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Possible Seperation Issues/Sore/Red/Irritated/Ballooning/Normal Development,etc.

post #1 of 140
Thread Starter 
The Normal Development Of The Intact Penis

The following information is to help answer some of the questions we see most often. In the course of the normal development of the intact penis some things might happen that may be alarming to those of us who have never been around an intact boy/man before. Some boys may have none of these things happen or one or more of them.

The following information has came from many sources including Internet searches along with personal experiences from myself and others. This is only a guide and isn't a replacement for medical care.

When the majority of boys are born the foreskin is fused to the head of the penis much like the fingernail is to the nail bed. As the boy ages the process of separation starts. This process can start shortly after birth or it may not be until the teen years and in some cases even into adulthood (some men go their entire lives never being retractable with no problems at all). There is no set age on when the foreskin will become or should be retractable just as there is no set age when a girl will start her first menarche. It appears that 2.5-3 years old is a really common time when a lot of the following issues appear. But as I mentioned before it can happen at any age.

The separation process in general does not happen all at once it happens over a period of time from weeks to months and in many cases even years. It can appear to happen over night for some boys. The foreskin will often have spots that are still attached even after the rest of the foreskin has released from the glans. This is not cause for concern, when the time is right the spot will release just like the rest of the foreskin has. Unless trauma has occurred in that case a skin bridge may form that may or may not need to be fixed by having it cut apart. But generally when the hormones of puberty hit these attachments will release on their own. This can cause a bit of soreness in the spot that will usually resolve within 24-48 hours.

When the separation process starts there are some things you may or may not see, these things include: ballooning, soreness, swelling & possibly some discharge.


Ballooning is a normal developmental stage and is not a cause for concern and does not require treatment, it is actually a sign that nature is doing it's job. Ballooning occurs when separation of the foreskin from the glans has started but the sphincter at the tip of the foreskin is still tight causing urine to pool under the foreskin. This is not harmful but it can be disconcerting to see it as the foreskin can balloon up quiet dramatically. It can last a short time or can come and go for months or years.

A child temporarily may report some discomfort or pain while urinating during this period. This occurs because the ballooning may tear at any residual connection to the glans. The discomfort will stop when separation is complete. The foreskin may still not be retractable at this point because the opening of the foreskin, sphincter, is still narrow. With increased growth and maturity, the ballooning will end when opening of the foreskin widens.

Pain, Swelling & Redness

Pain, swelling & redness can also go along with the ballooning or it can be seen without it. If either case 9 times out of 10 the pain and redness will resolve within 24-48 hours. If anything lasts longer than that the odds are higher that there is a infection present. It is important to note that if the problems last longer than the above mentioned time frame or you feel something is really wrong a trip to the Dr. is warranted since long term untreated infections can lead to scaring of the glans resulting in loss of sensation in those area's. Sometimes you may see small amounts of blood but it should not be much and it shouldn't last very long.

The most common infections are yeast or bacterial. The treatment for these is not at all difficult. Depending which is present treatment will either be anti fungal, OTC yeast medications like Monistat 7 day treatment (not the 3 day kind) and for bacterial infections OTC Bacitracin (a safer less reactive cream than Neosporin) can be used. Sometimes a prescription of oral antibiotics is required as well. If you do go the antibiotic route make sure to finish the whole prescription even if you son's penis looks healed in just a few days.

Neosporin is not recommended since some people react badly to it. It is important to figure out if you are dealing with yeast or bacterial since the treatment for bacterial infection can make yeast worse. So a swab culture is essential to figure out exactly what you are dealing with.

If you do take your child to the Dr. make sure that his foreskin is not pushed back on at all (See the Warning For Parents Of Intact Sons sticky at the top of the forum for more information as well as The Definition Of Retraction & Why it is BAD) If there is infection present this will make it easier to spread and cause more pain and trauma. To check to see exactly what pathogen is present a swab culture should be done. This is done with the long q-tip and a gentle rub of the very tip of the foreskin will pick anything up that is present without pushing on the foreskin at all.

