Doctor retracted at 4 month visit

[PeterJ]

Hi everyone,

I took my intact son for his four month checkup last Friday.  I mentioned to him that when bathing, his foreskin still appears to be very tight, and if this was ok.  I should add that I have never retracted or used any force on his foreskin.  Up until then, the doctor's advice had been "just pull on it a little bit, not too much".  When I found that I couldn't pull on it at all, this is what led to me asking the doctor about it.

The doctor then proceeded to tell me that when they circumcise, the foreskin is fully retracted, so doing it now is the same thing.  I have since learned that obviously a circ removes the skin, whereas a forced retraction on an intact penis can cause adhesions to form.  So my son's foreskin was fully retracted, and the doctor told me everything looked fine.  I didn't really think too much about it until I noticed that it was slightly red and inflamed at the end.  This led me to googling, reading all of the info about this and basically obesessively worrying that I have allowed my son to be harmed.

I'm very confused that the Pediatrician did this because he was trained in England, where circ rates are very low.  You would think that he would know how to handle an intact penis.

I'm really interested in hearing from parents who have had this experience.  Specifically how they cared for the penis in the months/years afterward and if there were any problems or infections following the retraction, and if the foreskin naturally separated after the forced retraction, and when.

I am thinking of switching Pediatricians and getting a referral to a urologist, just to check that everything is ok.

Thanks you so much in advance for all help and guidance.

Peter

[MCatLvrMom2A&X]

No need to see a urologist because they are just as likely to hurt your ds. One time retraction isnt a problem but you should take steps to insure it never happens again, whether finding a new ped. or keeping this one and not allowing him to touch your ds's penis again.

What he did was against all the up to date intact care instructions out there. The tip of the foreskin is a sphincter and like the anus when not in use it clamps down so the size of the opening dosnt matter because it changes to allow urine to flow.

The only one to ever stretch/mess with the foreskin is the owner of the penis so lightly pulling on it is as much a as pushing it back is because there is no need and it is potentially damaging.

[Lauren82]

My son just had a tiny little pinhole of an opening which was barely noticeable unless he was peeing. At 8 years old he still cannot fully retract and that is a normal variation. Some boys wont fully retract until puberty or later. I'm so glad you looked up information. I think your son will be just fine but I would not allow a doctor to touch his penis again.

[shanniesue2]

DS was forcibly retracted at least once that I know of... probably twice.  About a year and a half ago, DS had to have open heart surgery to repair a major hole... they were going to have to cath him for the surgery, and I asked them not to retract him for the cath.  They were very adamant about it, and honestly, in the grand scheme of things, these are two of the best pediatric heart surgeons in the world, and I chose not to make a big issue of the retraction because I felt that that issue paled in comparison to the heart defect that needed repair.  So, DH was retracted and cleaned for the cath, and about a week after coming home, he did have some pain on urination... but other than that, he hasn't had any problems.  He is currently in the separation process (without any other force applied by anyone but him)... has some ballooning, and for a while a couple months ago, he complained once or twice that his penis hurt.  But that's it.

My understanding is that a one time forced retraction (while it isn't something I would ever recommend) probably isn't going to cause permanent damage.  I think that you can probably just chalk this up to a lesson learned and try to relax about.

[Lauren82]

I just came across this excellent article that is applicable to your situation:

http://www.savingpenises.org/1/post/2010/07/only-clean-what-is-seen-reversing-the-epidemic-of-forcible-retraction.html

How is your son doing?

[PeterJ]

My son is doing fine at this point - and I must thank everyone so much for their replies, advice and guidance on this issue.  There just appears to be a lot of contradictory views regarding this issue - with the medical community on one side and the anti circumcision groups (that I know includes many doctors too) on the other.  This makes for a very confusing situation, where parents feel entirely lost about what to do or which medical professional to trust. 

