need some info (re: balanitis and circ) - Page 2

[Fi.]

That lump and "pus" just sounds like a smegma pearl. Sep trauma also sounds very realistic especially in combination with a smegma pearl. Get a culture, insist on it.

Also, if he's got sensitive skin you really don't want him sitting in water that has any kind of soap in it, even baby wash, and even non retracted.

[carriebft]

http://www.mothering.com/discussions...d.php?t=764732

Many find the above thread helpful.

I also second that many people, even in the medical field, mistaken smegma for pus, especially in intact boys because it pearls under the foreskin and they freak out seeing the lump.

Culturing is going to be the best way to see if there is an infection. If you don't culture you don't know what it, if any, infection is present. Any clearing up in the course of the antibiotics could just be coincidental. I would demand a culture.

And this:

5 - i think rhys is prone to skin infections as is (this is not his first, nor the first location of a skin infection for him).

is telling me, again, there may be something deeper doing on here. A dermatologist or a urologist are probably a better bet for the discovery of the problem rather than a ped.


Also, note that another big factor in balanitis is not properly drying the genital area.

[Fellow Traveler]

You should insist on a culture just to be sure it is an infection and find out exactly what it might be, no use treating with abx if it isn't. You said this hadn't been done yet so defiantly do that. Also as carriebft mentioned, considering the other skin aliments perhaps there is a connection. If it turns out not to be an actual infection it could be yeast or separation we just want to be sure.

Don't sweat the tone; everyone is here to help you and yes tone is difficult to judge on a message board. FYI there have been many who have come through here in your position (sometimes even with a circumcision scheduled) which was resolved after talking to members. So any tone is more directed at doctors who aren't up to speed on treating intact boys and is in no way directed at you. You are clearly trying your best to do what is right. Often times the infection those boys had were not infections but part of the normal separation process which may come and go for a period of time and does include smegma discharges. Some boys go through it many do not, I don't recall going through this myself.

So the long and short of this would be to get the culture and let us know what they tell you so we can help you out. In the end it might be recommended to give NOCIRC a call just to talk to someone one on one I hear they field these calls from time to time and they may also be able to provide a local reference for a second opinion.

We know your doing you're best thats why you're here.

[Daisymae6]

my youngest had a case of balanitis when he was 6 months. I noticed during the morning that it looked like it was swollen so kept an eye on it during the day. He was really irritated and wouldn't be held on the hip then when i changed his diaper in the evening it was very swollen, by the next diaper change i just wanted to cry, so i took him to the after hours pediatrics. They gave him a shot of an antibiotic and then we got an oral dose for 10 days. We were also told just to let him sit in the bath twice a day and massage his little penis to get it circulating. his cleared up completely within two days and hasn't returned.

The urologist had suggested that we get him circ'd to avoid further infections but i just told him that circing was NOT an option for us.

[wendy1221]

I haven't read the other replies, but my first thought was Did they culture the "infection?" I have 3 intact boys and NONE of them has ever had an infection. I have 2 intact nephews and same thing. It seems really unlikely that a kids would get an infection TWICE in the same year when infections are so rare. Now, my 2nd nephew, my sister did have someproblems where her ped THOUGHT his penis was infected, but it was actually just retracting, and te sweling and redness was normal and the white discharge was just smegma working its way out of the newly retractable parts. My sister realized this after talking to me about it, and thankfully before starting the antibiotics the ped gave her.

Now all of my boys have had at least 1 YEAST infection, which will be made worse or at least more recurrent if you use antibiotics. I figured it was yeast w/ my oldest b/c he had yeast diaper rashes really often (and still wore/wears diapers at night, so even now at 8.5 will get a yeast rash once in a while. He is a SN kid.) W/ my 2nd I "tested" our new ped on our first appt b/c i suspected ds2 had a yeast infection, and the ped picked up his penis to look at the tip w/out retracting, and said, looks like yeast, put some OTC Gyne-Lotrimin 7 day yeast cream on it twice a day for a week, and NEVER pull his foreskin back. I was very pleased.

The symptom of a yeast infection in an intact penis are red inflamed membranes and a watery discharge, sometimes slightly yellowish (I think this is mainly due to the irritated mucous membranes.) My boys have always complained it burns when they pee when they have a yeast problem. There is no bad odor, just normal people genital scent, although sometimes there is a urine smell. I think that's a GOOD way to tell if it's yeast or a bacterial infection. I would think a bacterial infection would have a bad odor, just like the difference between when a woman has a vaginal yeast infection vs bacterial vaginosis.

