can anyone help...5 yr old w/ sore penis

[My_Three_Sons]

My 5 1/2 year old is today saying his penis hurts. It is indeed reddish and swollen. He's intact, of course, but hardlly retractable at all. It seems his foreskin is pretty tight still. The red part seems to be underneath his foreskin though, and ds says it hurts all the way around his penis. The tip actually seems fine, and he says it doesn't hurt to pee. Dh put some vaseline on the tip (he is intact himself and says he thinks it's the right thing to do) and we're giving him Tylenol for the pain.

Any thoughts on what this could be? I thought if the boy was non-retractable that there would be a seal, and no urine, etc could get underneath the foreskin, but dh thinks otherwise. We've never had any penis problems at our house so I'm kind of at a loss here!

Thanks in advance if anyone has any ideas.

[Fellow Traveler]

Originally Posted by My_Three_Sons

My 5 1/2 year old is today saying his penis hurts. It is indeed reddish and swollen. He's intact, of course, but hardlly retractable at all. It seems his foreskin is pretty tight still. The red part seems to be underneath his foreskin though, and ds says it hurts all the way around his penis. The tip actually seems fine, and he says it doesn't hurt to pee. Dh put some vaseline on the tip (he is intact himself and says he thinks it's the right thing to do) and we're giving him Tylenol for the pain.

Any thoughts on what this could be?

So far the things you describe sound like the foreskin is separating from the glands. This happens in different ways and at different rates for different boys at different ages. This process may or may not include soreness and some discomfort along with possible discharge of smegma. Any soreness or discomfort should abate within 24 to 48 hours and may reoccur from time to time as the separation process doesn't always occur in one go. Different sections may free themselves at different times (This is in part how the multiple infection myth got started and persists).

A warm bath is a good idea and usually helps. There is usually a recent thread (with substantial content) that discusses this issue such as this thread , this thread, and this thread. Follow some of the links provided in those threads and there will also be a few other posters who might be able to provide more details. Dr. Fleiss's article also discusses it further.

Tylenol would proabably help the soreness but I don't see how vaseline would help (or hurt) so if it works for your son go with it.

Originally Posted by My_Three_Sons

I thought if the boy was non-retractable that there would be a seal, and no urine, etc could get underneath the foreskin, but dh thinks otherwise. We've never had any penis problems at our house so I'm kind of at a loss here!

Thanks in advance if anyone has any ideas.

Well in the beginning this is true, the foreskin is essentially sealed against the gland but that clearly changes as it begins to separate but getting urine underneath wouldn't be problematic. I suspect it helps the separation process. Incidentally, the small amounts of urine on the newly separate foreskin is possibly the cause of the irritation.

Bottom line just keep an eye on it some, but by no means all, boys go through this. If it doesn't abate within about 48 hours or so or gets noticeably worse you may want to investigate further. (Yeast, Bacterial Infection, or irritation due to soaps used on clothes or body just to name a few possibilities)

Hope this helps. Keep us posted we are here to help out.

[My_Three_Sons]

Thank you so much jwhispers! That is a really useful response. I never knew that the separation process could occur in this manner, and really I thought I knew a lot about the intact penis!

I will ask ds how his penis is doing tomorrow. He did have a warm bath with epsom salts tonight. Hopefully by morning things will be resolving for him.

Thanks again!

[My_Three_Sons]

Unfortunately it looks like ds may have an infection. Today he had a fever, said his penis hurt, and it does look worse than yesterday. Plus there was a discharge when we looked at the tip of his penis. If he is the same tomorrow a.m. I will be calling the dr to get it looked at.

I talked to my sister who's dh is a dr. They have a couple of boys and I always thought their boys were intact, but sadly I learned they're not. My sister says there were done to 'avoid infections'. Grrr... I just said there is no proven link. I was really shocked to hear though that her boys are circ'd. Sigh...

Poor ds. How unnatural for my 5 yr old to *want* to have a rest and go to bed before dinner!