I am obviously against circumcision, as I see it as an unecessary medical procedure.  I am also very concious that literature used by anti-circ groups tends to present the worst case scenario, in an effort to persuade parents who might be on the fence to 'leave it alone.'  Again, I must stress that I fully support the advice to leave it alone and have followed this completely (especially now that I am more informed since the retraction happened to my son), but I don't think that it is helpful to scare parents with mostly biased, anecdotal evidence that is not necessarily backed up by any studies, especially when parents are stressed after this may have happened to their son.  It adds to the stress enormously.  I wish that we could have an open debate, get the real facts out there and of course prevent all of the *potential* harm to our sons caused by forced retraction, but also at the same time, understand *excactly* what the risks are after a forcible retraction.  I have seen posts on this forum that purport to be guidelines from the AAP that state that a forcible retraction 'may serverly harm the penis'.  While in some cases this may be entirely true, when reviewing the current AAP guidelines regarding foreskin care, I cannot find this phrase and it appears that someone at sometime has inserted this phrase directly into the AAP statement.

Again, I'm absolutely against medically unecessary circumcision and forced retraction of any kind.  But there's obviously a lot of confusion over this issue, and I feel that as parents we deserve to know the truth.  That's why I'm still  eager to reach out to parents who have had a forcible retraction done to their son, and what actually happened in the months and years afterward, how they cared for the penis and if there were any future problems.

Many Thanks,

Peter

[PeterJ]

I should also add that attorneys appear to be wading into the issue and muddying the waters further.  I can't help but notice the number of articles on this issue written or partially written by lawyers using it as a commercal venture. 'Contact this attorney if this happened to you.'  It me reminds of the ads we see everyday with some attorney asking is if we have had ever had any complications taking this or that drug 'Call me now, there may be a significant cash award.'  I want to take the ulterior motive, commercial or political agenda out of this debate and know truly what *could* happen to my son after a forcible retraction.

Peter

(Absolutely against circumcision/forcible retraction, but also wanting to know the truth) 

[MCatLvrMom2A&X]

What could happen ranges from nothing at all to slight redness to major problems down the road. There is just no way to know exactly which it will be and why just keeping an eye on it is the only thing to do.

I have seen most of the things I listed above talked about here at different times. One boy was hurt so badly his foreskin split and he bled and it healed with no apparent problems but until he reaches puberty there is no way to know if adhesion will be left behind. The same goes for the ones who dont show any real damage at the time no way to know until he can retract.

The reason for being adamant about retraction is because of what can happen if that 1 time can be prevented then it is worth using very strong language about the dangers of retraction.

If you read articles from other countries you will see how against any retraction they are while the USA is wishy washy on it because leaving boys intact is so new here.

About Dr. when he/she goes to mess with you you have no way of knowing if he is just going to move the foreskin around or if they are going to try and see how far back it goes. So the best way to prevent possible damage is to prevent the Dr. from even touching the foreskin. No the foreskin isnt made of glass and isnt that breakable but it can be damaged and to me even a small risk isnt worth it.

I can add links to sites about retraction if you want me to from Dr's and other sources.

[Lauren82]

I'm so glad that your son is doing fine. If that happened to my son, I know I would be very upset and worried.

I agree that the correct information regarding ALL aspects of proper intact penis care needs to be out in the open. One of the biggest problems I see is the medical profession continuing to spread improper care guidelines. If your doctor tells you that his medical school taught him that the foreskin needs to be retracted at each diaper change and cleaned it does put you in an uncomfortable place to challenge his knowledge. It's important to understand that the US has been a pro circumcision country for years (thankfully this trend is declining). We are one of the very few countries remaining that is still practicing routine infant circumcision. Even the doctors that we are supposed to trust can often fail us. I had to remind my own family physician that he would not be touching my son's penis/retracting. It's not ideal that I had to tell him, but I am grateful he listened. 

That worst case scenario stuff that you are seeing on anti-circumcision websites can and does happen. I've heard some terrible stories right here on this forum posted by the mothers of the poor babies that were injured. It's not a scare tactic or biased, it can happen.

[MCatLvrMom2A&X]

Originally Posted by Lauren82

I'm so glad that your son is doing fine. If that happened to my son, I know I would be very upset and worried.