[MCatLvrMom2A&X]

In your ds's case he needs a culture to see exactly the culprit so that the proper abx can be used. Also bacatracin is the topical OTC cream of choice for this type of thing.

Ds improved within hours of me putting it on him. His penis was swollen to at least 5x's the normal size and he was in pain and had pus.

Like pp's have said balintitis is a catch all phrase for infections so in itself that is not a diagnosis. I cant stress enough how you need to get a culture, insist on it dont take no for a answer.

[thixle]

I found this photo, it's not in English, but shows a partially retractable child with a swollen penis with a smegma pearl trapped. Notice how swollen, red, and pus-like it is. There is a better picture somewhere else, but I cannot find it (and I have to go)... more later

Momof2xy
I know this has to seem hopeless to you because the "experts" are really not experts. I would try contacting Doctor's Opposing Circumcision- they have contact #s of foreskin-friendly doctors in your area.
again

[Momof2xy]

thanks guys the update from this morning - it is still swollen, but not as red. the lump is still there. he is saying his penis is "all better" this morning (he even put on his underwear!) so we will see. i'm hoping this clears on its own and we don't have to make a return pedi trip for abx or anything else and that we won't even have to *walk* this road. this is a lot of foreign info to us as ds1 is circ'd (hubby is circ'd but his brothers are not, so this is not an odd situation for us - when you know better, you do better).

Liv

[l_olive]

Liv, please, if you haven't already read this link

http://www.mothering.com/discussions...d.php?t=764732

you really should. MCatLvrMom2A&X worked hard on it, compiling a lot of information that sounds exactly like what you're describing, and what my son has personally experienced.

What I was SURE must be a horrible infection when his penis was red, swollen, and dripping "pus" turned out to be a completely normal part of the process which ultimately results in the separation of the foreskin from the glans. It can happen several times over the sometimes long period that this process takes place.

The only way to tell the difference between smegma buildup and infection pus is to have it cultured. And a good rule of thumb that I've heard is that an infection won't clear up on it's own in a couple of days. A smegma pearl or discharge will get better on its own (well, we did a couple of warm baths) in a relatively short time frame like a day or two.

I know from personal experience that this looks scary, and can be pretty uncomfortable for a little boy -- but what you've described really, really sounds like separation and NOT an infection to me.

Please keep us posted with how he's doing, OK?

[Frankly Speaking]

Liv, you've given us some great detailed information and that will greatly enable us to help you. I'm going to address some issues that have already been addressed but I am only doing that for emphasis.

First, we have to understand the term "balanitis." This is a catch all phrase for any infection of the penis. It is not a specific diagnosis and that is what is needed so that it can be appropriately treated. You have mentioned that a sample for a culture was taken. What were the results of the culture? Did you get them? Were they positive or negative?

w/in 12 hours, he had pus coming out of his (even redder and more swollen) penis.

Most likely, this was smegma and not pus. I know you have already discounted this but I fully suspect it was smegma. Smegma and pus have amazingly similar physical characteristics and are often confused by doctors. If it were only a drop, yes, it could be pus but any more in such a short time indicates that it was smegma. I'll address this in more detail later.

last time, he had some sort of wound under his foreskin that had pus coming out of it - doc said we needed to clean it to that point daily (several times) until the infection was gone in addition to oral antibiotics.

The wound indicates that the normal process of separation was happening. Unless it was obvious that the wound had pus in it and that it was emanating from the wound, it was more likely smegma. Did you see it?

doc did not do cultures (ER doc @ military hospital - blech). @ initial diagnosis, his whole penis was red and swollen (especially in the glans area), and had pus coming out of it. pus was not cultured.

A culture is one of the simplest and most accurate tools in a doctor's bag of tricks and should always be used for a diagnosis. It is simple, cheap and highly reliable. Think of it this way: Imagine someone came running up to you and said they saw a fish in the ocean and wanted you to catch it. What would you take, what size fishing rod? What size hook? What kind of bait? You can't know those things unless you know what kind of fish it is. It could be a guppy, a barracuda, a tuna, a shark or a whale. Likewise, not all antibiotics will work on all infections and if you don't know the infectious agents, you can't reliably choose the proper medication to be assured of a cure.

