Retraction at 3 yr well check?

[Drewsmom]

I read the sticky on forceable retraction but not all of the way down. Is there something official about intact care (I saw it mentioned in one of the first posts but no link to the papers) that I can hand to my dr? Ds seemed to be fine when she did it so he must already be naturally retracted but unfortunately I did have a bad ER experience with him at 8 weeks when the nurse did it before I had the chance to say no.

After asking the ped if she retracted newborns (as I am pregnant) she said, "No, I never retract before 3." At 3 they look for the midline on the head of the penis (?) So is this alright?

[QueenOfThePride]

No it's not alright.

At 3 they look for the midline on the head of the penis (?)

That doesn't even make sense to me either. Midline means an imaginary line that divides something in equal halves. She wants to make sure he has equal halves of his penis??? WTF???

They just keep coming up with wierder and wierder reasons to justify retracting. I don't know if any official care sheets would change her mind, since it sounds like she's just making up a reason.

[sadkitty]

Well, would it be allright for the doc to probe a daughter's vagina to see if the hymen was still there? No, it is the owner of the penis that has the right to retract it. Even pulling back "just to look" is invasive and unnecessary.

[eepster]

Why should she want to see the midline? If she is looking for something like meatal stenosis then you can simply inform her that intact boys don't get it so she doesn't need to look. Is she looking for perfect symetry? If it isn't perfectly symetrical what would she do about it anyway, so why bother looking. Intact boys don't have problems unless Drs create them so it should just be left alone.

[Quirky]

That is just wacky. : There's just no reason for a doctor to retract at a well visit, EVER. (Nor is there any reason to retract when they're sick....)

There's just no magical age at which kids are retractable. What does she do to the ones who don't retract at 3 -- force it? Recommend circ? Blech.

[Fyrestorm]

Here is a link to the intact care agreement...have her read it, sign it and put it in your file

Intact Care Agreement

[Drewsmom]

Thank you for that link. I've been trying to do my own research online to see if I could find "reputable" medical journals that concurred. The one that I did find encouraged retraction beginning after 1 yr during bath times once a week arrrggggg!

She actually is the dr of choice for natural moms in the area but obviously lacks on some info. I hate how they just do it without "asking" beforehand. I hate that she had a student nurse in there. Fortunately I clarified for the student's benefit and mine that she doesn't do it before 3 but I needed to follow up with more qu.s obviously.

She is the type that when I write a letter (I need to anyway letting her know about her colleague as well as the nurse who came in and examined without washing their hands, another arrgg) letting her know my feelings on retractions will take it to heart and won't do it again and will think about not doing it for other kids w/out permission next time. I'm thinking that somewhere in her training she ran across the info to start retraction at age 3 but from what I've read it may not even naturally retract fully until puberty and as long as there are no prob.s it should be left alone. There are no prob.s. I did ask ds if it hurt (he's very verbal) and he said no. However this kid has an extraordinarily high pain tolerance so now I'm going to have to watch for infection : and redness.

Why is it that the med community is so specific about the procedures of certain things and neglect to inject common sense into so much?

[MCatLvrMom2A&X]

Here is the AAP Intact Care Guide The rules she is supposed to follow as a Dr. and it clearly states NO RETRACTION.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin.

At any rate be sure to tell her that you do not want his penis even touched.

Why is it that the med community is so specific about the procedures of certain things and neglect to inject common sense into so much?

The reason they dont know about the foreskin is all they are taught in med. school is how to cut it off. It was taught for years that the foreskin should be forced back and scrubbed under from infancy : as the intact population here grows information on proper treatment is getting out there but the going is so slow.

[MCatLvrMom2A&X]

Another link http://www.nocirc.org/publish/pamphlet4.html

If you look in the resources sticky there are several links there from different places including other medical sites.

[buckeyedoc]

Originally Posted by Drewsmom

At 3 they look for the midline on the head of the penis (?) So is this alright?

Maybe for mild hypospadias? Why at age 3 instead of just waiting to see what's there once he is able to retract???

[hunnybumm]

It is never ok for a doctor to retract any persons forskin without their concent. Your son is only 3 and not old enough to give them concent. I don't think doctors (especially this one) are out to purposely retract because it's fun, they are just ignorant and are never taught how to properly treat a forskin. I would just make sure that any time you take your son to the peds (or any doctor) tell them first off that she is not allowed to touch your sons penis, not to retract, not to check for X Y or Z, period. Then if she starts to take off his diaper/underware repeat that she is not allowed to touch your sons penis. If she even makes an attempt to touch your sons penis slap her hand away and pick your son up and tell her the exam is done.

When your next baby is born, if it is a boy, the previous information is so very important. It sounds as if your 3 year old is mostly retractable, if not fully. But a smaller baby won't be retractable and if the doctor retacts, even a little bit, it could cause serious harm. So start your brain working now to tell any doctor that they are not allowed to touch your childs penis.

