Help- infection in penis??

[RiceMomma]

They sent me to this board because so many here are knowledgable in this area. Please don't flame me. My son is circed.

I'm not sure what to do with my 1yo. He's had something going on off and on with his penis for the last two weeks. He had a bad diaper rash after having a bout of diarrhea (so did his 2yo sister- they had the stomach flu.) Anyway, his penis was a little red, I assume it had to do with the diaper rash. the rash cleared up, but then the tip was still red and pussy from the urethra. I put some herbal cream on it and it cleared up. It's been red off and on since then, but not pussy, especially in the morning after being in a wet diaper so long, but it doesn't seem to bother him to pee. He doesn't have a fever, isn't grumpy, ect-all the things I look for when a baby isn't feeling well. He doesn't grab at his diaper or penis.

Then this afternoon, my husband changed his diaper and told me there was some blood in it- like a drop. Is this a warning sign? Has anyone had anything like this happen? I did notice that it does look a little puffy around the urethra this afternoon. Maybe a yeast infection? I am reluctant to go to our doctor becuase I have issues with her and at the present time am unable to change doctors. Is there something I could try at home before going the doctor route- I really don't want to put him on anitbiotics-which I know doesn't work in yeast, but I have the feeling this is what my doc will want to try.

BTW- my son wear cloth diapers.

[Tinijocaro]

Sounds like meatal stenosis- don't have time right now, but do a search. Hope the little guy is better soon!

[Frankly Speaking]

This is almost certainly a case of meatal stenosis which is a very common complication of circumcision. It affects at least 1 in 10 of all circumcised boys. It is basically unknown in intact boys.

Older information suggests that ammonia from wet diapers was the cause but more current information shows that ammonia is only a possible contributing factor and probably not significant. The true cause seems to be a reduction of blood flow to the affected area which makes the meatus (urethral opening) more susceptible to infections and much slower to heal. This is because this area, known as the frenular area is one of the few areas of the body that has a dedicated blood supply. It is supplied blood by the frenular artery and during circumcision, the frenular artery is severed and terminated. While there is some blood supply from the surrounding area, it is often not sufficient to provide adequate blood supply and leaves the area vulnerable to infections and slow to heal after any trauma such as the conditions that can cause diaper rash.

I really hate to tell you this but there isn't likely anything that can be done to help your son. This will be a condition he may eventually out grow or he may not. You can take some preventative measures such as using an occlusive ointment to proetct the area from any abrasion from clothing, etc. You should also be careful about anything that can cause irritation to the area. Prompt diaper changes will help. He should also not take bubble baths and be careful letting him swim in chlorinated swimming pools or in saltwater as these can easily irritate the area.

There is no way of knowing when this will abate. I know one mother of a 7 year old who is still battling this daily with applications of Vaseline and he still has irritations. The danger here is that this results in the formation of scar tissue that can close the urethra shutting off the flow of urine and that can cause kidney or bladder damage. Keep a close eye on him and watch for any sign of obstruction such as a fine thin urine stream or the inability to completely void.

If this obstruction does occur, the doctor will perform a procedure called a meatotomy where he/she will take a pair of surgical scissors and cut the opening to make it larger. It is common for this procedure to be performed with no pain relief and that is simply cruel and inhumane. I can tell you, being a man, that would be excrutiatingly painful. If this procedure does need to be done, insist on being in the room and make sure that anesthesia is provided before the procedure.

Good luck to you and your son. Hopefully, he will outgrow this soon!





Frank

[pdx.mothernurture]

Great info, Frank.

My stepson (now 13) also had meatal stenosis. I've always told people that while he may not conciously remember his newborn circumcision, almost certainly performed without a drop of anesthesia since it happened over a decade ago, he does vividly remember the recovery from the second operation, to correct the stenosis, which was done under general anesthesia. To this day he talks about how much it burned to pee afterwards.

It's apalling to me that parents are still told the risks of circumcision are 1-2% (if risks are mentioned at all), but nothing is mentioned about the complications that are far more common but harder to track that occur after the first week of life, like meatal stenosis among others.

To the OP: Until the irritation subsides you may want to begin to start changing his diaper halfway through the night, just so he doesn't sit in it quite so long, especially since you're using cloth. It sounds like he's experiencing meatitis/meatal ulceration, which could/will lead to actual stenosis. Limiting time in diapers, more frequent changes, and use of a barrier cream may aid healing by decreasing exposure and irritation...but be aware of the symptoms of meatal stenosis, as it can contribute to UTIs and may cause kidney damage.