4 - it could be irritation, but that irritation leads to infection because there was *pus* coming out of his penis. i'm relatively certain that a doc can identify pus, even if he thinks circ is a good idea (:P) - and even if s/he can't, i CAN. this is not my first kiddo, and i've worked medical before (actually up until i started staying home with our third kiddo). it was PUS.

The physical characteristics of smegma and pus are extremely similar and many doctors misdiagnose smegma as pus. If there was pus, it would be mixed with the smegma and since they have such similar physical characteristics, it would be virtually impossible to determine what was pus and what was smegma.

there is a lump just like last time from which the pus came).

This is a further indication that it was smegma. Pus would not be in a lump like this. Smegma pearls are the result of the separation of the foreskin from the glans. This is not always an even process and there will be areas that have released and areas that have not. Smegma will collect in these pockets and the dartos facia muscle in the foreskin will press the moisture out of them resulting in a firm lump. This will not happen with pus.

then they get to play (we bathe both boys together) until they get rowdy, then time to get out.

This is ill advised until the issue is cleared up as the boys can pass any infection back and forth. Some research has shown that circumcised boys can get the same infections as intact boys but are less likely to show symptoms so it is likely that your circumcised son has the same infection if there really is an infection.

thanks guys the update from this morning - it is still swollen, but not as red. the lump is still there. he is saying his penis is "all better" this morning (he even put on his underwear!) so we will see.

This is a strong indication that this is a foreskin separation issue. The typical progression is that the irritation is noticed in mid morning and progresses through the day. The belief is that "morning wood" erections pull at still adhered areas of the bond between the foreskin and glans. The foreskin is enervated and vascularized almost identically to the lips and just as a slight trauma to the lips can cause a "fat lip," similar minor trauma can cause a "fat foreskin." These cases of foreskin trauma almost always show significant improvement within 24 to 36 hours with no treatment at all and it appears that the majority of suspected foreskin infections are really this separation induced trauma.

One concept that is important to understand if it is in fact an infection is that the bacteria, viruses and fungals that infect boys are the same exact pathogens that infect girl's genitals and that they respond equally to the same medications. Girls never get treated with amputative surgery for these infections and the only reason boys do is because of medical ignorance and the cultural acceptance of male circumcision.

.

[Momof2xy]

Originally Posted by Phoenix Rising

Liv, you've given us some great detailed information and that will greatly enable us to help you. I'm going to address some issues that have already been addressed but I am only doing that for emphasis..

No worries glad i gave good info.

Originally Posted by Phoenix Rising

First, we have to understand the term "balanitis." This is a catch all phrase for any infection of the penis. It is not a specific diagnosis and that is what is needed so that it can be appropriately treated. You have mentioned that a sample for a culture was taken. What were the results of the culture? Did you get them? Were they positive or negative?..

maybe you misread? i said that they DID NOT do a culture of any kind.

Originally Posted by Phoenix Rising

Most likely, this was smegma and not pus. I know you have already discounted this but I fully suspect it was smegma. Smegma and pus have amazingly similar physical characteristics and are often confused by doctors. If it were only a drop, yes, it could be pus but any more in such a short time indicates that it was smegma. I'll address this in more detail later...

ok, i think i'm going to have to admit i was wrong :P given that by day 3, things are *fine* (still a small lump, but otherwise not red/swollen/painful), it probably was sep trauma and smegma :P ok, ok, i was wrong

Originally Posted by Phoenix Rising

This is ill advised until the issue is cleared up as the boys can pass any infection back and forth. Some research has shown that circumcised boys can get the same infections as intact boys but are less likely to show symptoms so it is likely that your circumcised son has the same infection if there really is an infection....

good to know - so far we've had no issues (other than just his issues from his circ, which is what prompted the not circ-ing for ds2).

Originally Posted by Phoenix Rising

One concept that is important to understand if it is in fact an infection is that the bacteria, viruses and fungals that infect boys are the same exact pathogens that infect girl's genitals and that they respond equally to the same medications. Girls never get treated with amputative surgery for these infections and the only reason boys do is because of medical ignorance and the cultural acceptance of male circumcision.

i came for alternatives to circ (because i don't want to circ him, and the pedi just kept saying "well, circ is our recco if he has 2-3 infections") and i wanted alternatives . so thanks for pointing that out to me - guess it should've been obvious, but i guess it just wasn't.

