Uncircumsised Penis in Preschooler - foreskin re-attaching to Glans?

[tooznie]

Has anybody experienced this occurence with their son/s?

We have been gently retracting his foreskin as neccessary for cleaning during his bathtimes since he started getting infections under the skin, (he's very prone to infections.) The foreskin has been fully detached from the glans for a while now, there has been no stress to the skin or infections for over 6 months. Recently with the new baby we have been a bit more relaxed about the daily baths & cleansing (he's also been toilet trained which has simplified life a little)... Lately it's been becoming more and more difficult to retract the skin, and today I discovered that the foreskin is re-attaching to the glans... The last time I had the foreskin fully retracted would have been two weeks ago and I did not notice any adhering at that stage. Has anyone else gone through this with their son/s? What course of action /inaction do you recommend or know of?

thanks in advance
Mel

[PassionateWriter]

i thought you werent supposed to retract an intact penis for any reason. seems that you may be contributing to his issues. im sure Frankly Speaking and others will chime in but Im curious as to what they say so I wanted to post.

[glongley]

There are a lot of things to consider here. There are a lot of links that could go with this discussion, but I am bit tired so will hope that other will post relevant links.

The first thing, is whether his "infections" were actually infections or not. Foreskins can get red or swollen for a number of different reasons, like chemical or mechanical irritation (e.g. diaper rash), or transitory separation irritation, etc. There's a sticky at the top of this forum that goes over a lot of the information about this.

Also, too much washing, especially with soap, or in dirty bath water, can actually be a cause of balanitis (inflammation of the head of the penis). Washing alters the bacterial balance under the foreskin and removes protective oils. Most sources say that before puberty, rinsing underneath a retractable foreskin need only be done occasionally, and some say there's no evidence that it needs to be done at all till puberty! Most sources that are most supportive of not circumcising and the most experienced with the intact penis will also recommend that they only person who should be retracting the foreskin should be the boy himself.

Sometimes a previously retractable foreskin will become unretractable. Again, chemical culprits like bubble bath may be the cause, or low grade yeast infection. The mild swelling that can occur in such situations is enough to prevent retraction.

Not sure if your son has been on antibiotics (if he's been diagnosed with infections, he probably has), but antibiotics can cause yeast overgrowth. The natural bacterial balance can be reestablished by the use of acidophilus applied in liquid form 4-6 times a day (just cup a little in you hand and dip the penis in it). Also oral powered acidophilus mixed in yogurt or juice or applesauce, for example.

I think the best thing would be to try to help his body get in balance with some of these ideas. There may be other approaches as well, such as dietary changes. I would not be washing underneath his penis like you have been. Just wash off the outside.

One other thing, I would point out that most boys' foreskins are not very retractable normally at this age. If it needs to be retracted by mom to stay retractable, and becomes unretractable when mom doesn't retract it, maybe that's the way it would just prefer to be at this age. Foreskins develop on their own time table. I wouldn't worry too much about it, as long as he's not having any overt problems - though it sounds like a round of acidophilus might be in order if there have been antibiotics.

Here's an article that talks about some of the variations or issues that may come up with an intact penis. I think it mentions the retractable/unretractable issue.
http://www.mothering.com/articles/ne...uncircson.html

Good luck!

Gillian

[fruitful womb]

Gillian has written an excellent post. I would head to her wisdom.

Basically, the only one who should EVER retract the foreskin is the child himself. Intact cultures, the boys discover their glans entirely on their own. The doctors (there) do not ever retract a child's foreskin nor do the parents. Infections in an intact culture is virtually unheard of. Of course, if it does arise then its treated appropriately. Not a circumcision.

I honestly believe *ignorant* US doctors and practitioners from other cut-happy cultures purposefully perpetuate infections on the intact child just to 'set-up' the stage for an excuse to circ later.

I wouldn't retract your ds's foreskin anymore. It could very well be that your ds
body is going into defensive mode. I have a friend who's ds did the same thing. She didn't know not to retract and did, to the point that he bleed once. This was back when I didn't have intact boys yet and I didn't know the proper care of an intact boy. Anyways, she knows now not to do it. The child was fully retractable at age 2. He is 8 now and has been completely un-retractable since he was 3 or 4 (I forget which age). She is sorry for what she did and hopes she didn't cause some serious damage. But the thing is, she isn't worried about his foreskin retracting right now. Its normal for a foreskin not to retract up until late puberty. As long as its fused to the glans, its self cleaning.

My 5 year old is retractable. I know this because I've seen him retract himself. I have never retracted him. Sometimes I'll tell him to Retract Rinse Replace while he is in the bath tub. Its not that important at his age. I tell him this for practice for when it does become necessary upon reaching adulthood.

