urologist recommending circumcision for my 4.5 year old :(

[lwills01]

Hello everyone, I'm hoping for some wisdom about how to handle this situation. A few months ago, our family doctor referred my son to a urologist because she was concerned that his foreskin wasn't retracting. He has had a few instances where his penis has become slightly swollen and red/inflamed, usually with some discharge, but I was under the impression this is normal for an intact boy and nothing to worry about. It always cleared up on its own within a few days. Other than those few instances he has never complained of pain (while urinating, with an erection, etc). At the appointment today, the urologist pulled back his foreskin as far as was comfortable for my son (only enough for the tip of the glans to be exposed) and showed us a white ring of what he described as scar tissue. He said the scar tissue would always prevent the foreskin from retracting completely, and that although we didn't have to do anything now, surgery to remove the foreskin was his recommendation. We want a second opinion. We really want to avoid circumcision at all costs. I've read that the white ring indicates a "true" case of phimosis, but I've also read that lots of urologists aren't informed enough about the range of norms in the foreskins of young boys. Obviously we'd like to try other treatment options as well. Any advice/recommendations are welcome.

[Lory]

He's only four and a half? Most boys are nowhere near retraction at that age... the doctor does not need to be touching his penis, or at least not pulling the foreskin back. The retraction by anyone other than your son is what could damage it and cause scar tissue. The foreskin is supposed to be tight at that age and will retract on its own, often as late as the teenage years.

If he can urinate, and as you say it is painless, he is perfectly fine. There is nothing wrong with him. The foreskin is fused to the penis at that age to *protect* it, that's why it's "tight," and never needs to be pulled back to be cleaned until later... I know I'm not a doctor, but I would suggest talking to a foreskin friendly pediatrician in your area, especially about the discharge, the ring, or anything else. That way you'll be talking to a knowledgeable person who isn't going to blame everything on the foreskin. http://www.thewholenetwork.org/intact-friendly-doctors.html

Good luck.

[MCatLvrMom2A&X]

The reason he saw a white band of tissue is because his foreskin has a sphincter at the tip and when not in use it closes down tight like the anus and when someone is messing with it it will clamp down even tighter.

At his age only a very few boys are retractable. The avg. age of retraction is 10.5yo the urologist is not up to date on the intact penis.

This is one of the main reasons we tell parents here to not allow Dr. to touch their ds's penis because it leads to needless worry and can cause damage if they are to ruff trying to retract it.

Your ds is normal for his age if after he is fully into puberty and he still cant retract and is complaining then the proper thing to do is steroid cream with stretching. If that dosnt work then a simple tiny slit is made to allow for retraction. Even manual stretching using a balloon or even just hands with local anesthetic can be done before circ is even considered. In no way is circ indicated for tight foreskin until all other options have been tried.

This link http://www.cirp.org/library/normal/ is a good one to read and this one which is from the UK where they dont circ without real cause http://www.norm-uk.org/circumcision_alternative_treatments.html goes into detail about ways to fix true phimosis without circ.

"True" phimosis --- better termed "preputial stenosis," because "phimosis" has so many different definitions it now is devoid of any useful meaning --- occurs in less than 2% of intact males.

Of these 2%, 85-95% will respond to topical steroids. Of those who fail this, at least 75% will respond to stretching under local anesthesia, either manually or with a balloon.

[lwills01]

This is exactly what I'm worried about Lory - that it's totally normal and my doctors are being way too aggressive. Unfortunately, I'm in Canada so your list won't help me. I wonder if there's a similar one I could find.