I agree that the correct information regarding ALL aspects of proper intact penis care needs to be out in the open. One of the biggest problems I see is the medical profession continuing to spread improper care guidelines. If your doctor tells you that his medical school taught him that the foreskin needs to be retracted at each diaper change and cleaned it does put you in an uncomfortable place to challenge his knowledge. It's important to understand that the US has been a pro circumcision country for years (thankfully this trend is declining). We are one of the very few countries remaining that is still practicing routine infant circumcision. Even the doctors that we are supposed to trust can often fail us. I had to remind my own family physician that he would not be touching my son's penis/retracting. It's not ideal that I had to tell him, but I am grateful he listened.

That worst case scenario stuff that you are seeing on anti-circumcision websites can and does happen. I've heard some terrible stories right here on this forum posted by the mothers of the poor babies that were injured. It's not a scare tactic or biased, it can happen.

[PeterJ]

Thanks for the insight guys.  As an interesting note, my Pediatrician trained in England, and spent a great deal of time dealing with intact boys.  I am intact and from England originally myself, and when I was growing up (33 now) the general advice was to tell boys to pull back the skin for urination.  I specifically remember my Dad sitting me down and telling me this on more than one occasion.  The confusion on this issue is more widespread than we think and not just limited to high circ countries like the US.  I also read that boys have been taught to do this in France, also a low circ country.  Again, I really MUST stress that I am anti-circ and against foreskin retraction.  I believe that it can be harmful and is totally uneccessary.  I understand that approaching this subject in a forum entitled 'the case against circumcision' perhaps isn't the best place to start an unbiased conversation, but I truly believe that the strong language used and the over emphasis on rare cases is NOT helpful to parents who have encountered a forced retraction and who are trying to figure out the best way forward for their child.  That is why I am trying to connect with parents who have actually been through this issue to get hard, real facts.  I'm finding it hard to find information that doesn't try and scare me (as if I was a soon-to-be-parent considering circumcision) and/or is signed by a lawyer offering legal services.

So, please, if you have been through this with your son, and are willing to give advice and guidance, please let me know.  I'm keeping an eye on my son, and tonight his foreskin looks a lot less red.  I'm definitely going to discuss this with my Pediatrician and possibly get a second opinion with a urologist and/or a different Pediatrician. In any case, I will not let ANYONE retract my son's foreskin, except my son, when he feels he can or is ready to.

Many Thanks

Peter

[MCatLvrMom2A&X]

I think I understand what you are saying now and I can tell you my personal experiences with my ds. At his 4 month check I wasnt very good at expressing myself especially about genitals so I didnt say anything before the Dr. started the under the diaper check but I was watching him closely just in case since I knew to watch for him trying to retract. He did indeed retract my ds to the point that I saw the tip of ds's glans at which point I put my hand over his and said "please dont do that" and he gave me a look but stopped. Ds had no redness at all after it or any changes that I saw. The second time I told the ped., a different one, before he looked under the diaper that I didnt want him to retract (have since learned using that word is a problem since Dr.'s hear it and think full retraction and not moving the foreskin) and he proceeded to again expose the tip of my ds's glans. Again there was no redness and ds has not had problems since then from the retractions. Both where very minor though and no force was used.

So while he was retracted it wasnt a full on forced retraction and he had no issues from it.

I hope that is more along the lines of what you are looking for if not then I apologize.

[PeterJ]

Thanks for that.  I think sharing experiences is such a wonderful way to educate ourselves about this issue.  My son was fully retracted, as far as I could tell his glans was pretty much entirely revealed.  To begin with I saw some redness on the tip of the foreskin the next day, like small red lines (the retraction was done last Friday).  The redness has mostly gone now, and he has never appeared to be in any pain or discomfort in the days afterward.  I've heard from others who have been through this that one isolated retraction is not usually as damaging as repeated forced/premature retractions.  So, I'm hopeful that everything will be fine, and if there is any damage at all, it should be relatively minor and will be able to heal.  Of course, the only way forward is to keep an eye on it (as we would be anyway), not to retract, and if there appears to be any infection, redness or discomfort, seek advice at that time.

I encourage other parents to share in this thread about forced retraction experiences, so that we can spread the knowledge about how to care for the penis after this happens.  It would be interesting to hear from parents of older children who may have had this done in infancy, and what happened (if anything) in the years afterward.  Developing our knowledge based on actual experience is of enormous benefit.

