Very confused...need help!

[jbarr]

My is turning 4 this month, in the fall (october-ish) he started getting really upset when he had to pee. He said it hurt alot, it was a bit red. He wouldn't go to the bathroom on his own, he wanted us to go with him so he could squeeze our hands. When he would go there would be ballooning, and you could tell he was trying to go just a bit at a time, I'm assuming that when his foreskin ballooned, before the urine came out it was causing the pain. Getting an appointment with our family dr is tough, so we went to a walk in clinic, the dr there didn't know what the problem or 'protocol' was, so he called a uroligist and called me the next day. We were given betamethasone and told to apply it 2 times a day for 6 weeks, if there was no improvement we were to make an appt with our family dr. There was no improvement, he still complained about it from time to time. Family dr reffered us to a uroligist. I was just there on monday, he looked, said it was very tight and that he thought a circumcision should be done, and he said he didn't want it to go on more that 6 more weeks. I was in shock. I cancelled it. I've been researching to no end, finding contradicting info everywhere. We can see a scar line, where the opening used to be. It literally is a pinhole, is this something that will eventually loosen? I know we're not suposed to be trying to retract, we just put the cream on the opening. Should we even be doing that? My son has sensory issues and I worry about causing him more issues. The uroligist said that with the scaring on the outside that he was concerned about scaring underneath as well? The whole situation just makes me want to cry. I want to leave it, seeing as it doesnt seem to be bothering him now...but at the same time I have no idea if it is even a problem? He will try to pull it back himself, and when he does you can't see the glans at all, just the little pinhole, with a line of scar beside it.

[Night_Nurse]

It sounds like normal separation issues to me and it should resolve on it's own.
There is a "sticky" post at the top of this forum, I think it's called "TAC Resources" or something like that. Please read through it, including the post about separation - http://www.mothering.com/discussions....php?t=764732?

As long as your son is urinating, his penis is doing what it's supposed to do. Some boys experience a bit of pain when the urine hits under the foreskin when the separation occurs, some don't. If it bothers him, you can have him urinate in the bath or in a cup of warm water to dilute the urine.

Are you in the US? If so, most US doctors aren't up to date on proper foreskin anatomy and function so parents often get poor advice. I hate to sound cynical, but urologists get paid for treating "problems" and they get big bucks for performing circumcisions. So naturally, they always recommend them.

I'm very tired and I can't address all your questions before bed but rest assured, many will chime in and offer helpful advice.

As far as the cream goes, some recommend it, some don't. To me personally, I would forgo it as your son is young and you mentioned sensory issues. I would bet his foreskin will open back up and retract as it's supposed to in given time.

Good luck!

[hakunangovi]

I agree with 'night nurse' that your son was most lkely experiencing "separation trauma". Once the synecchia bonding his foreskin to his glans have all released he should not feel any more discomfort. The opening to his foreskin will widen with time. Balooning with peeing is perfectly normal and will disappear once his opening gets wider, which may not happen until puberty.

Should his foreskin still be tight AFTER PUBERTY, there are many remedies that do not include amputation. See www.cirp.org/library/treatment/phimosis/ . I also saw a paper on a procedure that had ben utilised in Europe: www.biomedcentral.com/1471-2490/8/6 . Take a look at the pictures - the results are amazing. The child featured went from having a pinhole opening, as you describe your son's, to a fully retractable foreskin.

There is absolutely no reason for a boy to loose his foreskin.

[MCatLvrMom2A&X]

stay away from the steroid cream it is meant for boys in their teens or adults not young children. At his age once you stop using it the effects will wear off and you will be right back where you started.

The urologist is not right about needing circ. the only true reasons for circ are frostbite, gangrene and cancer.

Your ds needs a culture of the tip of his penis to see if yeast or bacteria are present. It is a very simple thing to do and might just be the answer to the pain and extremely tight opening.

He will try to pull it back himself, and when he does you can't see the glans at all, just the little pinhole, with a line of scar beside it.

That isnt a scar that is the sphincter doing its job. The tip of the foreskin has a sphincter like the anus it only releases to allow the urine to come out and closes down tight to prevent germs and stuff from getting up in there.

[Greg B]

It sounds like your doctors are ill informed and clueless about foreskins. What would be causing scarring at this point? Doesn't make sense. Why prescribe steriod ointment for a 4 yeras old, when many foreskins do not even become retractible until the teens? Doesn't make sense. Why worry about resolving this in 6 weeks, when he is peeing fine? Doesn't make sense.

Many doctors in the US are clueless about the proper foreskin care and development. Until you are sure you have a doctor that is not clueless, I would go for other opinions. Circumcision is most likely the wrong treatment at this point.

You might try reading the material at Doctors Opposing Circumcsion. they may even be able to refer you, not sure:

http://www.doctorsopposingcircumcision.org/

Be an informed and active part of the medical team. Your doctors, unfortunately do not sound like they have kept up with their education.

Best wishes

[beru]

Does someone have Marilyn Milos' email? (She is easy to find on facebook and I have messaged her there.) She is so knowledgable and could possibly recommend a doctor for you. If your son is not in pain right now and urinates effectively then take your time finding info. Perhaps you won't feel comfortable until a trustworthy, knowledgeable heathcare professional examines your son in person. Finally, a last resort surgery would be prepuplasty not circumcision.

