Tight Foreskin

[catmuse11]

Hi,

My 4 1/2 year old son's foreskin still does not retract. We met with a urologist who suggested circumcising him. She also said it would be okay with her if we wait until he is six, but, if it does not loosen by then, she said she would definitely suggest circumsizing him. I realize, of course, that we could just refuse, but she also said a non-retracting foreskin can be very painful come puberty and that it can lead to an increased risk of penial cancer. The research I've read is, not surprisingly, conflicted. One group says it'll eventually loosen prior to puberty--another says it is inhumane to let it go that long.

I guess my main question is: do any of you have any tips for loosening a tight foreskin?

Thank you.

[MCatLvrMom2A&X]

At 4yo he is supposed to have a tight foreskin. The avg age for retraction is 10.5yo and many boys do not retract until they are well into puberty. The urologist you saw is not up to date on her intact care unfortunately that is a common problem they are only taught about cutting off the foreskin not about how the foreskin works. At this age no one should be trying to make him retract it can hurt him and cause real harm.

She is a dangerous woman hurting many boys needlessly with her advice.

At 4yo my ds could retract at all he is 6 now and is about 1/2 way retractable, I know because I have seen him do it I dont touch it or allow anyone else to do so and he is 100% normal.. Many others here will tell you the same thing.

This link is by a Dr. who does know about the intact foreskin and how to watch out for Dr's who are not http://mothering.com/health/protect-your-uncircumcised-son-expert-medical-advice-for-parents

-Your son's foreskin is too tight. It doesn't retract. He needs to be circumcised.

The tightness of the foreskin is a safety mechanism that protects the glans and urethra from direct exposure to contaminants and germs. The tight foreskin also keeps the boy's glans warm, clean, and moist, and when he is an adult, it will give him pleasure. As long as your son can urinate, he is perfectly normal.

I hope you take the time to read the article and please contact the urologist and let her know how disappointed you are that she almost caused your son harm for no reason.

About the cancer that is not accurate. Having a foreskin does not make it more likely that he will get penile cancer, STD's are the deciding factor in that. I can provide you with links on that if you wish.

The human body is made to work on its own schedule and if left alone 99% of the time it will do the job when it is supposed to. It is when you start messing with things that things go wrong.

Remember the number one rule of intact penis care is never retract and never allow anyone else to try to do so.
Edited by MCatLvrMom2A&X - 5/16/11 at 5:27pm

[green betty]

Wow, what an American issue! (As in, the entire rest of the world wouldn't perceive that as a problem.) My 6 year old isn't retractable at all and nobody's worried--not us, not him, not our doctor.

The foreskin continues to loosen gradually over time. He's got years and years to get there. The reason it needs to retract, after all, is for sexual intercourse. Your child's genitals don't need to be ready for sexual intercourse at 4, or 6, or 8, do they?

My advice to you is to find a more educated doctor. Yours is making medical recommendations based on cultural beliefs, not medical facts.

[Night_Nurse]

Please don't get him circumcised over this. Your son's penis is doing what it needs to do right now, which is passing urine. Many boys don't retract until they are much older, including the teen years. Between now and then the foreskin will naturally loosen because of the child playing with and stretching it on his own and erections. Many boys don't have natural separation until they are older than your son. If you are in the US, many doctors aren't educated on normal foreskin anatomy and function. US doctors are typically trained to just surgically remove it and don't know what "normal" is. Like a pp said, it's an "American" problem because doctors in other parts of the world don't see a non-retractable foreskin at 4 or 6 or even 13 as a problem.

[hakunangovi]

Catmuse,  The replies from the pps are all good advice. Your urologist is not educated on the form, development or function of foreskins, and through her ignorance is harming little boys.  It is very fortunate for your son that you are a caring mother who came here to ask questions. You might be interested in reading www.cirp.org/library/normal and it would be a favour to many other little boys if you passed it on to your doctor.  The bottom line is that some boys do not achieve retractability until well after puberty, and although rare, there are men who happily live their lives with a foreskin that does not retract.

[nd_deadhead]

Of course a uroligist is going to recommend surgery - they are the ones getting paid for it, right?

If your son really did have phimosis (let's say he's 17 and still doesn't retract), the first treatment option would be application of a steroid cream - not surgery. The next option, after steroid cream didn't work is a small slit in the foreskin - not full circumcision. I would run - not walk - from a doctor who recommends invasive surgery before trying any other treatment option.

[PeterJ]

This is such a great example of how misinformation is transmitted to parents.  Here you have a urologist, who you would think should be intimately acquainted with the form and function of male genitalia, including infants, making an incorrect diagnosis of phimosis.  Unbelievable.  I would tell the urologist to go back to school and take a class on the difference between pathological and physiological phimosis.  Unbelievable.  The cynic in me believes that Drs must be making tidy sums from circs.