Liv

[l_olive]

Originally Posted by Momof2xy

ok, i think i'm going to have to admit i was wrong :P given that by day 3, things are *fine* (still a small lump, but otherwise not red/swollen/painful), it probably was sep trauma and smegma :P ok, ok, i was wrong

It really isn't that you're "wrong" -- just, like most of the rest of us, not well prepared for what changes an intact penis goes through during its normal development. Just think how bad you'd freak out if your son started losing his teeth -- if you didn't know ahead of time that was going to happen.

It's unfortunate that our circ-happy society has lost this information.

But it's reprehensible that the doctors on whom we rely for solid medical advice are equally uninformed. How many boys who are simply going through separation has this doctor given unnecessary antibiotics or, worse, circumcisions?

I'm so glad your son is better!

[Frankly Speaking]

Originally Posted by Momof2xy

maybe you misread? i said that they DID NOT do a culture of any kind.

Yes, apparently I did. I'm sorry! This is the next step if you suspect an infection and the one that will either confirm or deny an infection. Moreover, it will identify the specific pathogen causing the infection if there is an infectious agent present.

ok, i think i'm going to have to admit i was wrong :P given that by day 3, things are *fine* (still a small lump, but otherwise not red/swollen/painful), it probably was sep trauma and smegma :P ok, ok, i was wrong

Don't worry about it. Some of the best trained and experienced medical professionals have been wrong about this. This is a relatively new area for the medical profession that hasn't had the luxury of working frequently with intact boys.

i came for alternatives to circ (because i don't want to circ him, and the pedi just kept saying "well, circ is our recco if he has 2-3 infections") and i wanted alternatives . so thanks for pointing that out to me - guess it should've been obvious, but i guess it just wasn't.

Liv

Well, I can tell you it is not obvious. I was involved in this issue for years before this dawned on me. I had never seen anything about this despite hundreds of hours researching the issue. One day it just dawned on me but it was such a simple concept that I did not trust my own conclusions and decided to check it out with some real medical professionals. I asked two MDs, a microbiologist and a viral geneticist and they all essentially said "Yep, you're right about that." It also appears that this has also not dawned on your pediatrician or he would not have recommended a circumcision after 2 or 3 infections. He certainly would not recommend the same thing for a daughter, he would just assume he could cure the infection with medications and set about finding the correct meds to do the job until he was successful. He is also amiss for not taking samples for culturing and that should have been the first step. He basically took a short cut and made a diagnosis off the cuff and it was the wrong diagnosis.

.

[littlemizflava]

Originally Posted by Momof2xy

generally no, there is not already soap in the water - generally speaking, rinsing bits off is the first part of bath time. then they use soap (actually, they still like the baby wash, so we let them use it :P) to wash their hair and bodies. then they get to play (we bathe both boys together) until they get rowdy, then time to get out.

Liv

just another idea
if there is soap in the water even if he is just playing in the soap water it can and will still get under there what about having him rince it off under clean water before getting out of the tub.
i know we all are sensitive here. what i do is fill tub let them play drian it, soap them head to toe, rince and out.

[fruitful womb]

My Uncle was the oldest of 4 brothers aside from 5 sisters. He was born around WWII. This was at a time when hospitals were committing mass circumcisions without the parents knowledge. Lucky for him he was born at home. Doctors would do home visits back then too. After one doctor found out grandma was having her babies at home he asked if her ds was circumcised. She wouldn't dream of such a thing. She told him no. He strongly suggested that she forcefully retract him, he was 5 at the time (I think, or maybe 3) and scrub the glans with soap. My uncle had NO problems with his penis until his parents acting upon Dr.s orders. He developed balantitis. The doctor then circumcised him. Unfortunately since he was the first boy in the family the rest of the boys got circumcised because they didn't want the rest of the boys to possibly get balantitis. Her next child was born in the hospital in case it was a boy just so he could be circumcised at birth.

Its so screwed up.

Had they just left him alone he wouldn't have faced the predicament of circumcision.

I wonder if the Doctor knew this would happen so he advised grandma to do what she did just so he could circumcise him. No doubt many doctors these days set it up that way.

[Frankly Speaking]

Originally Posted by fruitful womb

I wonder if the Doctor knew this would happen so he advised grandma to do what she did just so he could circumcise him. No doubt many doctors these days set it up that way.