Helpful tips for dealing with pain

Some things you can do to help if your son is in pain is letting him urinate in a cup of water or the bath tub this will dilute the urine so that wont sting. If your son is old enough you can tell him to retract just enough that the urinary opening is exposed so the urine doesn't go back under the foreskin. Long soaks in the bath with baking soda or a very small amount of Tea Tree Oil can also help sooth the pain.

If you are breastfeeding you can also put breast milk on at every diaper change to help kill off bad bacteria and help reestablish normal balance. Diaper free time and stripping your diapers if you use cloth can be very helpful as well. Especially if dealing with yeast.

The things to watch for that would indicate more than separation injury is going on are: severe swelling that keeps getting worse, fever, discharge with a foul smell or dark green in color, unusual redness accompanied by any of the things mentioned above. If your son is having trouble urinating he needs immediate medical help.

The reason the foreskin reacts so strongly sometimes when separation is happening is because it is a very vascular organ and much like the lips even a small bump can cause swelling and pain.

The normal appearance of the glans and inner foreskin is usually a bright red/purple color. This is often disconcerting to parents who see it for the first time and they think that it is irritated, when in fact it is how it should look. The washed out color of the glans on a circumcised boy/man is caused from the drying out and keritinization of the skin caused by being exposed and rubbed against the clothing.

Smegma Pearl (Picture) Note: The penis in this picture is being partially retracted something that should NOT be done. The pearl is on the right side near the base of the glans it is the very large whitish area.

Something you may also see is called a Smegma pearl. This is a whitish lump that can range in size from very tiny to pea size or larger. Smegma (the Greek word for soap) is a substance that consists of dead skin cells, body oil and other debris that clumps together forming a ball. It is not damaging and will work its way out once separation is sufficient for it to do so. It is not recommended that you try to massage it out or mess with it since this could cause tearing between the foreskin and the glans and result in pain and possible infection.

The time that Smegma pearls are seen is when separation has started. It may make the glans under the foreskin appear like it is crooked. When touched it may feel hard but slightly squishy. It may also look like a blister under the foreskin. If there is any pain in that area odds are that it is being caused by separation and not the pearl, since Smegma is not a irritating substance in itself, unless there is a foreign body in there like lint, that can cause a bit of irritation. For the most part nothing will get under the foreskin but sometimes it happens, especially if separation is well underway.

You may also see a milky whitish discharge. This is Smegma mixed with urine and is no cause for alarm. On occasion you may see a very large amount come out or it may just be a small amount.

Smegma can be the consistency of cottage cheese or it can be like liquid. It comes in many colors, pure white, yellowish, greenish, tan or a combination, it is often confused with pus. But the main thing between pus and smegma is that pus will have a really bad odor like an infection. While smegma may smell strong like unwashed genitals depending on how long it has been under the foreskin but not have a odor you would associate with sickness.

Preputial Cyst (Picture) Note: The penis in this picture is fully retracted something that should NOT be done.

There is also something called a Preputial Cyst that occurs on occasion. Sometimes known as a Keratin Pearl caused by dead skin cells accumulating under the top layer of skin on the glans. The appearance of swelling may occur sporadically as preputial cysts break through adhesions (push up against them) to allow separation of the prepuce, foreskin, from the glans. These whitish cysts are sometimes mistaken for pus due to infection, but they merely represent sterile collections of dead skin. It is a lot like a Smegma pearl but is not between the glans and foreskin but under the skin of the glans. In either case nothing special needs to be done.