[Fellow Traveler]

Originally Posted by My_Three_Sons

Unfortunately it looks like ds may have an infection. Today he had a fever, said his penis hurt, and it does look worse than yesterday. Plus there was a discharge when we looked at the tip of his penis. If he is the same tomorrow a.m. I will be calling the dr to get it looked at.

My_Three_Sons, I am so sorry to hear that; poor guy. I was just a few minutes ago wondering how you were doing. OK, so the next step is a trip to the doctor; it's still not a big deal. My suggestion, and I hope other's will chime in for you, is this: A run of the mill infection can be confirmed with a culture so be sure the Dr. does this for your son. It will help determine how to treat him. If the Dr. suspects a UTI a urinalysis in in order to confirm the diagnoses.

Originally Posted by My_Three_Sons

I talked to my sister who's dh is a dr. They have a couple of boys and I always thought their boys were intact, but sadly I learned they're not. My sister says there were done to 'avoid infections'. Grrr... I just said there is no proven link. I was really shocked to hear though that her boys are circ'd. Sigh...

This is a poor excuse; infections are, in fact, fairly uncommon and can be treated in a noninvasive manner. I am surprised considering it appears you're in Canada.

Originally Posted by My_Three_Sons

Poor ds. How unnatural for my 5 yr old to *want* to have a rest and go to bed before dinner!

Probably pretty uncommon. If you have time you might want to dig through the links and check up on what people suggest for this 'stage'. As said above I am thinking culture. Good Luck hope your little guy feels better soon; let us know how it goes.

ETA: This was in the stuff I gave in the first post but I wanted to make sure you saw it:
http://www.changa.org/circumcision/ The last two paragraphs are now what to focus on and what can be expected at the Drs.

[l_olive]

I don't have much time to post, but....

Discharge doesn't necessarily mean an infection. Even though it may look like pus, it could still be smegma which has been washed out of pockets formed as the foreskin begins to separate.

The only way to tell if it's an infection is to have it cultured -- and that culture needs to be taken without retracting the foreskin at all. You will, in all probability, need to ASK for the culture to be done, and you will almost definitely, need to firmly INSIST on no retraction.

Keep us posted, OK?

[~Mamaterra~]

My four year old also gets a sore penis every once and a while. For him it is a cleanliness/rubbing against clothing thing and all we have ever done is put some zinc oxide on it and it goes away.

For pain control, we sit him in a warm bath with baking soda and that usually does the trick.

Hope all goes well.

[Fellow Traveler]

My_Three_Sons, is there an update? How's your guy doing?

[My_Three_Sons]

Hi, thanks for asking and I've been meaning to post.

Ds's seemed moderately improved on Monday (day 3 of sore penis). However the fever continued. By Tuesday I wasn't convinced the fever was a separate issue (ds was unreliable at best about whether or not his penis actually still hurt). So we went to the dr Tues afternoon. She checked out for cold symptoms (only fever and enlarged glands, some kind of viral illness, nothing to be done for it of course but rest, fluids, etc).

She looked at his penis, and checked out the very tip of his penis which is the only part we can see when gently pulling the foreskin back (there is no tugging or retraction, the foreskin is just able to go back about 1 mm). She said everything looked fine, but his foreskin is 'very tight'... then she muttered something to me about him possibly needing a circumcision. Luckily ds did not hear this, but even if he had he doesn't know what circ. means. Still...

I agreed that ds's foreskin is tight (it's not baggy or loose at all, compared to my other 2 ds's, who have much looser foreskins... which we don't retract but I can tell there's just more skin there). I said isn't is possible to use a steroid cream when he gets older to loosen it, if necessary? She agreed readily enough, and said to keep an eye on things and if he keeps having trouble it will be something to consider.

Fair enough, but why on earth would circ be the first thing that comes to mind, and not less drastic procedures? I just don't understand that. I really do love my dr, and frankly in Canada we don't have an opportunity to 'shop around' for a dr, so unless one has serious concerns about a family dr you just live with it. I guess this is where mommy education and determination comes into play!

