4 year old has very swollen and painful penis

[green_momma2007]

I'm going to be taking him to the doctor tomorrow morning. I noticed that he was swollen yesterday and it hasn't gotten any better today. He seems to have a bit of a yeast infection on his scrotum and it's possible that it has spread. I tied squeezing the penis gently to see if any pus would come out, but it was hurting him real bad so I just let it be. I've never retracted him but his foreskin is still pretty tight (though a former pediatrician did forcibly retract him when he was around 8 months old).
Any ideas what this could be, if not a yeast infection?

[Quirky]

You could always put some anti-yeast meds or some plain yogurt on the penis to give him some relief -- it won't hurt anything if it's not yeast.

It could very well be separation irritation -- if his foreskin is starting to separate from the glans, that often occurs with redness, swelling, and pain. Baking soda baths and lots of nakey time can help, as well as letting him pee in a cup of warm water to minimize any stinging.

If he's running a fever or there's significant swelling all the way down the shaft, or you start to see any gross discharge (like pus), then he might have an infection.

But this age is a very common one to get separation irritation.

http://www.drmomma.org/2010/01/painf...g-prepuce.html

If you do end up taking him to the doctor, do NOT under any circumstances allow the doctor to manipulate the foreskin or attempt to pull it back even if he says he's going to do it gently -- there's simply nothing to see that will be diagnostic and he could harm your son. The only person to retract the foreskin should be your son as he can tell how far back it can go before it starts hurting.

Also, if the doctor wants to prescribe antibiotics, make sure he takes a culture to make sure it's actually a bacterial infection.

[tutucrazy]

I completely agree with the previous poster.

It could be normal separation, yeast or both. Sometimes yeast spurs on separation and the symptoms become much more aggravated. I highly doubt it is a bacterial infection as those are not common. You should also read these links carefully:

http://www.drmomma.org/2010/01/basic...act-child.html

http://www.drmomma.org/2010/01/basic...act-child.html

[MommytoB]

if you think he has yeast infection on his scrotum get some monistat/vagisil and put a dab of that on the scrotum and the tip of the foreskin for up to a few days and see if it gets better .

I was going to suggest seperation trauma too but with the mention of possible yeast on the scrotum makes me think maybe there is a chance it did spread .

If you do take your child to see the doctor make sure you only allow him to do 2 swabs bacteria/fungal at the tip of your son's foreskin .

It's a big No No to retract a foreskin that may possible have a infection a great way for infection to spread .

[RunnerDuck]

My son had what they dx'ed as balinitis (sp) around 3 years of age. Very red, very painful - he was crying - but cleared up very quickly with meds. Never happened again.

[green_momma2007]

Well,
I took him to the doctor, as he had pus when he wokr up this morning. But the swelling was down somewhat by the time the doc checked him out. He did take a swab to culture it in case it's resistant to the antibiotics that he gave him. He also have me to triple antibiotic to put on the tip of the penis and some lotrimin for the rash on his scrotum. Hopefully he'll start feeling better soon. I guess I just need to be more careful about washing his penis from now on.

[MyBoysBlue]

Careful how? Like stop washing it. Because you shouldn't be using soap or anything on his penis. I've never ever washed my son's penis since he's been out of diapers. Just sitting in clean water is enough. He did have one bout of pretty much exactly what you described. We just gave it 3 days and it cleared up on it's own with no creams or abx.

[green_momma2007]

Originally Posted by MyBoysBlue

Careful how? Like stop washing it. Because you shouldn't be using soap or anything on his penis. I've never ever washed my son's penis since he's been out of diapers. Just sitting in clean water is enough. He did have one bout of pretty much exactly what you described. We just gave it 3 days and it cleared up on it's own with no creams or abx.

Careful as in wash it and not leave it alone as they said, because quite frankly I've left it alone and he got an infection, and I certainly do not want him to go through that again. I dunno, maybe you all are right, but at this point I need to go with my gut feeling.

[Quirky]

Mama, it can be hard to feel like maybe something you've done or not done has caused your baby pain, but again, it could be very normal separation irritation and discharge and not a bacterial infection at all.