Foreskin was retracting now it is not? (Taken from the Mothering Magazine Article by Dr. Paul Fliess)
Sometimes a previously retractable foreskin will become resistant to retraction for reasons that are unrelated to impending puberty. In these cases, the opening of the foreskin may look chapped and sting when your son urinates. This is not an indication for surgery any more than chapped lips. This is just the foreskin doing its job. If the foreskin were not there, the glans and urinary opening would be chapped instead. Chapping is most often caused by overly chlorinated swimming pools, harsh soap, bubble baths, or a diet that is too high in sugar, all of which destroy the natural balance of skin bacteria and should be avoided if chapping occurs. The foreskin becomes resistant to retraction until a natural and healthy bacterial balance is reestablished.

You can aid healing by having your son apply a little barrier cream or some ointment to the opening of the foreskin. Acidophilus culture (which can be purchased from a health food store) can be taken internally and also applied to the foreskin several times a day to assist healing, and should be given any time a child is taking antibiotics.

Spraying While Urinating

Many boys will spray at one time or another during the process of penile growth. If your son has entered a spraying phase, simply instruct him to retract his foreskin enough to expose the meatus when he urinates (if he can do so himself and without pain of course). This is a phase and generally wont last that long. But it might come and go several times during the separation process.


A question we see here a lot as well is if the toddler/child is retractable should the parent retract the foreskin to clean. The answer to this is no, if the boy is not old enough to do it himself then the penis should continue to be cleaned by washing like a finger from base to tip and swishing in the bath water. Once the boy is old enough that he can retract on his own then you can instruct the child to retract, rinse, replace in pure water, do not use soap on the exposed glans of the penis as this can cause pain, irritation and/or infection.

Paraphimosis (not common but good information to have)

Be sure to instruct your son to replace the foreskin over the glans so that it doesn't become trapped behind the glans. If this happens it is known as paraphimosis and it is a emergency situation that needs immediate attention. There are a few simple things that work most of the time to get it back in the proper position.

(Warning!: Actual medical pictures of reduction, genitals shown)

Here are two great article on reducing paraphimosis:


http://www.circumstitions.com/Paraphim.html (Drawings of reduction)

How the foreskin works animated pictures:


Edited by MCatLvrMom2A&X - 7/15/12 at 7:55pm
post #2 of 140
I love it so far---maybe we should PM a mod and see about consolidating the stickie "mothering articles on circumcision" into the web resources thread to make room for this new and important one.
post #3 of 140
Thread Starter 
Yes and maybe consolodating the foreskin issues sticky in with this one.
post #4 of 140
Also- maybe talk about smegma pearls during separation?
post #5 of 140
Thread Starter 
You are ahead of me carrie I just finished a paragraph on it. I am still working and will keep adding as i go.
post #6 of 140
post #7 of 140
I love the way you are writing this article/post. Very easy to follow, understand , and in no way scary! Thank you for taking the time to write something REAL that us mom's of uncircs can understand.
post #8 of 140
Thread Starter 
I hope some others will chime in with ideas. Since I am sure I will forget something or word something wrong.

Any ideas at all on what to put in the disclaimer?
post #9 of 140
Originally Posted by MCatLvrMom2A&X View Post
I hope some others will chime in with ideas. Since I am sure I will forget something or word something wrong.

Any ideas at all on what to put in the disclaimer?
the mods might be able to let you know what the disclaimer should contain- there might be rules on that.

Also, I remember in YUlia's thread she asked if she should have him massage the smegma pearl out or try to push it down. Should that happen or not?
post #10 of 140
Thread Starter 
From what I have been reading everything says just leave it alone and let nature take care of it. I added that in there.
post #11 of 140
Thread Starter 
Ok I think I covered everything but I am sure I missed something. Please anyone that has something to add let me know and I will add it.
post #12 of 140
Wow, thanks for writing this. I am expecting a little guy and have been reading everything I can. This is succinct and easy to read
post #13 of 140
Thread Starter 
Thank you for the feedback yarngoddess & mamajessica

Thank you carriebft for the nudge you gave me to try my hand at writing it.
post #14 of 140
This is some stuff I put together for a sticky on another board, it might be useful here as well.