As for tips on loosening the foreskin, as long as he is not having any problems with urination or infections, or any pain or discomfort, then it does not need to be loosened.  If he gets to adolescence and the foreskin is still tight, then you can go back to an educated Dr, and ask for non invasive help.  There are so many things you can do before a circ is even thought about.

Peter

[Ivy53]

Hi, I don't mean to hijack this thread and I'll make my own thread if I need to but I just thought, if you guys are already talking about this here it seemed silly to make a new thread.

Now, I have a very similar problem to the OP except my son is almost 5.5. And his foreskin isn't just tight, it's...I don't know. How tight is too tight? I cannot see the glans at all when I tell him to pull it back as far as is comfortable for him. His pee comes out of a tiny pinhole in his foreskin that isn't even quite in the center of the tip of his penis. I took him to a urologist because he's having problems with multiple accidents a day and he said he had to be circumcised, that his foreskin would never retract on its own, pointed to an area below the pinhole opening and said it was white because it was scar tissue and that it would just get worse and could even completely close, making it so he couldn't urinate at all!  I don't understand how the "white area" was scar tissue...it looked white the same way the skin over your knuckles looks white (or much lighter than the surrounding skin, anyway) when you make your hand into a fist and squeeze. The "white" area looked like the area the frenelum is, though I admit my knowledge of penile anatomy is fairly limited...

Anyway, I am going to call a nearby doctor from this list of intact-friendly pediatricians to get a second opinion. I read all this stuff a few months ago and I tried not to worry but this guy kind of freaked me out. He agreed with me that 5 year olds can't all retract their foreskins yet but that he had a functional issue that was serious and needed surgery...and it is such a tiny opening....

[MCatLvrMom2A&X]

Even if his foreskin has scar tissue a full on circ is the last thing needed. Simply removing the tip of the foreskin will allow for retraction and keep much of the foreskin intact. If you stretch any skin that isnt ready to be stretched it will turn white so that in itself wouldnt concern me at all. The first time the Dr tried to retract my ds when he was 2mo I saw that white area yet now that ds is almost 7 he can almost fully retract. The second time the Dr. tried to retract him at 4m I stopped it before it could happen so I dont know what it looked like then.

Now having said that at 5.5y many boys have the pin hole but by their teen years they can retract with no issues some have to use steroid cream and stretching to help but many do not.

I wouldnt even consider circ on a child for any reason simply because so much can change so fast when the hormones of the teenage years hit.

I am glad you are going to see an intact friendly ped but keep in mind even if he says something similar it is better to wait until puberty before doing any surgery for several reasons including the fact your ds's penis will be larger and they can have a much better idea of how much skin he needs to have a comfortable erection.

As long as he is not having pain while urinating or infections then there is no rush.

Having accidents has nothing to do with circ or intact it is a developmental thing or if he had a UTI if might cause it.

I am assuming you took him thinking he might have a UTI since his foreskin would have nothing to do with that kind of thing. Cutting off the foreskin of a boy who has accidents would be like cutting off the labia of a girl for the same reason neither makes any sense at all.


For him to have scar tissue at this age he would have had to either have been forcibly retracted over and over again or he would have had to have infections on top of infections. Could the first have happened? Since the second you would have known about it because that kind of infection is painful and very visible.

[Ivy53]

Well part of the reason I'm definitely going to see this ped is because they did a test on his urine (from before he was examined) and they said there were traces of blood in it. I've never had a doctor tell me this before so I don't know if this is a new thing or what. The urologist today said he wasn't even sure if it was coming from his urine, that maybe it's coming from his penis/foreskin, and that his suggestion was to circumcise him and then do the test again. He did do an u/s on him and confirmed his bladder was empty, so at least he can empty his bladder (which was what his ped was concerned about with the accidents).

Anyway this guy said he only does full circumcisions because anything else was ugly, and why should we make our child an "in between" that isn't circumcised but also not intact, and that would be a terrible thing to do to a child, and that every time he peed that it would cause more infection...and that I shouldn't wait for years and years to get it done because 1. the bit about the infection maybe closing the hole altogether (I've never noticed him having an infection?) 2. scar tissue is going to disfigure the glans if I leave it like this a long time and then, when he eventually has to have a circumcision, again, it will be ugly. Sigh. I would probably get a third and fourth opinion even if this intact-friendly doc thought he needed to be circ'd but hopefully he'll tell me something sane. I hate feeling like I'm not taking care of my kids correctly and that's how this guy made me feel. :(

[MCatLvrMom2A&X]

Dang that Dr. is dangerous to little boys He couldnt be farther from accurate if he tried. There is no way scar tissue on the foreskin can disfigure the glans. That is just silly talk.
i
Ugly really?? yeah I have seen pics online of men who have just had the tip removed and you cant tell the difference between them and an intact penis. Even the ones with the dorsel slit look very similar with only a little V mark at the tip where the cut was made. IMO it is better to look a bit different than loose all the nerves of the foreskin and never be able to enjoy sex as it was meant to be.