Unless I see my other ds's retract themselves I'll wait until he reaches puberty to explain Retract Rinse Replace. Just like we're not putting deodorant on our infants and children, there isn't a need to focus on their genitals.

I hope it all works out for the little guy. Kudos for you for leaving him WHOLE!

[Frankly Speaking]

welcome to the forum Mel!

I suspect your son is in the infant stage from some of what you wrote. This leads me to believe he was probably not ready for retraction yet. This can come any time from infancy to the teenaged years. Because you were able to retract it doesn't mean that it was the natural and normal time and the fact that it tightened up again tips me off that it wasn't time. It is common for the foreskin to tighten again after retraction.

There is no absolute reason to retract a child's foreskin, not even for cleaning just like it is not necessary or preferable to clean a young girls vagina. Both areas have a normall acid pH level and cleaning will neutralize the pH level. This pH level is a part of the immune system and the cleaning might have actually caused the suspected infections just as douching a girl's vagina would be expected to cause infections.

The preputial space is also colonized by beneficial bacteria. Some of these bacteria are also contained in yogurt and yogurt is often used to re-establish these beneficial colonies. Cleaning inside the foreskin of a child can damage these beneficial colonies and allow harmful bacteria to get a foothold.

Finally, the foreskin secretes at least two enzymes that essentially eat harmful bacteria and cleaning can remove these enzymes allowing infectious bacteria to become established.

Cleaning inside the foreskin is just not necessary. It is an esoteric matter for boys and men once they become sexually active but not a health matter. Many boys go 10 to 15 years without having the inner space of the foreskin ever cleaned and they enjoy perfect genital health. Some women also go their entire lives without cleaning their vaginas and enjoy perfect genital health. Can you imagine? LOL!




Frank

[Fellow Traveler]

First off tooznie, Welcome to the forum (I see this is your first post). And congratulations on leaving your boys intact. I hope you'll stick around and participate from time to time. Now based on what you posted you'll be getting a lot of material so take the time to page through it because I think you've gotten some bad advice. Others will be along to fill in the gaps.

First, I am a little confused as to what's going on here so I am going to make the following assumptions as I attempt to work through your questions.

1. You have two sons, one a preschooler the second a new born.
2. At some point you began retracting the older son during baths when he started getting infections.
3. The older son appears to be re ad hearing.
4. You are doing this with the younger son but less often.

Originally Posted by tooznie

Has anybody experienced this occurence with their son/s?
We have been gently retracting his foreskin as neccessary for cleaning during his bathtimes since he started getting infections under the skin, (he's very prone to infections.) The foreskin has been fully detached from the glans for a while now, there has been no stress to the skin or infections for over 6 months.

To the second point, this is generally not recommended. An intact boy requires no special care, retracting to wash is not really necessary until the boy reaches puberty. Boys may become retractable at any time between a few months of age through late teens. The average age of retractablility is 10.5 years but even then about half will not be fully retractable. The bottom line is only the boy should be retracting himself, not parents or doctors.

Now you mentioned that you have been retracting during baths to clean due to possible infections. Here is the skinny on this. As the boy grows, and as the foreskin begins to detach itself from the glands, a boy may go through periods where the penis appears infected. This is usually characterized by redness and soreness around the foreskin, possibly including the glands, along with discharge which may appear like puss but is actually smegma. The boy may also complain about painful urination during this period.

These things are in almost all cases normal and are not really infections but are signs that 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 (as described in the previous paragraph). Any soreness or discomfort usually abates 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). Some times these things may also be yeast or irritation due to soaps used on clothes or body just to name a few possibilities.

Unfortunately, many doctors misinterpret this as an infection when in fact it is part of the normal development process, much like a growing pain. There is usually a recent thread (with substantial content) that discusses this issue such as this thread and this tread. 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. Another member also put this thread together to describe this condition.

I want to stress that some, but by no means all, boys go through this. Since many parents and doctors are unfamiliar with typical foreskin development, the parents goes to the doctor who calls it an infection. They will then go on to recommend retracting and cleaning. Unfortunately, this frequently leads to more problems. Of course it sometimes may be an infection but 9 in 10 times it is separation. For a doctor to correctly diagnose an infection a culture of the foreskin or the smegma needs to be done. In the case of a suspected UTI a urinalysis should be done. If a doctor looked at your son, saw a sore redden foreskin with some discharged and called it infected he was proabably mistaken. If he cultured it and it came back positive well that's different. (If this was the case let us know it might change the advice.)