I suspect this was the case in many intact boys. Before the internet, many doctors would have believed that circumcision was inevitable for virtually every boy that was not circumcised at birth. As early as the 1940's they had already started circumcising every boy born at hospitals which was virtually all at the time. Many pediatricians never saw an intact penis in their practices and it appears that many saw foreskins with disgust and disdain and viewed parents who didn't get their sons circumcised as almost criminally negligent. All of the elements were there that what you suggest is not only possible but probable. In their twisted minds, they probably thought they were ultimately doing the child a favor by making him ill so that he could cut his foreskin off "for" him.

.

[Fellow Traveler]

Originally Posted by Phoenix Rising

I suspect this was the case in many intact boys. Before the internet, many doctors would have believed that circumcision was inevitable for virtually every boy that was not circumcised at birth. As early as the 1940's they had already started circumcising every boy born at hospitals which was virtually all at the time. Many pediatricians never saw an intact penis in their practices and it appears that many saw foreskins with disgust and disdain and viewed parents who didn't get their sons circumcised as almost criminally negligent. All of the elements were there that what you suggest is not only possible but probable. In their twisted minds, they probably thought they were ultimately doing the child a favor by making him ill so that he could cut his foreskin off "for" him.

Although it isn't out of the realm of possibility I find it hard to believe that medical professionals believed circumcision was inevitable. To believe that you would have to discount millennia of evolution and the in your face fact that it was uncommon before modern times. I can believe that the average parent of the time would not have access to information and not know that say most people in other countries don't do this but doctors? Its hard to believe but I suppose (it seems) it is true.

I am wondering has anyone had a doctor tell them it is necessary and have you then confronted them with the facts? Like if it is necessary why don't people do it anywhere else? What was that discussion like?

[eepster]

I also consider it unlikely that many Drs in the the '40s believed it was inevitable. Most Drs in those days were family practitioners not pediatricians so they wll have had plenty of older patients who were intact with no problems. I suspect their many motive for encouraging it will have been the belief that it promoted "moral hygene."

[Frankly Speaking]

Originally Posted by jwhispers

Although it isn't out of the realm of possibility I find it hard to believe that medical professionals believed circumcision was inevitable.

By the 1960's, many doctors would be in practice a substantial portion of their careers without seeing an intact penis. This would deny them the opportunity to have counter experience. It was also quite common for them to misdiagnose normal phimosis as pathological phimosis and in their practice, most boys would get a circumcision that they had escaped earlier. This would lead them to believe that circumcision was inevitable for most boys. Even today, we still see a lot of that.

To believe that you would have to discount millennia of evolution and the in your face fact that it was uncommon before modern times.

Well, they are certainly ready to accept that evolution has made a serious mistake that they must correct or we would not have circumcision today. I doubt many doctors know that circumcision in The US was once extremely rare. Since it is mentioned several times in The Bible, they assume that it has been a routine of birth for thousands of years.

I can believe that the average parent of the time would not have access to information and not know that say most people in other countries don't do this but doctors? Its hard to believe but I suppose (it seems) it is true.

Doctors are given virtually nothing in medical school about the origins and history of circumcision and do not generally witness or perform their first until they are in their internships. In this respect, they are no more knowledgeable than their patients.

I am wondering has anyone had a doctor tell them it is necessary and have you then confronted them with the facts? Like if it is necessary why don't people do it anywhere else? What was that discussion like?

Only recently has this began to happen and that is only because of websites such as this one where parents can get the information. Sadly, it appears very rare that doctors visit sites like this one.

It appears that some doctors will go to any length to convince parents to circumcise their sons. I heard of one case where a doctor was telling Hispanic patients (who don't generally circumcise) that circumcision of all newborn males was required by law. This was obviously not true since if it were required by law, there would be no consent form, it would just be done. This doctor had found a vulnerable population and was taking advantage of them.

.

[3Chimes]

Thank you for this information!!

I have looked everywhere and have a pediatrician who has hinted at circ, which I do not want to do, or I would have done it when ds was born! Thank you for posting such comprehensive info!! I do have two more questions.

How long can this process last?

Should ds be pulling back his foreskin to clean it, because he does have a lot of discharge. It is whitish and he has had some very paperthin cuts that have mildly bled, but he has never complained of itching. (The suggestion to culture is exactly what we need to do!! DS had a knee surgery post-poned because the pediatrician thought it was a bacterial infection, when really it sounds like separation, but he never tested for it. Ugh!) We do have a topical called Vusion which is an anti-fungal. Should I have him use that just in case? It is very hard for him to wash it off because it is petroleum-based, though.