Thank you all so much (((hug)))
I've calmed down a bit and reminded myself that although these doctors have hurt him with their "exams" I have NOT ever retracted his foreskin or taken any of their advice, and chances are he will be fine as long as I continue what I'm doing.
I have a plan in place.
I'm giving every doctor information before each and every appointment from here on out. I'm also faxing the NP we saw information, and I'm sending his urologist a letter.
IT WILL NOT HAPPEN AGAIN! and I am completely confident in this, for the first time ever, and you helped me get here. thanks again
Here's the letter I will be sending the urologist in case any of you are interested. Be sure to let me know if I left anything important out, or there is something that needs to be edited.
In light of the my son's injury, bad medical advice, false information and bogus diagnoses of phimosis my son received on our last visit with you.* I feel I need to at least try to educate you, and possibly others who happen to read this as well.*
There is absolutely nothing wrong with my son's penis.* If when he starts to mature into an adult and he has any issues at all (and we won't know for sure until then) it will be because of uninformed medical professionals like you, and many many other professionals that we have met throughout his life.* His penis is intact and whole as nature intended.* This does not mean that there is anything wrong.* I realize that circumcision is performed more than not in this country, and because of that, most medical professionals are ignorant to how foreskin works and what it's function is.* They just are not as familiar with penises that are left intact as they are circumcised penises, and I understand this fact.* In no way does this take away from your credibility as a professional in my eyes, and you are by far the best urologist we have met to date and I have the utmost respect for you and the way you practice.*
Most likely the cause of Eric's occasional stinging while urinating, is not because he has normally functioning foreskin, but because of his Hypercalciuria and Hypocituria, combined with lengthy periods of mild to moderate dehydration since infancy that escalates during times of illness and unwellness.* Possibly the fact that he has passed 3 small stones in the past (possibly more), has been painfully catheterized, and has concentrated tiny crystals passing through his urine almost on a daily basis, would all be a better conclusion to come to as to why it sometimes stings when he urinates, rather than "phimosis".
At our last visit with you you unnecessarily retracted my son's foreskin and it took well over a month for his penis to heal from the experience.* The tip of his foreskin eventually cracked and bled, and remained red, irritated, and sore for quite some time.* I'm hoping that no scar tissue will form.* Luckily I know what to do to help him as this has unfortunately happened to him countless times in his short life, and I will not let it happen again.
You as his physician needed to examine my son's penis to check for structural abnormalities, and also because he complained of stinging upon urination, but it could have been done in a less harmful way.* I no longer see the need for you to examine my son's penis other than to look at it's outer surfaces that are already exposed, without manipulation.* We already know it functions properly, and he has no structural abnormalities. There's no reason to look "inside".* If you for some reason feel you need to see his urethral opening, Eric and Eric alone will retract his foreskin enough to see the opening.* Only he knows how far it can be retracted without pain or doing him harm.* If you retract his foreskin again I will be forced to take legal action.
As more parents opt out of the unnecessary procedure that circumcision is, more medical professionals will need to no how to correctly "care" for a boy who is left intact.
The following is information I have put together in hopes to educate, and keep not only my son but other boys unharmed as well.The Foreskin
Our bodies are covered with skin. The skin on our noses goes to their tips and the skin on our fingers and toes goes to their tips. The penis, too, is covered with skin. The fold of skin that covers and protects the glans (head) of the penis is sometimes called the prepuce, but is more commonly known as the foreskin.
The inside fold of the foreskin is mucous membrane and keeps the surface of the glans soft, moist and sensitive.
The foreskin contains a concentrated number of blood vessels and nerve endings. The frenum which secures the foreskin in its forward position, is continous with the frenar band. This band of specialized tissue encircles the foreskin where the inside and outside folds meet (at the mucocutaneous junction) and is extremely sensitive.Care
The intact penis of an infant or child needs no special care.
The foreskin should never be pulled back during infancy or young childhood. If the foreskin is prematurely retracted, pain, bleeding, and scarring can result.
During the first few years of life, the foreskin and glans are connected by a common membrane called the synechia (just as the fingernail is attached to the finger). This connective tissue dissolves naturally - a process that should never be hurried.
The foreskin can be retracted when its inside surface separates from the glans and the opening widens with the aid of hormones produced at puberty. This usually happens by age 18. Even if the glans and foreskin separate naturally in infancy, the foreskin still may not be retractable because the opening in an infant's or child's foreskin may be just large enough for the passage of urine and not wide enough to expose the glands.
The white emollient under the child's foreskin is called smegma. Smegma is probably the most misunderstood, most unjustifiably maligned substance in nature. Smegma is clean, not dirty, and is beneficial and necessary. It moisturizes the glans and keeps it smooth, soft, and supple. Its antibacterial and antiviral properties keep the penis clean and healthy.
Studies suggest that it is best not to use soap on the glans or inner foreskin.
Retracting and washing a young child or infant's foreskin destroys the beneficial bacterial flora that protect the penis from harmful germs and can lead to irritation and infection. The best way to care for a child's intact penis is to leave it alone. After puberty, males can gently rinse their glans and foreskin with warm water, according to their own self-determined needs.Timetable for foreskin retraction
The prepuce is normally not retractile at birth. The ventral surface of the foreskin is naturally fused to the glans of the penis. At age 6 years, 80 percent of boys still do not have a fully retractile foreskin. By age 18 years, however, 97 to 99 percent of uncircumcised males have a fully retractile foreskin.
The only person to retract a child's foreskin should be the child himself. Once a boy discovers that his foreskin is retractable, he can easily learn to care for himself.Answers to common QuestionsWhat causes my son's foreskin to be red?