[Lory]

I think Marilyn Milos would be happy to talk to you! I called her once and she was really friendly. I'm sure she would help someone outside of the U.S.. it's not the same as finding a doctor to go to, but she is an RN and she'll answer your questions. [phone]

[MCatLvrMom2A&X]

She may still be able to help you with a Dr. name and at least give you good reliable advice.
NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
[e-mail]
Phone: [phone]
Fax: [phone]
www.nocirc.org

[Quirky]

You know the saying about when the only tool you have is a hammer, every problem looks like a nail? Unfortunately, even in Canada, which now has much lower circ rates than the US, most urologists that you will find were trained in the era when circumcision was the hammer for every nail. UTI? Circ. Phimosis? Circ. Inflammation? Circ. Yeast infection? Circ. Looks funny? Circ.  So the problem that you have even if you go to find another doctor is that you are asking for a solution to a problem that does not exist. At age 4.5, your son by definition does not have phimosis. And even if he were 20 and not retracting, circumcision would not be the answer! There are far less invasive solutions to real phimosis (which is very rare), including steroid creams, stretching exercises, and at maximum a dorsal slit.

Here is another good page for you to read through, from Doctors Opposing Circumcishttp://www.doctorsopposingcircumcision.org/info/retraction.html

[Quirky]

Ugh, sorry, this message board is acting really wonky tonight! I meant to add: my advice is, just don't go to another doctor. Don't seek a second opinion. Because there's nothing wrong with your son. Do the research and have confidence that yes, in fact, you do know more than your doctor, who's practicing 19th century medicine and is simply not educated on the normal penis and its normal functions. This guy's advice, although he may be wearing a white coat and he may speak authoritatively, is not any more advanced than the doctor from 300 years ago who advised bloodletting for a fever because of an imbalance in humours.

[lwills01]

Thank you so much, all of you. You confirmed what I suspected and the resources you pointed me too were so helpful. My husband and I have decided we will be doing nothing about this, since we are convinced there is nothing wrong! The most I will consider at this point is a second opinion, but that's mostly because I'm an information junkie and I'd like to find an informed, foreskin-friendly pediatrician who can provide us with any other information that will help going forward. Honestly, a circumcision as the first method of treatment is so extreme that I have no faith in the urologist who recommended it. Crazy.

[Vancouver Mommy]

Good choice, and welcome to Mothering. I agree with the other posters that your son sounds perfectly normal and the doc should be told to keep their hands off.

[MCatLvrMom2A&X]

Welcome to the board I am glad you found information that helped you make a decision. It is so hard sometimes to find reliable health care not only on this issue but others. I hope you are able to find a Dr. who is knowledgeable if you choose to get a second opinion.

[PeterJ]

I'm sorry that you're having issues that are worrying you.  The last thing you need is confusing and contradictory advice from medical professionals.  It seems that you have also reached this conclusion, but my advice would be to seek out a foreksin friendly pediatrician for a second opinion.  This might take some work on your part in asking some questions.  Well meaning forum folks who have not examined your son, telling you that everything is fine is not a substitute for a good medical opinion, especially if you feel that there might be an infection.  Additionally, other posters are absolutely right when saying that all other options should be exhausted before circ is even considered.  The fact that you are doing your own research and informing yourself is the most positive thing you can do.

Best wishes,

Peter

[Quirky]

Peter, I have to say I respectfully disagree. When a doctor has diagnosed something that's a non-issue in the first place, I don't see that it's worthwhile to move heaven and earth to find another doctor to debunk the first one. We see this all the time -- an ignorant doctor (unfortunately more prevalent than the enlightened kind when it comes to foreskins) diagnoses "infection" or "phimosis" when it's normal separation irritation, normal age-appropriate phimosis, etc. I don't think it does much good to tell parents to get a second opinion for a non-issue when the majority of doctors in the US or Canada did not receive correct information or training on the normal penis. When medical education and training catches up, then a second opinion would be worthwhile, but to me this falls into the category where it's entirely appropriate to do your own research, satisfy your own mind, and then let it go. Particularly because I think it's very inappropriate to keep subjecting a young boy to further penis manipulation by a health care professional in search of a non-problem.