[wallacesmum]

docs look for problems. if they can't find them, they will create them. it's their training. that's why we don't do wbv.

[Drewsmom]

Thank you Melissa! That is *exactly* what I was looking for. Unfortunately something from a source like the AAP would probably be deemed as more credible or credible enough to have her question her practice of doing so at 3 yr well checks. I will continue to gather info so I can have enough to send her way. I just think that it's important not only for my son but for all of the others that will/are attending her practice.

And yes, if this is another boy I definitely know now! Noone will touch his penis period, period. It's fine with me if they look for a descended testes but that is it and I will remind, remind, remind as the exam goes on and ask constantly what they will be looking for, letting them know of my experience, educate them on why you don't retract and let them know that noone has permission to touch my son's penis except for his parents and himself.

Thank you ladies.

[wendy1221]

My ped has never retracted any of my kids at a check up, even my 7yo. The only time he even touches their penis is to move it out of the way if it's in the way when he checks the testes. Ds3 had a very red tip once and I wasn't sure why, so I asked doc while we were there for something else. He picked it up from the base to look at the tip, no retraction, and told me to try a little Lotrimin or similar cream on it. And if that didn't work, just keep diaper rash ointment on it until it clears up, no big deal, it was either yeast or dry irritated skin.

[Drewsmom]

OK, so I'm in the process of writing this letter to my Dr. (who I do again for the record think will be open to the information). I think that she was checking for hypospadias and initially the med information says to look at the meatus for an indication.

So...my question now is does anyone have offhand some info re: that if surgery needed to be done to correct something like that it could be done afterwards and yes it does happen to intact boys. The good thing is that with intact boys they use the foreskin for reconstruction so a circ'd boy has a much more diff. time with the reconstruction I would assume.

[falcon]

To your original question, definitely no. Our dr didn't even ask to look at ds penis at his 3 yr check up. I'd definitely write a letter

[Lula's Mom]

Kristen,
There are degrees of hypospadias, the abnormal location of the meatus lower on the glans, shaft, or even the scrotum. As the degree of abnormality increases and the meatus is seen farther down on the penis, other defects are seen too.

So with a very mild case of hypospadias, which allows the boy to urinate freely and where the meatus is just barely out of its normal position, you might not know it in an intact boy. That's OK because this requires no surgery. He essentially doesn't have a problem.

But if the hypospadias present is more severe, the type that may require surgery, you will see defects such as hooded foreskin and chordee associated with it. That means you can't miss moderate to severe hypospadias; it's not something that would be hidden in an intact boy and only seen when he becomes retractable.

This may help explain why: http://www.emedicine.com/ped/topic1136.htm

The prepuce normally forms as a ridge of skin from the corona that grows circumferentially, fusing with the glans. Failure of fusion of the urethral folds in hypospadias impedes this process, and a dorsal hood of prepuce results. On rare occasions, a glanular cleft with intact prepuce may occur, the megameatus intact prepuce (MIP) variant.

Chordee, or ventral curvature of the penis, is often associated with hypospadias, especially more severe forms.

You're right that most of the time, they use the foreskin to repair the abnormality (man, I hate saying 'defect' and 'abnormal' when it comes to kids! ) So when the baby is born, and they can tell from the outside that he has this condition (usually from the incomplete foreskin that he has), the doctors will not circumcise him. They already know he's probably going to need whatever foreskin he's got for the surgery, if his parents opt for that.

So again, it's not a surprise- it's not like they circumcise the baby and then go "whoops! This kid could've used that foreskin because he has severe hypospadias!" They would have known that in advance.

The bottom line is, there's nothing she needed to see in there, and she shouldn't have retracted him. She was wrong.

[Lula's Mom]

One more thing- your last post made me think you were replying to eepster's post #4 when you said "Intact boys do get it"- but she was speaking of meatal stenosis. That is a condition found in 10% of circumcised boys. It's caused by the urethra being exposed to friction and the burning effects of urine and who knows what else, until it scars almost shut and the boy has trouble urinating. Then they have to go and widen the meatus. Ouch.

http://www.emedicine.com/ped/topic2356.htm

[Drewsmom]

Originally Posted by Lula's Mom

One more thing- your last post made me think you were replying to eepster's post #4 when you said "Intact boys do get it"- but she was speaking of meatal stenosis. That is a condition found in 10% of circumcised boys. It's caused by the urethra being exposed to friction and the burning effects of urine and who knows what else, until it scars almost shut and the boy has trouble urinating. Then they have to go and widen the meatus. Ouch.

http://www.emedicine.com/ped/topic2356.htm

You're right and I assumed that's what she was talking about and thank you so much for the info it will be passed along to Dr.

You ladies are wonderful!