Some symptoms to watch for:

Abnormal strength and direction of urinary stream

Visible narrow opening at the meatus

Discomfort with urination (dysuria and frequency)

Incontinence (daytime and/or night-time)

Bleeding (hematuria) at end of urination---[Sounds like he may already have this one, since you've found blood in his diaper.]

Urinary tract infections

Here's some more info:

http://www.cirp.org/library/complications/persad/

Sorry to hear what he's going through, hope things improve.

Jen

[RiceMomma]

So there's no way it's a yeast infection? I posted this question on the baby board, and someone mentioned yeast infection, and I did some research on the symptoms- one of them is scaley skin, sometimes patterned looking- which sometimes it does after being in those night time diapers.

Wouldn't he have had problems before 1yo??

I have started changing his diapers whenever he wakes up in the night- which he still does sometimes for a little snack

Thanks for all the info. Very interesting. Definitely something that my doctor NEVER told me.

[Maman Soleil]

I haven't seen what it looks like, but, from your description, it can also be a balanitis, it is something more common than meatal stenosis. It is an inflammation or infection of the tip of the penis, which usually resolves easily but can recur. You can try to put him a few times a day in the bath and if it is only inflammation, it should improve. If not, you may need some antibiotic cream to help. (See your ped)

Good luck

[Frankly Speaking]

Originally Posted by RiceMomma

So there's no way it's a yeast infection?

It's impossible to rule out anything without a culture but from the symptoms you have described, they point to meatal stenosis. Since meatal stenosis is far more common than either yeast or bacterial infections, it is the best guess at this time and with the information provided.

Wouldn't he have had problems before 1yo??

The symptoms can start at any time, even up to 2-3 years old for the first occurance.

Thanks for all the info. Very interesting. Definitely something that my doctor NEVER told me.

No, they don't tell you this. At most, they may make mention of "Extremely rare" complications. The problem is that most infant circumcisions are performed by OB/GYNs who by definition are specialists in the female genitals and never see the boys they circumcise again and are never aware of the problems they cause. This explains why OB/GYNS are far more supportive of circumcision than pediatricians and why OB/GYNs perform the vast majority of circumcisions (more than 75%) in this country.

To hear them tell it, circumcision will prevent all of these problems instead of causing them. However, you have to take the advise of The AAP when they say "the risks outweigh the potential benefits." They know what they are talking about.



Frank

[Xenogenesis]

I also have a circumcised son. Many of us here do.

Originally Posted by Frank

If this obstruction does occur, the doctor will perform a procedure called a meatotomy where he/she will take a pair of surgical scissors and cut the opening to make it larger. It is common for this procedure to be performed with no pain relief and that is simply cruel and inhumane. I can tell you, being a man, that would be excrutiatingly painful. If this procedure does need to be done, insist on being in the room and make sure that anesthesia is provided before the procedure.

Better Yet: Discuss THOROUGHLY the exact procedure AND anesthetic LONG BEFORE they have your son anywhere near the operating table. Write down what they say. Ask him/her to repeat or write out what you don't quite understand. That way they won't try to just swab a local on his most sensitive parts and claim that it'll do the trick. Do not allow any last minute short cuts to be made with your son. Don't let them rush you into anything that you don't feel 100% comfortable with. Let us know how he's doing.

[RiceMomma]

Well, he doesn't seem to be improving- I'll see how he looks this morning when he wakes up. I've been putting an anti-fungal on him, and mostly putting him in prefolds with out covers during the day to give him lots of air. I'll probably call the dr today and see if I can get him in. Will the doc most likely recognize the problems you all are describing? I have found that I have to know at least as much, if not more, as the doctor about a particular problem to get appropriate treatment, not just with my family doc, but with any doc I've seen in this area. It's very frustrating. and to top it off, I've stopped vaxing my kids, so that's another reason I'm hesitant about going in.

I do believe a ped circed him, though I would have to check to be sure.

[Xenogenesis]

Breathe Deep . . . you are the customer . . . please don't forget that . . .

"they" are hired by you to do something for you . . . much like a mechanic services your car . . .

If by any chance your not taking advantage of the other services they provide comes up - stand firm. They can't make you buy their stuff.

Lots and lots of

[Xenogenesis]

To everyone else:

What are the names of some folks who can refer this lady to some "In Real Life" people or doctors or specialists?