Phimosis? Foreskin Development & Normal Age for Retraction


"As a consequence of misdiagnosis and confusion of normal developmental narrowessness and non-retractablity with pathological phimosis, many unnecessary circumcisions are performed."

What Is Foreskin Retraction?

Sometime during the first several years of your son's life, his foreskin, which covers the head of the penis, will separate from the glans. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months or years.

After the foreskin separates from the glans, it can be pulled back away from the glans toward the abdomen. This is called foreskin 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.

American Academy of Pediatrics
Retraction of the Foreskin

At birth, the foreskin is usually attached to the glans, very much as a fingernail is attached to a finger. By puberty, the penis will usually have completed its development, and the foreskin will have separated from the glans.8 This separation occurs in its own time; there is no set age by which the foreskin and glans must be separated. One wise doctor described the process thus, "The foreskin therefore can be likened to a rosebud which remains closed and muzzled. Like a rosebud, it will only blossom when the time is right. No one opens a rosebud to make it blossom."9

Even if the glans and foreskin separate naturally in infancy, the foreskin Ups can normally dilate only enough to allow the passage of urine. This ideal feature protects the glans from premature exposure to the external environment.

The penis develops naturally throughout childhood. Eventually, the child will, on his own, make the wondrous discovery that his foreskin will retract. There is no reason for parents, physicians, or other caregivers to manipulate a child's penis. The only person to retract a child's foreskin should be the child himself, when he has discovered that his foreskin is ready to retract.

Mothering Magazine:
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. There is no age by which a child's foreskin must be retractable. Do not let your doctor or anyone try to retract your child's foreskin. Optimal hygiene of the penis demands that the foreskin of infants and children be left alone.

Mothering Magazine:
Avoidance of premature retraction. Care-givers and healthcare providers must be careful to avoid premature retraction of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.3

The Development of Retractile Foreskin in the Child and Adolescent
A guidance for healthcare providers from Doctors Opposing Circumcision

Also available in a PDF leaflet.
Almost all boys are born with narrow non-retractile foreskin which are fused with the glans beneath. This is a normal developmental physiological condition and is not a cause for concern. Some parents needlessly worry that the opening is not large enough.

Retraction of the foreskin should never be forced. It will retract when it is ready. There is no "right" age for retraction to occur.

A narrow non-retractable prepuce in boys is within the normal range of development and usually causes no problems. The prepuce usually will spontaneously widen until complete retractability is obtained. About 50-60 percent of boys at age ten do not have fully retractable foreskins.16 This is normal.16 After puberty, the percentage of boys with full retractability rapidly increases spontaneously.16

If a narrow or non-retractile prepuce becomes a problem, a wide variety of conservative alternative treatments to circumcision are are now available. Circumcision is an outmoded, radical, traumatic, disproportionate, unnecessary surgery for a minor problem.

Normal development of the prepuce: Birth through age 18
See Also: Intact Care Agreement

More great info, from the Canadian Paediatric Society:

In general, there is inadequate recognition of the long period before the natural separation of the prepuce and glans is complete.96 Some authors still refer to the presence of "adhesions," when, in fact, separation has not yet taken place; similarly, a nonretractible foreskin is still sometimes incorrectly diagnosed as phimosis.97

In a study by Rickwood and Walker98 involving 420 boys referred to their unit for possible circumcision, only 116 (28%) required the procedure. They found no true phimosis in boys younger than 5 years of age. Most of the patients had developmental nonretractability of the prepuce, and their preputial orifice, although somewhat narrow, was supple and unscarred. The authors compared this finding with data from the Mersey region of England, where phimosis was the most common indication for circumcision, accounting for 87% of the procedures, and where 390 of the 950 patients circumcised were younger than 5 years of age. They estimated that approximately two thirds of these circumcisions performed in the Mersey area were probably unnecessary.
The false diagnosis of "Phimosis" in young boys

Conservative Contemporary Treatment of Phimosis

Can foreskin problems be treated without circumcision?