I saw that you mentioned on another thread that your doctor suggested circ. That tells me that your doctor isn't very informed about the intact penis and may have been prone to diagnose a bacterial infection because he is not used to seeing the normal developmental issues that can arise during separation. So I'm just saying, take the diagnosis with a grain of salt.

If the swelling is down you might consider holding off on the antibiotics for a day or so and see whether he truly needs them or whether in hindsight it was just separation irritation with some discharge.

Also you will need to keep an eye on the yeast because the antibiotics (esp. if he's taking oral antibiotics) may kill off the beneficial bacteria and actually make him more prone to yeast.


The penis, like the vagina, is self-cleaning -- there are beneficial bacteria and enzymes (lysozyme) with antibacterial activity inside the preputial space between the foreskin and the glans after separation occurs. Also, urine is sterile as it exits the body and really only a drop or so might remain behind. So unless he's rolling around naked in the dirt, he's really not going to get all that grubby inside his genitals in any way that requires a rigorous hygiene protocol or makes him more prone to bacterial infections.

Just as with women/girls, you need to be careful with washing so as not to upset the natural balance of bacteria and beneficial enzymes -- boys/intact men can get yeast infections from too much washing that upsets the pH levels and kills off beneficial bacteria, too. Soap can also cause irritation of the mucousal membranes of the glans and the inside of the foreskin. Think of your son's internal penis as being similar to the inside of your vagina and requiring the same kind of hygiene (i.e., plain water and very mild soap occasionally).

It's fine to encourage your son to retract as far as he can comfortably and swish in a bathtub of clean non-soapy water; but the best thing really is to think of your son's genitals just as you would your daughter's or your own and not think of the foreskin as a disease-prone ticking timebomb, which it really isn't!

I hope all is back to normal soon!

[green_momma2007]

Ok I've only given him one dose of the antibiotics. Is it ok if I hold off on giving him the rest or simply go ahead and give him the rest since I already started? I figured if there was pus that means there is an infection.

[MommytoB]

Who knows maybe your ds doesn't have an infection at all and your using abx for no reason at all . Hence did your doctor only do one culture if it was just for bacteria and it comes back negative you won't recieve a call. Abx with a yeast infection is not a good mix as in very bad .

Plus the swollen penis was subsiding before the doctor visit makes me lead to believe that it is seperation trauma .

My son's penis was really bright pinkish red all the way around the whole foreskin . Really Swollen all around the shaft part of the foreskin .

He complained it hurt bad and it obviously looked like it was very scary looking hence what I saw is proably what doctors would describe balantitis which is just a part of seperation proccess .

I put him in a lukewarm bath , put a little cream on his foreskin it was to relax the pain feeling , he went to sleep, still looked slightly swollen the next but the inflammatin color was gone.

After 48 hrs it was just like back to normal

Also, what seem to be mistaken as pus is actually smegma . Smegma can come out white thickish cottage cheese looking lumps, to be really like almost like a semen discharge but not as liquidy .

[MyBoysBlue]

If he's already on the mend I don't see how it would hurt to wait. You've only given him one dose. If it doesn't get better in the 2-3 days timeframe that most separation trauma episodes take then I would consider continuing the abx.

Have you tried the bath with baking soda in the water? Just encourage him to play with himself in the water, not that most boys need encouragement.

[green_momma2007]

We've decided to hold off on the antibiotics for two days. If it doesn't seem to be getting any better than we'll continue with it.

I have a question about the separation though. Alot of you mention that there is a discharge of smegma when this happens. It's clear to me that what my son had this morning was not smegma, but pus. It looked like vanilla pudding, and had a slightly yellowish/greenish tint to it, especially when it dried on my sons undies. So my question is, when it's this separation that everyone is talking about, is there actually pus coming out, or is it just smegma and some people confuse it with pus? Because it that's the case then my son definitely has an infection. Either way, I'm still going to wait it out a few days becauuse he seems to be getting better on his own. I am applying the neosporin and the lotrimin on the outside though.