[PeterJ]

While I understand the sentiment and your very good intentions, (believe me, my son has been on the receiving end of an uneducated Ped himself) I just cannot agree.  If you are not a trained medical professional yourself, it would be unwise to diagnose any symptoms as a 'non-issue' and to just let it go.  This is not good advice to parents who may have a son with an infection that requires treatment, or corrective procedure.  I would also not encourage others not to seek medical advice, particularly when I do not personally have a firm grasp of the specific situation.  I wholeheartedly endorse your view to do as much research as you can, but there is a limit to how far you take self-medication and self-diagnosis borne out of a mistrust of Drs.  This can create a situation in which more damage is done in the long term.  The answer is to educate yourself, and seek out a competent medical professional, who can advise you without subjecting your son to an unnecessarily invasive examination.  Armed with the correct knowledge regarding the anatomy and development of the penis, you are in the best position possible to make your wishes clear to the Dr, and to ask specific questions regarding the concerns you have.

So I guess we'll just have to agree to disagree on this one Quirky, but with every respect to your position and view.

Peter

[Storm Bride]

Originally Posted by PeterJ 

 If you are not a trained medical professional yourself, it would be unwise to diagnose any symptoms as a 'non-issue' and to just let it go.  This is not good advice to parents who may have a son with an infection that requires treatment, or corrective procedure.  I would also not encourage others not to seek medical advice, particularly when I do not personally have a firm grasp of the specific situation.  I wholeheartedly endorse your view to do as much research as you can, but there is a limit to how far you take self-medication and self-diagnosis borne out of a mistrust of Drs.  This can create a situation in which more damage is done in the long term.  The answer is to educate yourself, and seek out a competent medical professional, who can advise you without subjecting your son to an unnecessarily invasive examination.  Armed with the correct knowledge regarding the anatomy and development of the penis, you are in the best position possible to make your wishes clear to the Dr, and to ask specific questions regarding the concerns you have.

So I guess we'll just have to agree to disagree on this one Quirky, but with every respect to your position and view.

Peter

I get what you're saying, but there are no "symptoms", according to the OP. The referral was made, because the boy isn't retracting yet.  That's not a symptom. It's a biological norm.
 

[pigpokey]

That's what I was about to say:  there were no symptoms.

What they did to this boy is the same as a doctor examining a 4yo girl and claiming that her hymen was obstructing the vaginal opening and referring to a specialist.

My son was fully retractable from a young age, and so what?  We are really hoping he holds way off in needing that function in a practical way.

How many times should a child have someone looking at and touching his or her normal junk?

I agree that she should find a foreskin-normative, foreskin-friendly ped, and go there the next time he actually needs medical care.  You guys got any Indian doctors up there?

[MCatLvrMom2A&X]

Originally Posted by Storm Bride 

I get what you're saying, but there are no "symptoms", according to the OP. The referral was made, because the boy isn't retracting yet.  That's not a symptom. It's a biological norm.
 

: in this particular case there is no problem other than a Dr. who has no idea about the natural foreskin.

[ElliesMomma]

amen. if it ain't broke, don't "fix" it.

AND you are under no obligation to partake of the "recommended treatment." 

but you already know this!

[Momily]

Is it really normal for a child's penis to become swollen and inflamed with discharge, multiple times in the first 4 years of life?  I fail to see how that is "no symptoms".  I don't think that's the norm for an intact penis, it certainly hasn't been my son's experience.

I think the OP is right to ask about this, and also right not to jump to the conclusion that circumcision is the solution, simply because one doctor said so. 

[Storm Bride]

Originally Posted by Momily 

Is it really normal for a child's penis to become swollen and inflamed with discharge, multiple times in the first 4 years of life?  I fail to see how that is "no symptoms".  I don't think that's the norm for an intact penis, it certainly hasn't been my son's experience.

It doesn't happen to everyone, but it's not uncommon at all. (It hasn't happened to either of my boys - well, if it happened to ds1, he never mentioned it, anyway, and ds2 was retracting at about 3.5 - but it comes up here a lot.) In any case, the OP said that her doctor made the referral, because her son isn't retracting yet. That is not a symptom of anything.

I think the OP is right to ask about this, and also right not to jump to the conclusion that circumcision is the solution, simply because one doctor said so. 

I think we got different impressions of the OP. I didn't get the feeling the OP was questioning anything - only that the ped was worried about the fact that her son isn't retracting "yet".