I’m writing this post anonymously because we’re a fairly observant Jewish family, and in that context, I’m very committed to protecting my son’s privacy until such time as he’s able to decide for himself with whom to discuss the issue of circumcision.
My hope is that in writing this post, I can offer more information about using steroid cream to treat “phimosis” in young boys, as well as reassurance to distressed moms. At times, in this forum, I’ve seen posters state that steroid cream should never be used with young boys, that it thins the foreskin (thereby making future adhesions more likely), and that even if it’s successful in loosening the foreskin, the foreskin will tighten up again post-treatment. None of these statements are supported by the research literature, as far as I know (and if anyone knows of any studies that do support those statements, please let me know). To the contrary, all the studies I’ve read suggest that steroid cream is a highly effective, non-invasive, non-surgical option in treating so-called “phimosis” in young boys.
(I’m putting “phimosis” in quotes because obviously, a tight, non-retractable foreskin is normal in young boys. As such, steroid cream should never be used to treat a tight foreskin in and of itself, because that’s not a medical problem – it’s normative. However, if the foreskin causes chronic medical problems, then – and only then – would the cream become appropriate.)
I really want to emphasize that, given my son’s level of distress and physical discomfort, if I hadn’t been reassured that steroid cream was an option with a high likelihood of success, or if I had been dissuaded from using the cream, I would have considered circumcision. I would have done anything to end my son’s pain and fear. I now believe that a significant percentage of childhood circumcisions performed for “medical reasons” are actually performed because the parents were inadequately informed about steroid cream (by similarly ill-informed physicians), were not prepared by their physician to give it an optimal chance for success, and were understandably upset by their child’s pain and anxiety. I’m hoping that this post might reach at least one mom who’s as scared and sad as I was, and let her know that she does not necessarily need to circ her little boy.
(1) First, there’s now a substantial number of empirical studies showing that steroid cream (usually in the form of Betamethasone 0.5) is a highly successful, low-cost, non-traumatic, non-surgical treatment for preputial stenosis in young boys. It works by accelerating the normal growth and expansion of the foreskin that occurs over several years. Follow-up studies conducted 3-5 years post-treatment have found no thinning of the skin, no increased incidence of adhesions, no return to a non-retractile state, and – in the majority of cases – no need for further or repeated applications. If you’re interested in the research, a good place to begin is this page: http://www.cirp.org/library/treatment/phimosis (the studies under “Topical Medication” are particularly helpful; the citations can lead you to other, similar studies).
(2) We had a very bad experience with the first physician we consulted. He gave us the cream with very few instructions, no information about success rates, and a few comments about circumcision being the only option if the cream failed. We were confused and devastated. We then had the incredible good fortune to be redirected to a different physician – another religious Jew, ironically, who we know from our community – who presented the cream in an entirely different light. He explained that the cream has an 85-95% success rate, and that the success rate could be even higher with uniformly correct application. He wisely advised us to “use the cream until it works.” The first physician had given us a 2-week time frame in which the cream might work; in contrast, our second physician stated that we needed to give it as much time as we could – up to 2 months prior to another medical consult - and he expressed every confidence that it would work. So please pass along the information to other parents that the cream has a very high probability of success if used in a reliable, consistent, thorough manner.
(3) We found that long, warm baths were helpful in alleviating pain and urinary discomfort. Soaking in a baking soda bath – one entire box of baking soda in the bath, with the child soaking for up to an hour and urinating while in the tub – was very reassuring to our son. Also, I made baking soda poultices by mixing a paste of baking soda and water, then spreading on 4”X4” gauze and placing against my son’s penis. Baking soda is helpful because it’s amphoteric, which means that it behaves as a base in acidic medium and as an acid in basic medium (in other words, it’s uniquely effective at balancing pH levels).
(4) Our first physician instructed us to apply the cream 2 times per day. We quickly found that was insufficient. For the first week, we applied the cream every time our son urinated. We would blot the tip of his foreskin with toilet paper, to remove any residual or "trapped" traces of urine (the source of his problem), and then apply the cream. Fortunately, our second doctor instructed us to USE GAUZE when applying the cream, or else it will immediately rub off on underwear or clothes. So we applied the cream, then placed a small piece of gauze as a barrier between our son’s penis and his underwear, to “hold” the cream in place. Also, don’t dab the cream on – really slather it on the penis, covering the entire tip liberally.
(5) The ultimate goal when using steroid cream is to get the cream under the foreskin, since that is where it will loosen the foreskin and correct the condition that’s causing the symptoms in the first place. Our son’s foreskin was so tight that we were initially unsuccessful in getting any cream into the foreskin. However, if this happens to you too, please do not give up on the cream. We had the following idea, which very quickly and successfully resolved our son’s symptoms:
Get a small syringe (just to be clear, you’re not going to use a syringe with a needle – THERE SHOULD BE NO NEEDLE ON THE SYRINGE. Instead, use an empty syringe, like one you would use to squirt food into a small animal’s mouth). Make sure that the syringe tip is clean (we wiped it down with an alcohol pad). Suck up steroid cream into the syringe. BALANCE (do not press) the syringe, very gently, against the tip of the foreskin. NEVER FORCE OR PUSH IT IN. You are NOT aiming to place the syringe under the foreskin, but rather to rest it lightly against the tip of the penis. You will be using NO strength or force – you will simply be balancing it (if your arm is tense at all, do not try this - wait until you’re loose and relaxed). Gently balancing the tip of the syringe against the tip of the penis (you might need to rest the tip of the penis and the tip of the syringe across your finger, in order to get them into close proximity), slowly press the syringe plunger. Due to the placement of the syringe tip, microscopic bits of cream should lodge in the very first part of the foreskin opening.
Our son experienced intense symptom relief almost immediately after we began this technique. Within one week, his foreskin was visibly, if minimally, looser. This slight increase in skin elasticity stopped the cycle that had caused the problem in the first place. We continued with the cream for one more week, just to complete the treatment, but all of his painful and distressing symptoms were gone.
Since that time, he has had no recurrence of symptoms, no re-tightening of his foreskin (which is loose enough to prevent medical problems, but not completely loose), no adhesions, and no other problems. After leaving our first doctor’s office convinced that we may be forced to circumcise our son in order to end his physical discomfort and anxiety, I was amazed to learn that a simple cream could do it, with great success, in 2 weeks, with full preservation of his foreskin.
I really, really want to get the word out that NOT EVERY DOCTOR IS AWARE of the success rates associated with steroid cream, or of the correct methods for application (including the amount of time potentially needed to see results). If your doctor seems unconvinced of the cream’s capacity to help your son, please seek a second opinion. If the cream does not work for you within a couple of weeks, please give it additional time, using the methods described here. As our second physician said, try to use the cream until it works. There is no reason for a physician to recommend circumcision before steroid cream (and, after that, dilation and stretching in conjunction with the cream) has been given a full opportunity to work.
Finally, please remember that just because your son may be having problems associated with preputial stenosis, that does not mean your initial decision not to circumcise was wrong. There is no reason to cut off healthy human tissue absent compelling medical need, and the vast majority of cases, steroid cream can easily and quickly resolve a child’s symptoms. Having been through this experience with my child, I can say that in the days following his initial diagnosis, I felt terribly guilty and completely responsible for his pain. I was very vulnerable during that time, and had a doctor or family members pressured me, I may well have consented to circumcision. Fortunately, I had the support of both my husband and our (second) physician, both of whom were reassuring and optimistic. It’s my belief that nonjudgmental support, accurate medical information, and a healthy dose of optimism can potentially avert an otherwise preventable circumcision allegedly performed for “medical reasons.”
I hope that this post was helpful.