[MCatLvrMom2A&X]

NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
[e-mail]
Phone: [phone]
Fax: [phone]
www.nocirc.org

From what I have read here she is very willing to help anyone who contacts her

[jbarr]

Thanks for the advice. I am in Canada, not the US, not sure what kind of difference that makes...

I guess my dr is ill informed, he was talking to me about how he was happy that some american health journals are now saying that circ is uncessecary. I am suprised at this as he sits on the board of pediatrics here, and does teaching and seminars across Canada for developing hospital protocols. Maybe he is more labour and delivery.

Anyways, for the sphincter at the end of his foreskin, I understand that concept, but there is a sealed shut line, the same as a scar on my finger from a cut. It is not raised at this point, but the opening used to be there. Now the opening is at the very side rather than the whole 'line'. Its as if it was 'squished' flat and then got stuck there.

I'm happy to have found some useful info here, I registered because I couldn't find a whole lot of info, most seemed contradicting; even on the same website, in the same articles.

Thanks again, and I will check out those links...keep any advice coming!!

[jbarr]

I meant to add, that the photo of the pinhole opening, is pretty much exactly what it looks like

[glongley]

I wouldn't be concerned about the size of the opening per se. There is a circular arrangement of muscle at the tip of the foreskin that tightens down to keep it closed in between voids. If a doc tries to examine the opening by pushing the foreskin back toward the body, the sphincter will resist and will make the opening look impossibly, and falsely, small. Here is a brief journal commentary about this issue, which suggests that this false examination impression can be avoided by pulling the lips of the foreskin away from the body when examining. http://www.cirp.org/library/normal/catzel/

The other factor in tightness of the opening is that the foreskin opening in a child is more inelastic than it will eventually be in the adult. There are literally more elastic fibers in the adult - this developmental change takes place naturally with time. It is not something that indicates a need for surgical intervention unless it persists in adulthood AND causes the person problems one way or another.

My older son had an opening that was just about the size of a pinhead till he was 8 years old. The only problem this caused him was sometimes peeing in funny directions. Then when he was 8, the opening started quickly becoming looser and looser, and almost over night he became quickly retractable. So the small opening DOES take care of itself.

Stinging with urination can mean that some separation is going on underneath, leaving the newly exposed glans or inner foreskin a bit raw for a few days. He could also have a low grade yeast infection which could cause stinging when urine gets on the inflammed tissue (Applying acidophlilus liquid or OTC Yeast medicine can help with this). Or he may have played with the foreskin a little too forcefully, leading to some micro-tearing. Peeing in a cup of warm water tends to dilute the urine and lessen the stinging.

Also, ballooning is a totally normal phase in the separation of the foreskin that some boys get, and requires NO treatment.

Without being able to see it, I am not sure about what you are describing as a scar line. Unless he has had multiple repeat rampant infections, it's probably not really a scar, rather some other non-pathological variation in the tissue. BTW, the shape of the foreskin outlet can change over development as things loosen underneath on one side or another, so something that was centered and round can shift to the side a bit or become distorted in shape.

As everyone else has said, and especiallly since he's not having any problems right now, as long as he can pee fine (i.e. no just drops), he's should be just fine, and you can sit back and just know that his foreskin will develop normally in its own good time.

Please read "Protect Your Uncircumcised Son" by Paul Fleiss MD, foreskin-friendly pediatrician extraordinaire. He goes over all the reasons why a doctor might sometime say and intact boy needs to be circumcised, and why it's almost never true.
http://www.mothering.com/health/prot...advice-parents

Good luck and keep asking questions. There is lots of experience, good info, and emotional support to be had here.

Gillian

[MyBoysBlue]

I'm wondering if the scar you are seeing is actually the raphe line.

[PuppyFluffer]

I love the function of the foreskin video that Doctor's Opposing Circumcsion have made. It really tells so much about the foreskin. After watching it, one has a solid sense of how the foreskin functions and why it is valuable. This info can really help you to see the value in remaining intact. This doesn't relate to your specific situation but I think it's important stuff to know.

I think the above posters are right on with their advice. Please let us know how things go.

[trailblazerbarbie]

really stupid questions about penis in general...

I am having my third child, first little boy in April. I have decided to NOT circumcise, however I'm a bit confused about what some of the actual parts of the penis are. I've certainly heard of the foreskin and glans but not having my own penis I've never paid much attention! Where can I find out (a diagram or chart would be great) that literally points to what each part is. I just ask b/c I understand your not supposed to retract ( I could use help with how one would do this as well?) and cleaning it just like a finger but any further insight would be greatly appreciated!

I meant to post this as a new thread...so mods please feel free to move it, or if anyone has any help in this post that would be great!

[trailblazerbarbie]

As an aside note, is there a place I can go to find intact friendly peds in my area...I have no idea how our pediatrician feels about circumcision as I only have girls at the moment, but I would love to know how to find one in case our current ped isn't as favorable.

[MCatLvrMom2A&X]

Here is a link that shows the foreskin moving and the anatomy. Actual pictures of the intact penis so be warned. http://www.noharmm.org/anatomy.htm

[KGB]

Originally Posted by trailblazerbarbie

Where can I find out (a diagram or chart would be great) that literally points to what each part is.

This video is very descriptive about the anatomy of the foreskin (prepuce):
http://www.doctorsopposingcircumcisi...o/prepuce.html