[MyBoysBlue]

That is exactly what it looked like for my son. Vanilla pudding LOL good description.

Have you read the Possible Seperation Issues/Pain/Sore/Red/Irritated/Ballooning/Normal Development,etc. thread?

[MCatLvrMom2A&X]

The smegma can be white, yellow, green, yellow mixed with any of the other colors and sometimes even a bit of blood. Smegma can indeed look like vanilla pudding or it can be hard. Or anything in between.

Not being able to see your ds we cannot diagonse which it was but by him getting better on his own I would bet $ that it was not pus but smegma you saw.

Infections happen but there are things we can do to make it less likely number one being leaving the penis along so that the body can do what it was meant to do without interferance. Please read the thread that MyBoysBlue has in her post it has a ton of information in it that can be very helpful.

When my ds was around 2 he had a bacterial infection his penis swelled to 5x's it normal size (not kidding it was the size of his wrist) the discharge he had was a watery yellowish color. But after the infection cleared up he had some seperation happen and the stuff that came out was like vanilla pudding (good discription by the way) with a funky odor and yellowish green in color. It was smegma that was released due to him seperating after the infection.

It is VERY easy to confuse pus with smegma in a newly seperating foreskin because the smegma has been trapped so long that it gets a bit funky.

I hope your ds continues to improve.

[MCatLvrMom2A&X]

Please keep us updated on your ds OP.

[glongley]

Originally Posted by green_momma2007

Well,
I guess I just need to be more careful about washing his penis from now on.

Agree with other posters that over cleaning, especially with soap can cause more problems. There is one study in particular that showed increased balanitis with excessive soap use (Search for Birley at cirp.org). Anyway, if he's not retractable, what's to clean? You certainly don't want to be trying to retract an unretractable foreskin or trying to dig around underneath. If he's not retractable, really just washing off the outside with water should be quite sufficient for cleanliness.

One thing you might consider though is focusing more on handwashing for him, especially if he plays with or manipulates his foreskin a lot. Little boys can sometimes have grubby hands. They may also touch the anal area and then transfer those germs to the foreskin. Also, again if he handles his foreskin a lot, paying attention to keeping his nails trimmed is a good preventative idea.

BTW, frequent warm tub soaks or sitz baths can be good with foreskin irritations or swelling, as the warmth brings in circulation which can hasten healing.

Sounds like he's on the mend. Best wishes!

Gillian

[green_momma2007]

Originally Posted by glongley

Agree with other posters that over cleaning, especially with soap can cause more problems. There is one study in particular that showed increased balanitis with excessive soap use (Search for Birley at cirp.org). Anyway, if he's not retractable, what's to clean? You certainly don't want to be trying to retract an unretractable foreskin or trying to dig around underneath. If he's not retractable, really just washing off the outside with water should be quite sufficient for cleanliness.

One thing you might consider though is focusing more on handwashing for him, especially if he plays with or manipulates his foreskin a lot. Little boys can sometimes have grubby hands. They may also touch the anal area and then transfer those germs to the foreskin. Also, again if he handles his foreskin a lot, paying attention to keeping his nails trimmed is a good preventative idea.

BTW, frequent warm tub soaks or sitz baths can be good with foreskin irritations or swelling, as the warmth brings in circulation which can hasten healing.

Sounds like he's on the mend. Best wishes!

Gillian

Your post really resonated with me, because Jeremy sure plays with his penis a lot. In fact, I'm always running after him with undies because he loves to walk around naked (for easier access I guess). So I'll definitely keep that in mind. Thanks for all the support ladies!

[trini mamma]

HI ladies i'm a 23 year old mom of 3 my son is 5 and he is having the same problem do i need to take him to the doctor or can u give me some ideas on how to wash it and make it better i really don't want then cut it please help..

[MCatLvrMom2A&X]

Wash like a finger never retract and never allow any one else to do so. Infection is never a reason to circ unless he has gangrene so dont worry about that.

Here is a thread you should read http://www.mothering.com/discussions/showthread.php?t=764732 it might help you decide if it is an infection or just separation.