I hope you can find a Dr. who actually knows about the intact penis.

Urine under the foreskin will not cause infection if it did every intact man in the world would be having infections.

[ursaminor]

Originally Posted by Ivy53 

Well part of the reason I'm definitely going to see this ped is because they did a test on his urine (from before he was examined) and they said there were traces of blood in it. I've never had a doctor tell me this before so I don't know if this is a new thing or what. The urologist today said he wasn't even sure if it was coming from his urine, that maybe it's coming from his penis/foreskin, and that his suggestion was to circumcise him and then do the test again. He did do an u/s on him and confirmed his bladder was empty, so at least he can empty his bladder (which was what his ped was concerned about with the accidents).

Anyway this guy said he only does full circumcisions because anything else was ugly, and why should we make our child an "in between" that isn't circumcised but also not intact, and that would be a terrible thing to do to a child, and that every time he peed that it would cause more infection...and that I shouldn't wait for years and years to get it done because 1. the bit about the infection maybe closing the hole altogether (I've never noticed him having an infection?) 2. scar tissue is going to disfigure the glans if I leave it like this a long time and then, when he eventually has to have a circumcision, again, it will be ugly. Sigh. I would probably get a third and fourth opinion even if this intact-friendly doc thought he needed to be circ'd but hopefully he'll tell me something sane. I hate feeling like I'm not taking care of my kids correctly and that's how this guy made me feel. :(

This is Marilyn Milos contact info:
Phone: [phone]

email: [e-mail]

She literally takes calls all day from parents.  She is a registered RN, midwife, and the founder of NOCIRC, she is also on Mothering's ask the experts section.  Give her a call, I bet she could help you find a foreskin friendly doctor.  She is very easy to talk to and extremely compassionate:)

[hakunangovi]

Originally Posted by Ivy53 

Well part of the reason I'm definitely going to see this ped is because they did a test on his urine (from before he was examined) and they said there were traces of blood in it. I've never had a doctor tell me this before so I don't know if this is a new thing or what. The urologist today said he wasn't even sure if it was coming from his urine, that maybe it's coming from his penis/foreskin, and that his suggestion was to circumcise him and then do the test again. He did do an u/s on him and confirmed his bladder was empty, so at least he can empty his bladder (which was what his ped was concerned about with the accidents).

Anyway this guy said he only does full circumcisions because anything else was ugly, and why should we make our child an "in between" that isn't circumcised but also not intact, and that would be a terrible thing to do to a child, and that every time he peed that it would cause more infection...and that I shouldn't wait for years and years to get it done because 1. the bit about the infection maybe closing the hole altogether (I've never noticed him having an infection?) 2. scar tissue is going to disfigure the glans if I leave it like this a long time and then, when he eventually has to have a circumcision, again, it will be ugly. Sigh. I would probably get a third and fourth opinion even if this intact-friendly doc thought he needed to be circ'd but hopefully he'll tell me something sane. I hate feeling like I'm not taking care of my kids correctly and that's how this guy made me feel. :(

Ivy,  I have never heard such nonsense in my life - this doctor is quite literaly off the wall.   So long as your son can pee, he is just fine.  Retraction often does not happen until much later - puberty or sometimes after. Please read www.cirp.org/library/normal  .  Should a tight foreskin become an issue after puberty, there are many ways to rectify the condition without harming the foreskin, starting with the application of Betamethasone cream and stretching,  to various types of preputioplasty - a surgical technique that preserves all of the foreskin (removing the tip is not a good idea since the muscles of the frenar band are lost).  Please read www.cirp.org/library/treatment/phimosis  and  www.biomedcentral.com/1471-2490/8/6 .  Print these out and present them to that doctor so that he might learn something and halt the trail of destruction that he is undoubtedly leaving behind him.

[Ivy53]

Thank you all. See, I had read all that a few months ago, about how retraction sometimes doesn't happen until puberty and I even mentioned to the doctor that I've read not all 5-year-olds can retract their foreskins and he agreed with me but when this guy just took one look at it and says "no, he needs to be circumcised, this will never retract on its own" and he said it in this tone of voice like...like I should somehow have known he had a serious condition instead of just a normal non-retracted foreskin and it was my fault I hadn't gotten it taken care of sooner. I guess that's what upset me. I just thought, well, it IS a very tiny hole, maybe this IS unusually tight? To look at it now it certainly looks like something that doesn't seem capable of ever stretching naturally. And to tell you the truth I had never seen what a foreskin on a child looks like when it is stretched back until my older boy was sitting on his potty when he was three and a half and he called me in because he wanted to show off what he could do with his penis, and that was when he found he was able to retract it partway.

