Best ped practice for examing intact little guys?

[leftcoast_trillium]

Hi Bob,

Thanks for being here. I came to this spot because I'd like a little help figuring out how we want our pediatrician to handle our intact son. We feel that it (circumcision) is a personal decision and are happy to talk to others if asked, but don't believe that it is as high on the horrible parenting choices scale as some people do. I'm pretty uncomfortable with the shrill tenor of discussion that surrounds this issue.

We're both scientists and like evidence based practices. When our ped told us we needed to retract our newborn's foreskin every day we just ignored her because we knew that it wasn't true. We like her; she's smart and compassionate and really takes her role as the child's health advocate seriously. She gives us her opinion and then lets us decide what to do without punitive reciprocations (we do our own schedule for vaccination and have chosen to avoid vaccinations for things we feel are low risk for children (like hep B)). We just felt her opinion on this issue was pretty dated.

That being said, at our son's developmental checkups she likes to pull back his foreskin to see how his penis looks. It's always been able to be fully retracted. He's turned out to be very verbal so I kind of talked him through things last time (18 mo) and he was a little surprised but didn't act like it was a big deal and it wasn't, compared to what he likes to do to it! He reacted to some other things pretty strongly, like taking off clothes and being taken outside to be weighed...I've decided he doesn't have to do that again. We're getting ready for his 2 year visit next month and I'm wondering about this. I've read some stuff that really seemed hysterical to me about how terrible it was to let the ped do this to your child. I don't think it's terrible per se, but at the same time, it does seem invasive. I guess what I'd like to know is what you believe is the best practice for intact penis examination at checkups and the evidence that informs your belief.

Thank you

[DrBobSears]

In my experience, most intact kids aren't retractible until three years or older.  I've seen a few earlier than that, but it's pretty uncommon.  I don't really try to retract kids - I'll stretch it back a tiny bit just to see how mobile it is, but I NEVER try to pull it back more than it naturally wants to go.  I've seen kids stay non-retractible even as old as twelve.  I've spoken with urologists who say this is not a problem. When I do see the foreskin start to retract, I'll ask the child to do it and I see how far it goes - but the child is in control, so it won't be painful. I tell the child to pull it back in the shower to get it gradually fully retractible over the years.

There's no harm in your child's being retracible at this early age.  I would typically gently retract it during my exam if it seemed very easy to do without pain (since I can't ask a child this young to do it). If it was uncomfortable, I wouldn't do it. 

I don't know what the evidence says on this.  This is just my personal practice.

Let me know if you have more questions.

[ammiga]

Does it matter how mobile the foreskin is? What is the reason for testing this?

[fitmommy]

Wow my son is intact & through my research i read that  NO BODY not even a Dr is so pose to retract the foreskin!

http://circumcisiondecisionmaker.com/foreskin-facts/development/

Here is a quote off this website-

Foreskin Retraction Danger

Forced foreskin retraction by an uninformed adult is the greatest penile risk boys face. It causes severe pain, bleeding, scarring, and may lead to infection and adhesions. The foreskin should be retracted only by the boy himself, and only when he is ready to do so.

CAUTION: Never forcibly retract his foreskin or allow anyone else to do so! It is painful, and can lead to infections and adhesions. Stay with your boy during all medical examinations, and state that his foreskin should not be retracted. Your son should be the first and only person to retract his foreskin.

[QueenOfTheMeadow]

I just wanted to remind everyone of the expert forum guidliines:

The expert forums are intended to be in a direct question and answer format between the member posting the question and the expert. These forums are not for community participation so the only exchange of posting in thread will be between the member and the expert.

Feel free to PM the OP or invite them to whatever forum seems appropriate. Thanks for your cooperation.

[DrBobSears]

It doesn't matter that much.  It's more just to see how it's doing. 

[ammiga]

From my understanding, there is a risk associated with any foreskin manipulation, so I'm trying to figure out if there is a benefit to the manipulation that outweighs any risk. If the boy urinates fine and shows no signs of issues, is there still a reason for the foreskin to be checked? Why do we need to know how it is doing and what are you checking for in terms of how it is doing?