Question for a friend....yikes...

[SlingMomEsq]

Putting this here because you guys would know!

Circ'd boy...about two.... his mom just called me and asked if it was normal if there is something like dried puss in his penis when she retracts it all the way back to clean. Help! I had no IDEA!

Are you even supposed to fold down what sides are left over in a circ'd penis to even clean like that at his age?

She says she only notiuces it and it only hurts him when she cleans vigorously there. Yikes...!

She is going to take him to the ER but is wondering if it is his foreskin trying to reattach or something she should be worried about.

I just have no idea whatsoever but told her I would post where the experts are (she can't..she is on vacation...which means she would take him to someone not his doctor) and I would call her with what you said.

Thanks!

[eepster]

Sounds like smegma. I certainly wouldn't go to the ER over what is most likely smegma.

If it hurts to clean "vigorously" (I'm pretty sure it would hurt me to clean my genitals vigorously) then I would change to cleaning them gently.

[Anastasiya]

I agree that it's smegma. An ER visit for that seems over the top.
Smegma will accumulate in folds in the genitals....girls, boys, intact, circumcised. If there's a fold that doesn't get exposed much or cleaned much, there will be smegma (dead skin cells and oils).

She shouldn't be cleaning it that roughly.

Poor kid.

[fruitful womb]

I don't know, even at age two the glans are still pretty vulnerable. Remember, the average age for natural full separation of an intact prepuce organ is 10.5yrs. Its not normal for the glans to be exposed at that age. Its not meant to be an external organ. Its meant to be protected, an internal organ.

I'm inclined to believe the synechia is trying to rebuild itself.

Premature separation from the glans when it isn't fully developed can cause infections, scar tissue, abnormal adhesion and skin bridges.

Didn't the AAP warn against lysing remnants of the prepuce organ?

[PlainandTall]

I think it's probably just smegma. I wouldn't worry about it if I was her unless he was in pain.

After a boy has been circumcised, the "game plan" about cleaning changes radically from the care of an intact child.

1. The synechea never regrows- that's a once in a lifetime fetal detail. After that has been destroyed (circumcision will do that) it will never come back- which is why the normal adhesions on an intact child that have never been disturbed are NOT the same thing as the re-grown adhesions of a circumcised child with a skin fold. There is no agreement on how post-circumcision adhesions should be managed- but if they exist- they should be monitored to be sure they do not involve the scar line.

2. The circumcised child has scar tissue somewhere in that skin fold- scar tissue is known to grow in unpredictable ways and attach to and through the surface of the glans- sometimes causing skin bridges that will not come apart without surgery. Preventative care to be sure the skin bridges and adhesions don't form is the standard of care for circumcised children. I think if this mama feels that the cleaning is causing pain to her son, that she needs to figure out another way to do it - I would suggest only at bath time to make sure the skin is relaxed and the debris is soft and ready to rinse away. I'm sure that his glans is sensitive and diaper wipes and abrasion probably are very uncomfortable to him.

3. The tip of the foreskin keeps diaper mess and debris OUT of the deeper recesses of the penis. If you cut that off- the child's penis is no longer a self cleaning organ- now you have a skin fold and the coronal groove that can hold debris that worked its way in from outside the penis- but you don't have the protective "gateway" that would have kept that stuff out.

[fruitful womb]

Originally Posted by PlainandTall

I think it's probably just smegma. I wouldn't worry about it if I was her unless he was in pain.

After a boy has been circumcised, the "game plan" about cleaning changes radically from the care of an intact child.

1. The synechea never regrows- that's a once in a lifetime fetal detail. After that has been destroyed (circumcision will do that) it will never come back- which is why the normal adhesions on an intact child that have never been disturbed are NOT the same thing as the re-grown adhesions of a circumcised child with a skin fold. There is no agreement on how post-circumcision adhesions should be managed- but if they exist- they should be monitored to be sure they do not involve the scar line.

2. The circumcised child has scar tissue somewhere in that skin fold- scar tissue is known to grow in unpredictable ways and attach to and through the surface of the glans- sometimes causing skin bridges that will not come apart without surgery. Preventative care to be sure the skin bridges and adhesions don't form is the standard of care for circumcised children. I think if this mama feels that the cleaning is causing pain to her son, that she needs to figure out another way to do it - I would suggest only at bath time to make sure the skin is relaxed and the debris is soft and ready to rinse away. I'm sure that his glans is sensitive and diaper wipes and abrasion probably are very uncomfortable to him.

3. The tip of the foreskin keeps diaper mess and debris OUT of the deeper recesses of the penis. If you cut that off- the child's penis is no longer a self cleaning organ- now you have a skin fold and the coronal groove that can hold debris that worked its way in from outside the penis- but you don't have the protective "gateway" that would have kept that stuff out.

I knew that!