Many Thanks for all of the guidance,

Peter

[Weevil]

My son is 5 weeks old and had his first appointment with the pediatrician this morning (he had been seen by the midwife up until now).  He is intact, but my husband is not and we are both pretty clueless about intact penises.  We know not to retract and have just been keeping him clean by gently wiping with a wet cloth during diaper changes and baths.  During his appointment the pediatrician started pulling back his foreskin.  I didn't expect it because she had told us she was very supportive of keeping boys intact, so I assumed she would just not touch it at all (I was still watching carefully, just in case).  When she started I said "woah woah, you're not retracting him are you?" and she said no, that she would never retract, she has two intact sons and would never do that.  But the foreskin was pulled back and the tip of the glans was visible underneath.

How big of a deal is this?  Is this normal/ok?  Would this harm him in any way?  Should I ask her not to touch his penis at all on future visits?

[MCatLvrMom2A&X]

That is retracting no it is not OK and you either need to tell her not to touch his penis at all during exams or not allow under diaper exams at all. It is POTENTIALLY harmful but odds are your ds will be fine. There is nothing under there that she needs to see honest.

[Weevil]

Originally Posted by MCatLvrMom2A&X 

That is retracting no it is not OK and you either need to tell her not to touch his penis at all during exams or not allow under diaper exams at all. It is POTENTIALLY harmful but odds are your ds will be fine. There is nothing under there that she needs to see honest.

Thank you.  This confirms what my gut was telling me.  I've felt awful all day that I didn't speak up beforehand, but I'm not sure it would have helped since she doesn't think what she did was "retracting".  I'll have to make it clear in the future that she is not to touch his penis at all.

[Crunchy Frog]

Originally Posted by PeterJ 

I am obviously against circumcision, as I see it as an unecessary medical procedure.  I am also very concious that literature used by anti-circ groups tends to present the worst case scenario, in an effort to persuade parents who might be on the fence to 'leave it alone.'  Again, I must stress that I fully support the advice to leave it alone and have followed this completely (especially now that I am more informed since the retraction happened to my son), but I don't think that it is helpful to scare parents with mostly biased, anecdotal evidence that is not necessarily backed up by any studies, especially when parents are stressed after this may have happened to their son.  It adds to the stress enormously.  I wish that we could have an open debate, get the real facts out there and of course prevent all of the *potential* harm to our sons caused by forced retraction, but also at the same time, understand *excactly* what the risks are after a forcible retraction.  I have seen posts on this forum that purport to be guidelines from the AAP that state that a forcible retraction 'may serverly harm the penis'.  While in some cases this may be entirely true, when reviewing the current AAP guidelines regarding foreskin care, I cannot find this phrase and it appears that someone at sometime has inserted this phrase directly into the AAP statement.

I just wanted to say that I have a copy of the AAP guidelines on intact care saved to my hard disk.  This is not a copy of a copy that was posted on an anti-circ site, but one that was posted by the AAP themselves.  It has since become unavailable online; I think they want money to be able to access it.

Anyway, this is a quote which I took directly from that document:

"Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin."   (I hope posting this excerpt doesn't violate any copyright restrictions.)

Anyway, this is not just hearsay or something from the intactivist community.  This is really what the AAP says in its guidelines on care for intact boys.  It doesn't mean that every forced retraction will cause severe harm, but it means that it's a possibility (probably especially if the tissues are still very tightly adhered together, a situation which is extremely variable from one boy to another).

If anybody would like a copy of the full document, I can email it as an attachment if you send me a private message.
 

[littlest birds]

I don't think it is the medical community vs. the anti-circ community.  Individual doctors overall simply do not seem very interested in normal penises.  So there is just a severe lack of staying informed there and using information that comes from vague and personal opinions, anecdotes, or is outdated.  If the advice is European and 30 years old it simply is outdated.  Being from England doesn't itself lend authority to this, even though I see how there is a natural inclination to assume so.  ...FWIW nothing wrong with retracting to urinate if you are retractable and it is obvious you shouldn't if not retractable.  That advice is perfectly fine for retractable adults but the outdated part is that it is normal to retract from the beginning.  That is misinformation that is widespread, not just in the U.S.  So there is only one basic piece of information that is affecting others:  Should retraction be caused to happen or allowed to happen.  The advice may be given in a country with 100% intact men and still everyone could could have gotten this detail wrong for decades without seeing clear evidence to the contrary because cause and effect can be hard to put together especially when it comes to something so private.  (It's not the kind of evidence that has historically often been collected and analyzed YK)  We have seen so many health issues in which assumptions about cause and effect are incorrect for years, decades, and more.  Penises are the kind of thing that most people really don't want to ask a lot of questions about and that was even more true in the past--it's a bit taboo and that relationship of passing advice from one generation of men to the next is also treated as sacred and unquestionable. 