[RiceMomma]

I took my little guy in today- we didn't see our regular doc- she wasn't in. And they didn't say about the vaxes. Anyway, you all were right. Not that you'll be surprised by that, but I must confess, and apologize, I really did think you all were trying to scare me. Not to mention the fact that I didn't want there to be anything wrong with my son. Anyway, he has an appointment with a urologist next Tuesday.

Here's what happened: The doctor didn't know what to make of it, so she went and got another doctor, and he recognized it-- of course, they both ignored me and anything I had to say as they examined him, like I had nothing to do with it- just talked over me. I'm so sick of doctors. Anyway, they told me what it was, his meatus was becoming obstructed with new skin growth. They told me it's so rare. The first doctor had never seen a case and the second one had only seen it once. ???

Then the doc told me to put my son in disposable diapers until Tuesday because they are so much softer. What???? No way are they softer than a fleece lined fuzzi bunz. The prefolds might have a little texture, but no way am I putting him in a disposable if he's irritated!!

She also told me I did nothing wrong. It's not my fault this happened, becuaes I was asking her so many questions about why it happened. I told her I was also concerned because I am pregnant, and should I circ my baby if it's a boy? (I know how you all will answer that question.) She said this is so rare, and if she had other children who were circed, she wouldn't decide not to circ based on this incident. Huh? Why not??? She may say it's rare, but if it's happening to you, it's 100%. What does it matter if one of my sons is already circed? Is that really going to affect a next son? If I want to cut something to make them look the same, can't I just focus on their hair or something that will grow back?

Well, I'm sure you didn't need all of that. I didn't think too much about the circumsicion decision when I had my son, because my husband is circumcised, and I kind of felt that was his department.

But I have to say, in reply to that doctor saying I did nothing wrong-- I did choose, albeit uninformed, to have him circed. If I'm not responsible, then who is? Why aren't parents responsible for the choices they make for their kids???

Sorry for the rambling post, everyone. Thank you for all your help. Is there anything I need to know before we see the urologist on Tuesday?

[pdx.mothernurture]

First, I'm sorry your son is going through this.

Second...your doctors are really, really ignorant if they claim this is "rare". 10% of circumcised boys get Meatal Stenosis---10%! That's not rare.

Here's an article that says exactly that, and more: http://www.emedicine.com/ped/topic2356.htm

"After circumcision, a child who is not toilet trained persistently exposes the meatus to urine, resulting in inflammation (ammoniacal dermatitis) and mechanical trauma as the meatus rubs against a wet diaper. This causes the loss of the delicate epithelial lining of the distal urethra. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in children who are not circumcised, circumcision is believed to be the most important causative factor of meatal stenosis. Another hypothetical cause of this condition is ischemia due to damage to the frenular artery during circumcision, resulting in poor blood supply to the meatus and subsequent stenosis."

HTHs...

When my stepson had this condition, he was put under general anesthesia for the operation. I've heard it's more commonly done in the office...but if they do this be SURE that anesthetic is used to reduce the pain. Don't assume the doctor will use anesthetic...if he doesn't mention it, ask...and demand it.

Jen

[Xenogenesis]

Originally Posted by RiceMomma

Then the doc told me to put my son in disposable diapers until Tuesday because they are so much softer. What???? No way are they softer than a fleece lined fuzzi bunz. The prefolds might have a little texture, but no way am I putting him in a disposable if he's irritated!!

You are totally right to question this. The chemicals in the sposies might make things worse for him. If anyone uses mama pads I know they know that you are right.

Originally Posted by RiceMomma

She said this is so rare, and if she had other children who were circed, she wouldn't decide not to circ based on this incident.

Does anyone know of the tendency for this type of thing to "run in the family". Or is it the technique of certain doctors that is more likely to contribute to it.

Originally Posted by RiceMomma

I didn't think too much about the circumsicion decision when I had my son, because my husband is circumcised, and I kind of felt that was his department.

But I have to say, in reply to that doctor saying I did nothing wrong-- I did choose, albeit uninformed, to have him circed. If I'm not responsible, then who is? Why aren't parents responsible for the choices they make for their kids???

"I did then what I knew how to do. When you know better, you do better." ~ Maya Angelou.

Originally Posted by RiceMomma

Sorry for the rambling post, everyone. Thank you for all your help. Is there anything I need to know before we see the urologist on Tuesday?

Yes.

Absolutely, Positively MAKE sure he has 100% pain control.

And know that if it isn't being effective that they will STOP and remedy the situation.

I'm sorry your son is going through this. I'm glad you came here to ask.

[Frankly Speaking]

We are not going to try to scare you. You have enough problems as it is and that would just be cruel. We are not like that here.

