Forskin tears and circumcision

[isleta]

Hello all! I have a question in regards to circum. when one has UTi's and tears. Backround-my son who is three, this week was in terrible pain. Dr. Fleiss told me that it was just inflamed and he gave me tropical ointment to put on. However, he was still in pain and then the doctor pulled back his forskin slightly and noticed a tear at the forskin where his penis will eventually come out. More cream. He also said no UTi, but there was blood and white cells in his urine, so I asked for antibiotics. He is feeling better now. This is the second UTI and third tear he had endured.
I know some of the blame is on his first ped. who pulled back his forskin at a year and told me to do it daily. Then, at two and a half she stated his forskin was too tight and not normal and he needed a circumcision. I did not want this, so I recieved a second opinion from Dr. Feiss who of course said NO! I was not aware of the non-pulling back of the forskin and now am thinking he has aquired phimosis. My question was should I circumcise him due to the pain of the tears and the UTI's. I have been reading the other threads and know you all are very knowledgable about this topic!!
I am against circumcision, but am thinking of my son's best interest, because I am not the one suffering right now. Given his history, it also seems that the scar tissue will be a problem later on. Sorry this is so long! I am just a little confused and trying to get as much imput as possible! Thanks so much!
Isleta:

[Frankly Speaking]

Here is a link to an excellent article on phimosis:

http://www.mja.com.au/public/issues/...w10610_fm.html

There are two types of phimosis. Every boy with a foreskin has normal infant/child phimosis. Then there is acquired or pathological phimosis. From the pictures, you can determine which your son has. If it is pathological/acquired phimosis, the least invasive treatment is stretching with the assistance of betamethesone cream .05%. If all attempts fail, there may be some indication for circumcision. However, to set your mind at ease, about 1 in 10,000 to 30,000 boys will get to that point.

Dr. Fleiss is probably the best Dr. you could possibly get for an intact boy and I would trust him before any other doctor in the United States.


Frank

[laidbackmomto2]

Hi isleta.

Here's a good link for some conservative treatment info on phimosis and acquired phimosis...although I would suggest you discuss your concerns with your ped as well.

http://www.cirp.org/library/treatment/phimosis/

Do you have any idea how your son is getting these tears of his inner foreskin? Is he or you retracting his foreskin? Perhaps it is not yet ready to be fully retracted. Perhaps the preputial sphincter (opening) is not yet "relaxed" enough to allow the foreskin to retract fully over the glans without tearing. My son is almost three and while I believe his foreskin is fully separated from the glans and it looks as though his preputial opening is "relaxed" enough for the foreskin to retract over his glans, it hasn't happened yet. He is (finally) starting to be consistent on the potty (yeah!) and I'm really not worried about anything getting "in" there. He plays with it incessantly in the tub...but he still pulls it forward, not back.

I guess what I'm suggesting is that maybe any retraction should be stopped for a period of time to allow the tears to heal. Then you and your ped can discuss how to proceed from there. If there is scar tissue, perhaps some manual stretching could be beneficial. There are other options to explore rather than jump right to circumcision. And, in my opinion, as long as your son is urinating fine, it doesn't sound like phimosis is a concern.

As for the UTI's, this is an internal infection. Circumcised boys and men still occassionally get UTI's (ultimately, males have about a 1% chance of ever enduring a uti). Will circumcision guarantee that your son will never suffer another UTI? NO. Does the foreskin cause UTI's? NO. Is non-invasive antibiotic therapy effectively treating the UTI? It seems so.

Seems to me that you are on the right track with the help of your ped.

Anyway, I hope that your son is feeling better soon.

Cindy

[isleta]

Thanks so much for your links and support!! Frank- My son does not look like either picture? Last year however, he did have the "pin-hole" looking one. Now, it is much bigger! I had not retracted it at all untill Dr. Fleiss did it too look at it better. And Cindy, my son does pull it forward, not back. Well, untill know because we put ointment on it. Dr. Fleiss said that the tear is from friction. He does wear a pull up at night and he said it could be rubbing it. However, I don't know if they make cotton cloth that fit him.

I don't know much about manual stretching-I am ordering Dr. Fleiss book and hopefully it will explain more. The UTI comes from the tear because the bacteria growth from the tear goes up the urethra. I am just concerned about it because it is so painful for him. Thanks for you imput! And today he felt much better. It is so comforting to know there is some place I can find answers and support. Frank-you are right DR. Fleiss is probably the best and my son adores him! He is really good with kids. We had a disagreement about the UTI, and he was very understanding of my request. Not common in my experience. He also fits us in whenever I call-that day. He has made me quite the advocate!

BTW, my son also likes the bath and is very happy to tell me,"look mama it's big now" and "Oh well it's little again" I am happy your guy is using the potty-my son is doing pretty good with it so far.
For me, I was a sudden(well 9 months) single mama and really did not explore thee issue. I thought that no one should have any part of their body cut off and his father is not circumsized-so done deal! I am know coming out of my ignorance and getting a little knowledge-I know most boys don't even have any problems! I also remenber that whenever a boy was at his bris, someone, usually a male fainted at the cut! I know it was to get laughs but also thought it was sad! Well I a ramblin' Thanks again!
Isleta

[Quirky]

Hi there,

Just wanted to chime in that you can definitely find cloth diapers to fit your son if you're so inclined. Check out our Diapering board here, and these sites:

www.happyheinys.com

www.toddlingtots.com

[Frankly Speaking]

At 3 years old, your son is too young to worry about preputial stretching unless there is blockage of the urine flow. Maybe at 8 or 10 years old, he will be ready if it is even necessary then. Ask us again in 5-7 years.



Frank