I think the main problems are that older doctors think they already know and don't want to know more, and pro-circ docs don't want to know more, and then sometimes people (even docs!) just misunderstand something that they think they do understand so they think they have more knowledge but they have misinterpreted it--these ones also think they have nothing to learn.  And among the many things docs are trained to do is to sound like they are quite sure of information that they are not actually 100% knowledgeable about because as decision makers that posture inspires confidence and is the role they need to play for their patients and staff.  Your European doctor was all the more confident that he has no need to learn more since he had so much experience with the intact and represents an intact-knowledgeable nation.  Despite his confidence he really doesn't know anything about the risks of forced retraction, while his confidence keeps him from finding out.

What it comes down to is that most docs are not motivated to learn more than they already think they know.  Lack of motivation means they are not actively seeking or acquiring new information and remain comfortable with limited knowledge.  Anti-circ parents are very motivated, enough to actually bother looking closely at the AAP info, for instance.  The docs aren't motivated to look at that closely and thoughtfully.  They are busy with many far more pressing subjects.  Yet, whatever limited amount they do know, they tend to act authoritative about it no matter what because it is their job/vocation/habit to act that way.  That's not the position of the medical community as a whole you are encountering, but good ol' human weakness and ignorance in persons in whom it seems surprising and contradicts other things you know about them.  And the combination of authority and ignorance is exactly the reason that some kind of health questions should not be asked of doctors, because you can get completely wrong answers from a person that seems so completely believable.  Sigh. 

Some areas of knowledge are really weak among doctors.  This is not the only one.  In such areas their plain old personal opinions become the thing they are actually telling you, not the most sound advice based on the research-based collective opinion of the "medical community."  If only they didn't still sound like experts when they switched to a personal opinion in an area in which they are not keeping with the profession at all.   

[PeterJ]

Thanks so much for the ongoing replies.  I really appreciate the effort and input on this issue.  With regard to the 'severely harm the penis' statement, I have seen this statement both included and deleted from the AAP pdf leaflet available online, so I'm assuming that either it has been inserted by the AAP more recently, or deleted.

There is an awful lot of talk about the 'potential' harm that forced retraction can cause, but comparatively little or zero medical dialog concerning the long term actual harm, substantiated with evidence or case studies.  This happened to my son, and trying to find any kind of reliable information about the road ahead is extremely difficult.  This is very frustrating for a parent trying to figure out what to do next.  That's why I'm still very interested in hearing from parents who had this happen some time ago.

For something so utterly basic, like foreskin care, it's hard to accept that the 'message just doesn't through' to doctors who insist on forcibly retracting our sons.  I think that there has to be a wilfull non-acceptance by some doctors who differ in opinion to the AAP.  If this issue is as big as we think, and the potential harm as severe as some believe, why is the message not getting through to our pediatricians?  Married to the lack of accessible evidence regarding the actual long term effects, it makes for a very confusing situation indeed.

So, please, if your son was forcibly retracted, I would very much appreciate your guidance with regard to the road ahead.  I also would like to thank the parents who have already responded with their words of advice.

Many Thanks

Peter

[TigerTail]

Would a 'forced retraction' of your nail from your nailbed do more than 'cause possible problems'? Since that's the very kind of adhesion we are speaking of (and watch the separation of the fused foreskin to the glans in a circ video, if it's hard to grasp fully in words), I think it's reasonable to expect problems from 'soreness' to infection to problems manifesting themselves to years while the foreskin tries to reattach itself to the glans.

Read the polls with 'average age of retraction (one from 2006, & a current one) if you are concerned about false diagnoses of phimosis.