In any event, ds's penis is ok now, and we are STRONGLY anti-circ and anti-forced retraction, so unless he continues to have problems (and really, this is the first problem he's had in 5 1/2 years!) we will leave well enough alone.

Re: the comment about my sis's dss being circ'd even though dad is a dr, these kids are close to their teens and I believe circ was common enough 10-12 years ago in Canada. Sadly, I do know of people who still have their ds's circ'd. Not many to be sure, but by no means should Canada have a sterling reputation when it comes to infant circ. There is work to be done here.

Thanks for all the help and comments, they are much appreciated!

[Fellow Traveler]

Originally Posted by My_Three_Sons

Hi, thanks for asking and I've been meaning to post.

Ds's seemed moderately improved on Monday (day 3 of sore penis). However the fever continued. By Tuesday I wasn't convinced the fever was a separate issue (ds was unreliable at best about whether or not his penis actually still hurt). So we went to the dr Tues afternoon. She checked out for cold symptoms (only fever and enlarged glands, some kind of viral illness, nothing to be done for it of course but rest, fluids, etc).

So did the doctor believe the two were independent events? That's what it sounds like.

Originally Posted by My_Three_Sons

She looked at his penis, and checked out the very tip of his penis which is the only part we can see when gently pulling the foreskin back (there is no tugging or retraction, the foreskin is just able to go back about 1 mm). She said everything looked fine, but his foreskin is 'very tight'... then she muttered something to me about him possibly needing a circumcision. Luckily ds did not hear this, but even if he had he doesn't know what circ. means. Still...

I am sure you know this already but keep in mind that there is no time table for full retraction. Just in case you need it: http://www.cirp.org/library/normal/

Originally Posted by My_Three_Sons

I agreed that ds's foreskin is tight (it's not baggy or loose at all, compared to my other 2 ds's, who have much looser foreskins... which we don't retract but I can tell there's just more skin there). I said isn't is possible to use a steroid cream when he gets older to loosen it, if necessary? She agreed readily enough, and said to keep an eye on things and if he keeps having trouble it will be something to consider.

I think most people would agree with this but, steroid cream should only be considered once he's much older. Provided normal function is not inhibited.

Originally Posted by My_Three_Sons

Fair enough, but why on earth would circ be the first thing that comes to mind, and not less drastic procedures? I just don't understand that. I really do love my dr, and frankly in Canada we don't have an opportunity to 'shop around' for a dr, so unless one has serious concerns about a family dr you just live with it. I guess this is where mommy education and determination comes into play!

I think it might be the fact that Dr.s are still feeling out handling intact boys even in Canada. It will unfortunately take some time. Even in Britain, I recall reading, the NHS or some group along those lines published a report that Phimosis was being overly diagnosed as compared to what might be expected in a population. The implication being that Drs. are misdiagnosing the condition and they needed to be aware of that and learn the distinctions. Perhaps if the discussion comes up with the Physician again you could provide some literature on the subject.

Originally Posted by My_Three_Sons

In any event, ds's penis is ok now, and we are STRONGLY anti-circ and anti-forced retraction, so unless he continues to have problems (and really, this is the first problem he's had in 5 1/2 years!) we will leave well enough alone.

Sounds to me like you've got it on the ball. I am sure things will be just fine if you continue doing what you've been doing.

Originally Posted by My_Three_Sons

Re: the comment about my sis's dss being circ'd even though dad is a dr, these kids are close to their teens and I believe circ was common enough 10-12 years ago in Canada. Sadly, I do know of people who still have their ds's circ'd. Not many to be sure, but by no means should Canada have a sterling reputation when it comes to infant circ. There is work to be done here.

Thanks for all the help and comments, they are much appreciated!

Well give it time. Hey compared to your southern neighbor you guys are to be commended.