Anyway, hopefully I can find a doctor who will tell me if it is normal or not. There's one in Irvine on that intact-friendly list, hopefully he would give me a second opinion, or I'll just call the number posted above and maybe she can find me someone else.

[PeterJ]

Hi Ivy,

I'm sorry you're having some worrying issues right now.  I would say that you are doing the right thing by seeking out a foreskin friendly pediatrician for a second opinion.  If the only symptoms right now are some accidents, then it is worth putting up with that, doing some research and consulting others before you make a decision about what to do.  As you know, it is quite normal for a 5 year old not to be able to retract, but with the other additional issues, a good second medical opinion is what you need.  From what you have told us, I honestly cannot find anything that you did wrong whatsoever.  You did the right thing by taking him to the doctor to get it checked out - it's just a shame that this Dr. was somewhat high-handed and made you feel inattentive, which obviously is not the case at all.  The very fact that you are following through on this issue and are determined to get the best care for your son, shows that you are a very caring parent.

Best wishes

Peter

[A&A]

Originally Posted by Ivy53 

Hi, I don't mean to hijack this thread and I'll make my own thread if I need to but I just thought, if you guys are already talking about this here it seemed silly to make a new thread.

Now, I have a very similar problem to the OP except my son is almost 5.5. And his foreskin isn't just tight, it's...I don't know. How tight is too tight? I cannot see the glans at all when I tell him to pull it back as far as is comfortable for him. His pee comes out of a tiny pinhole in his foreskin that isn't even quite in the center of the tip of his penis. I took him to a urologist because he's having problems with multiple accidents a day and he said he had to be circumcised, that his foreskin would never retract on its own, pointed to an area below the pinhole opening and said it was white because it was scar tissue and that it would just get worse and could even completely close, making it so he couldn't urinate at all!  I don't understand how the "white area" was scar tissue...it looked white the same way the skin over your knuckles looks white (or much lighter than the surrounding skin, anyway) when you make your hand into a fist and squeeze. The "white" area looked like the area the frenelum is, though I admit my knowledge of penile anatomy is fairly limited...

Anyway, I am going to call a nearby doctor from this list of intact-friendly pediatricians to get a second opinion. I read all this stuff a few months ago and I tried not to worry but this guy kind of freaked me out. He agreed with me that 5 year olds can't all retract their foreskins yet but that he had a functional issue that was serious and needed surgery...and it is such a tiny opening....

As long as he can pee without pain, he is FINE!!! 

You know not to forcibly retract the foreskin, right?

[bunny's mama]

count me as another mom of an intact boy with a partially retracted foreskin. my DS is 8 years old and his was very tight at 4. he likes to play with it and pull the foreskin, which has probably been what's loosened it a bit. but he also wants to see what's underneath the foreskin and has shown me that it doesn't pull all the way back. we've told him this is okay and normal and that it will loosen as he grows and his body is ready & not to pull it if it hurts.

totally normal! very disappointed to hear about these ignorant docs.

[rross1967]

My 2 yo grandson is not circumcised and for the last few weeks has been complaining of the pain.  He has been to the dr twice and confirmed no infection but that the foreskin is pinching him.  The pediatrician put in a referral to the pediatric urologist for review and possible circumcision.

I don't want to be in a debate :)   But based on what I'm reading, it sounds as though his foreskin is supposed to be tight.  But should it be causing pain?  How tight is too tight?

Thanks!

[MCatLvrMom2A&X]

At his age the pain may not be pain it may be that he dosnt know how else to describe it. It is definitely supposed to be tight still at his age very few are not.

Also erections can feel funny and they may say pain.

I hope that the urologist he sees is foreskin friendly but odds are sadly not good that he will be. They only know how to cut things off since that is what they are taught.

A tight foreskin isnt a problem until puberty and adulthood and only then if it is causing pain. Or if the boy cannot urinate other than that it is 100% normal.

I personally wouldnt go to the urologist and if I did I would be prepared to say no thank you if he/she brings up circ.

Odds are his foreskin is still fused to the glans which is very normal but many Dr. will say to tight or a problem simply because they dont know any better.

[Yoshua]

Wow, glad there is a wealth of knowledge here. You are asking all the right questions and getting all of the right answers.

Your son may not retract until puberty, or even during or after, and that is 'normal'. A eurologists job is to 'fix' things, so often times people who are used to 'fixing' things through circumcision will jump to that conclusion. It probably isn't anything sinister on his part, its just that you were referred to him with a possible problem and he wanted to find a solution to 'fix' it.

Thing is there is no problems yet, from the sounds of everything you described, everything is on track and normal. Good that you came here asking for input though.