a great advocate like you and I'm sure that you will be able to resolve this in the most non-invasive way possible... phimosis DOES happen. It may be over diagnosed, and wrongly diagnosed, and it may be falsely diagnosed in order to get insurance coverage for elective circumcisions... but sadly- it does happen every once in a while.

By the way- my brother was born in Germany (not US mil. ... just in a little village in Germany) and he was circumcised as an infant at few months old because he allegedly had phimosis. This was over 50 years ago and my mother and father didn't know any better than to allow it. (I'm going to just go with my gut feeling that in my brother's case the diagnosis was totally unwarranted!) Just goes to show that you can't assume that every Dr. in Germany is conservative with the treatment.

[eepster]

Since the Dr said it wasn't an emergency, I would mostly go with the wait and see approach. If he still has issues when he is 15, then revisit the options.

As for avoiding more balanititis, just have him follow the advice women get to avoid vaginal infections. Don't use soap, just plain water. Rinse in plain water after swimming in chlorinated pools. Sleep without underwear. Eat yogurt or take probiotics. Wear plain white cotton underwear, not synthetics like polyester or nylon.

[hakunangovi]

Cristina - there is a thread on this page by a mother who did utilise steroid cream to cure preputial stenosis of her 5 year old. You may find it interesting.

If your son still has a problem after trying Betamethasone cream, and I am not necessarily advocating it's use at his current age, there are many surgical solutions that are no where near as invasive as circumcision and still preserve the foreskin. Take a look at www.circ.org/library/treatment/phimosis/ there are lots of references at the bottom of the page. You might also look at www.biomedcentral.com/1471-2490/8/6 which describes a more recent version of preputioplasty with what appear to be amazing results. I am sure that you will find something there to suit your situation.

Good for you in protecting your son. I applaud your efforts in resisting the advice from doctors to amputate. You have a lot more common sense than is common.