The #1 rule for intact care is to leave it alone.

The first person to retract a boy's foreskin should be the boy himself.

Until then, just wipe it off like you would a finger or give it a swish of plain water in the bath.

Once he can retract it himself, all he needs to do is "RETRACT, RINSE, REPLACE" in the shower or bath.

A note about 'separation trauma':

Red, Swollen, or Inflammed Foreskin (by Frank)

Oh no! Your son has a very red, swollen or inflamed foreskin! Classic symptoms of a dread foreskin infection, right? Well, maybe but probably not. But, how do you know?

Often its not most of the time, it can be something called separation trauma that is a normal part of development in boys. The foreskin is exquisitely sensitive and very similar to the eyelids and lips. Just like a minor bump on the lip can cause it to get very red and swollen with what we call a .fat lip. the foreskin responds the same way to any physical insult. As the boy.s foreskin prepares for separation of the bond to the glans, it is not an even process with spots remaining adhered and areas around it fully released. With the boy pulling at it and with erections, these spots get pulled and slight tears in the inner mucosal foreskin or surface of the glans result and the response of the child.s body is redness or swelling. This redness or swelling can be significant and alarming but the situation is not serious. The symptoms will improve greatly or completely subside within 24 to 36 hours and everything will go back to normal just as a fat lip will. Watch your son for 24 hours from the first symptoms and if you see significant improvement, continue to watch

But, what if it is an actual infection? Simply, the symptoms will not subside within the 24 to 36 hour period. That is not something to be overly alarmed about as these infections are simply minor skin irritations and will cause no long term damage as long as they are treated promptly and treatment within a couple of days is well within the range of prompt treatment. The only thing to watch for is any restriction of the urine stream such as a weak stream or a fine thin stream. If this situation develops, immediate medical attention is needed.

If it does turn out to be an actual infection, insist that the doctor take samples for a culture. This is the only way to assure that the pathogen (bacteria or fungal) is accurately identified and the only way that you can be assured that the proper medication is prescribed. When the doctor takes samples for a culture, he/she will swab the end of your son.s penis with two cotton tip swabs, one for bacteria and one for fungals. (yeast) It will take two to three days for the results of the test to return and the doctor will probably give you a prescription for a medication based on a visual examination of the symptoms but you should call the doctor about 3 days later to make sure that the medication is effective on the particular pathogen. If not, you will be given a new prescription that is effective.

With the proper medication, you will see results within a couple of days. However, even with a culture, not all medications are effective all of the time and if you do not see a complete abatement of the symptoms within five days, call the physician for an alternate treatment. Although the symptoms disappear quickly, the prescription will probably instruct treatment for 10 days or so. Be sure to administer the prescription for the full time. Although the symptoms may be gone in two or three days, some of the pathogens may remain that can flare up again if the treatment is ended.


I grant free and unfettered permission to post this (Red, Swollen or Inflamed Foreskin?) any where on the internet ~Frankly Speaking~

post #15 of 140
Thread Starter 
Thanks pdx.mothernurture Since we already have a retraction sticky I didnt feel it was needed to go into detail in this one about the dangers of retraction. I havnt added any links but that would be a good idea. If I could find one on smegma pearls I would like to add it but not a single search I did talked about a pearl. I was only able to find one site that talked about the cysts and the info on the page is outdated indicating dr should retract. So I only got the information on what the cyst is. Sucks sometimes information is hard to find.
post #16 of 140
Thread Starter 
post #17 of 140
post #18 of 140
Thread Starter 
If you have anything to add please let me know. Also grammer corrections would be welcome as well. I want this to be easy to read and accurate. Thanks
post #19 of 140
Thread Starter 
I wanted to bump this up for a poster.
post #20 of 140
Great job!!
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