I suspect they say it is rare because they don't recognize the symptoms unless they are severe. Dr. Paul Fleiss says he sees signs of meatal stenosis in about 60% of his circumcised patients. Of course, he is very much against circumcision and is very educated on the problems so he is probably just more aware than the average pediatrician. I suspect that your pediatrician has a similar number of patients with lesser signs of meatal stenosis that she has just never recognized for what it is.

Don't put too much blame on yourself. You have been deceived by the medical profession with a very institutionalized lie. They have lied about it so much and for so long that the lies have become "common knowledge" even though no one outside the medical profession knew they were lies before the advent of the internet. Now they are being exposed for what they are.

Now you have had a heads up on the circumcision issue. It's toobad it had to come like this but this one is really fairly insignificant. Much worse could have happened. Learn all you can about it before this next bundle of joy arrives so that you can make an informed decision.




Frank

[hummingbear]

How are you and your boy? Have you been to the urologist yet? My sister has a boy who has had extensive experience visiting a urologist for different reasons. I will ask if she has any general advice to offer.

Sorry you are going through this and good luck to you all.

Ann

[RiceMomma]

Thank you all so much for your kindness and wisdom. I have been meaning to reply, but every time I come back here, I get all teary eyed- mostly hormonal from the pregnancy, but also because everyone circs, and it's so freaking stupid, and I myself did it to my own son. I try to tell my freinds about this, and I'm met with silence- what I say goes in one ear and out the other and they act like, "Andrea's on another one of her psycho missions again."

We see the urologist tomorrow. I will be sure that measures are taken to eliminate any pain my son might feel. I will come back and let you all know what happens. I am officially on the anti-circ band wagon now. Boy I wish it hadn't taken something like this to wake me up.

[RiceMomma]

Well, today I sent around an email to most of my freinds with young boys, or who may someday have baby boys, letting them know what's happened to my little guy. Two have emailed me back- both with horror stories about intact foreskins, and one demanding to see for herself that the AAP doesn't recommend circing. Interestingly, she didn't offer me a source for her horror stories. Here is a little exerpt.

"Hi, sorry to hear this is happening to you. But on the flip side I can tell you of some extremely scary cases of grown men (one was 65) who almost lost his entire penis because they weren't circed and got etremely dangerous - not to mention painful - infections. This was due directly to the foreskin. They ended up having to be circumcised. Like anything there are always possitives and negatives to both sides. Also this is the exception - not the rule. Also you shouldn't think it [meatal stenosis] is a direct result of being circed "

[Frankly Speaking]

Andrea, I've heard stories like that too and every single one of them were untrue to some extent or another.

In the case of the 65 year old man, it is highly unlikely because by the time the infection would get this bad, it would have had to be going on for weeks or months. The man would be in horrible pain for most of that time and his penis would have been badly swollen for weeks. As you can see, even the most stoic man would have been in the doctor's office long before it got to this point. Once at the doctor's office, he would be given some antibiotic ointment and within 36 hours, most or all of the symptoms would be gone. Either your friend is repeating a story she heard from someone else who had embellished it liberally or she is a drama queen.

As to her statement "Also this is the exception - not the rule. Also you shouldn't think it [meatal stenosis] is a direct result of being circed" Your friend is trying to be the expert when she doesn't know what she is talking about. Meatal stenosis is unknown in intact boys but is very common in circumcised boys. That is well documented medical fact. It can't even be argued in medical circles any more.

I suspect she has circumcised a son or is planning on circumcising future sons and is trying desperately to defend her decision. That is very common. These people often speak with certainty and conviction as if everything they are saying is fact when it is mostly urban legends and misinformation passed down from people equally invested in circumcision and misinformed about intact genitals.



Frank

[mattemma04]

Good for you Andrea. I am not suprised by the responses.Genital cutting is clung to very strongly by those that do it,and often only problems in someone they know very closely can help change their views.But then again not in some cases like the parents in BC whose son bled to death after a circ(they will circ future boys).
I have an intact boy,and there are no issues with his penis and foreskin.The horror stories... I just don't get them,unless they are retracting these boys and putting soap on that area. Ask for details and break them down.I have had more problems with my girl than my boy! The elderly generally have more health issues than the young.To circ an infant becasue they might*need(highly unlikely) circumcision at 60+ is silly.

Don't give up due to the negative responses.You might eventually help change someones mind,and save a little boy from the pain and resulting injury of circumcision.

I hope all goes well with your son.
Sara