Sometimes the tip of the foreskin becomes reddened. This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive glans and urinary meatus (the opening for the passage of urine and semen).
When bacteria in the feces react with urine, they produce ammonia, which burns the skin and causes ammoniacal dermatitis, commonly known as diaper rash.
Common reasons for a reddened foreskin are:
•Too much exposure to soiled diapers
•An inbalance of skin bacteria caused by:
◦-too many bubble baths
◦-swimming in highly clorinated water
◦-soap on the genitals
◦-laundry soap or detergent on clothing
◦-antibiotic therapy (microbial flora can be restored by eating yogurt with live culture.)
•Concentrated urine because the boy is not drinking enough water.
Drinking water, soaking in warm baths, and letting children run around with bare bottoms to air their genitals helps healing.What is the white lump under my son's foreskin?
The white lump is made up of the cells that once attached the foreskin to the glans. As new cells form on the glans and the foreskin's inside fold, old cells form pockets that eventually work their way to the tip of the foreskin, where they are discharged and can eventually be wiped away. The space they occupied becomes the preputial space between the foreskin and the glans. So, if you see a white lump under the foreskin you know that the separation of the glans is occurring naturally.Would my son's foreskin need to be retracted if he were catheterized for a urinalysis or medical treatment?
No. A catheter can be inserted when the foreskin is retracted just enough to see the meatus (urinary opening). if the foreskin's opening is too small to retract far enough to see the meatus, a catheter can be inserted through the foreskin's opening and into the meatus "by feel." The foreskin should never be retracted for any reason.What is phimosis?
The Greek word phimosis means muzzled and is used -- often incorrectly -- to refer to a foreskin that cannot be retracted (for whatever reason). What parents and doctors should know is that almost all babies have non-retractable foreskins, that this is normal, and that the foreskins of most males become retractable by the time they are 18. It is also important to know that many adult males with non-retractable foreskins are perfectly happy with them that way. Adult males with non-retractable foreskins who would rather their foreskins were retractable can easily and safely stretch their foreskin opening until it is large enough to slip comfortably over their glans. A non-retractable foreskin is not, in itself, an indication for circumcision or medical intervention.
Phimosis is often used as a diagnosis when a doctor does not understand that the child's foreskin is supposed to be long, narrow, attached to the glans, and resistant to retraction. Some doctors are prescribing steroid creams for phimosis, but this is unnecessary in children, since the foreskin does not need to be retractable in young boys. The hormones of puberty will do the same thing at the appropriate time that a steroid cream is doing prematurely. In adults who still have a foreskin that is attached to the glans or a foreskin with such a narrow opening that the glans cannot easily pass through it, steroid creams are a conservative therapy. This is if the adult wants a foreskin that fully retracts. Many males don't, preferring a foreskin that remains securely over the glans. It is purely a matter of personal choice, one that only each male can decide for himself.Why does my son's foreskin "balloon" when he urinates?
Ballooning of the foreskin is considered to be a sign that separation of the foreskin from the underlying glans penis is proceeding normally. It is not a cause for concern. Ballooning is a normal stage of development. Ballooning will stop when the opening of the foreskin enlarges with normal growth and development over a period of time.What happens if someone retracts my son's foreskin prematurely?
Retracting the foreskin back can cause pain, as well as problems.
Tearing the foreskin from the glans leaves an open wound which can lead to infection.
Raw surfaces touching each other can heal together and form adhesions between the foreskin and the glans.
Small tears in the opening of the foreskin can heal to form non-elastic scar tissue, possibly causing acquired phimosis.
If retracted past the glands, the foreskin can get "stuck" behind the glans (paraphimosis). By squeezing the glans, the foreskin can be brought forward again, without circumcision.What should I do if my son's foreskin is retracted?
Regardless of your son's age, first explain that you didn't know anyone would do that to him, apologize, and tell him you will do your best to make sure no one ever does that to him again.
If your son's penis is swollen, sitz baths will help relieve the swelling and discomfort.
If it hurts your son to urinate, put him in the bath several times a day so that his urine will be diluted by the bath water, then rinse him off. Do not use soap on his penis.
Even if you have been told to retract your son's foreskin, don't. He has been hurt and traumatized and his penis needs to be left alone to heal.
Watch for infection. If infection is suspected the tip of the foreskin should be swabbed to determine if it's bacterial or fungal, and appropriate treatment applied.
Your son may develop adhesions when his foreskin and glans heal but you might not know whether these have separated by themselves or will need to be separated surgically until he has completed puberty.
No one except your son should manipulate his penis to check for adhesions or to see how far his foreskin will retract. A narrow foreskin deserves the same respect as a tight hymen. Both openings will enlarge with sexual maturity.How do I teach my son to wash?
When a boy is old enough to bathe himself, he can wash his penis just as he washes any other part of his body.
When a young boy pulls at his foreskin, he usually pulls it outward. This is normal and natural and no cause for concern; he won't hurt himself. One day, he'll pull his foreskin back, and you can discuss retracting, washing, and returning the foreskin to its forward position over the glans. Telling your son about retractablility beforehand will keep him from becoming alarmed the first time his foreskin retracts.
At puberty, you can let him know that with hormonal activity comes new responsibility, including genital hygiene.
In short, leave it alone.
In case you feel it's diagnostically necessary to examine inside the foreskin of your patients even after reading the information I have given you, please change your way of doing it and try this method first.
If foreskin is grasped with both index fingers and thumbs on either side
and pulled upward the true size of the opening is apparent, and if the opening is large enough you can even get a peak at the glands this way all without hurting, scaring, opening up the chance for foreskin infection, or emotionally scaring a child.
(I also added the diagram from this article http://www.cirp.org/library/normal/catzel/