To the third point, with respect to your immediate problem, foreskin re-ad hearing, I wouldn't worry too much about it. I would wait for other posters to come along and comment but my first thought would be to just leave it be. At his age there isn't any reason to be retracting and cleaning. Or he (and only him) could simple retract as much as comfortable in the bath but again don't worry about the ad hearing.

Originally Posted by tooznie

Recently with the new baby we have been a bit more relaxed about the daily baths & cleansing (he's also been toilet trained which has simplified life a little)... Lately it's been becoming more and more difficult to retract the skin, and today I discovered that the foreskin is re-attaching to the glans... The last time I had the foreskin fully retracted would have been two weeks ago and I did not notice any adhering at that stage. Has anyone else gone through this with their son/s? What course of action /inaction do you recommend or know of?

thanks in advance
Mel

To the fourth point, with respect to your new son, just leave him be (if you are starting to try and retract him). Here is a pamphlet for you to read and the AAP Intact Care Guide to show to your Dr. (though some Dr. wont believe it applies to them). This is another point of contention with many doctors. They don't realize that you shouldn't retract a boy and sometime recommend it to parents at the hospital or at the peds office.

I hope this will help you and again welcome aboard. Be sure to ask if you need any clarification on any of these points.

[eepster]

and congrats on the new baby.

You don't need to retract his foreskin, just clean the outside. Avoid bubble bath and too much soap, shampoo, etc in the bath water.

[tooznie]

Thanks for the welcome. We're in Australia, where in most cases you have to specially request circumcision and it is highly discouraged. The main 'special' circumstances that seem to be heeded are religious. So the decision to leave our boys intact was a non event.

So, I just wanted to clarify that in no way have we ever forced the foreskin past the point that it has naturally allowed us, and the only reason we began to retract it at all was due to the infections (so rest assured that we haven't touched the newborn's), which from what I've read here may not have been infections, which is very annoying. Our doctor prescribed cream & oral antibiotics which seemed to improve the situation, the question niggling in my mind now is whether or not the cream actually worked on the 'infection' or if it was just a timing thing. Dirty bathwater would not have been a culprit since he takes showers, and we alternatively use gentle or non-soap based cleansers.

The 'infections' included what we 'fondly' refer to as mushroom penis where the head of the penis was so large, swollen and red, that it looked like a big old mushroom had sprouted down there : He would complain of burning while urinating and be pretty much inconsolable.

[Fellow Traveler]

Originally Posted by tooznie

Thanks for the welcome. We're in Australia, where in most cases you have to specially request circumcision and it is highly discouraged. The main 'special' circumstances that seem to be heeded are religious. So the decision to leave our boys intact was a non event.

Yep, you Australians are well ahead of us here in the US. There seem to be doctors here that still actually think it is necessary, hard to believe.

Originally Posted by tooznie

So, I just wanted to clarify that in no way have we ever forced the foreskin past the point that it has naturally allowed us, and the only reason we began to retract it at all was due to the infections (so rest assured that we haven't touched the newborn's), which from what I've read here may not have been infections, which is very annoying.

It is annoying. The doctors should know what they're talking about and we are supposed to trust there advice. With respect to this issue though that isn't always the case. Even in places that have essentially abandoned circumcision this type of bad advice persists. Not just in the US, Canada, or Australia but you even hear such advice in a place like the UK where it routine circumcision hasn't been performed in nearly 6 decades. For some reason, when it comes to the foreskin, doctors don't follow there normal procedures. What should have happened was a culture and perhaps a urinalysis. Actually, if you poke around our board and flip through the pages, you'll see several threads that discuss this very issue.

Originally Posted by tooznie

Our doctor prescribed cream & oral antibiotics which seemed to improve the situation, the question niggling in my mind now is whether or not the cream actually worked on the 'infection' or if it was just a timing thing. Dirty bathwater would not have been a culprit since he takes showers, and we alternatively use gentle or non-soap based cleansers.

The 'infections' included what we 'fondly' refer to as mushroom penis where the head of the penis was so large, swollen and red, that it looked like a big old mushroom had sprouted down there : He would complain of burning while urinating and be pretty much inconsolable.

It's hard to know what effect they would have had since we are not sure if it was actually an infection or not. It sounds like he had a pretty difficult time with separation but it is impossible to know. Just take what you are reading hear under advisement for the future. For your current situation, with the older boy, I wouldn't worry about re-ad hearing hopefully another poster can affirm that opinion.

[Frankly Speaking]

Originally Posted by tooznie

Thanks for the welcome. We're in Australia, where in most cases you have to specially request circumcision and it is highly discouraged. The main 'special' circumstances that seem to be heeded are religious. So the decision to leave our boys intact was a non event.

Yes, the Australian legislature is considering banning it altoghther as they have with female circumcision. It has already been banned in public hospitals and this further action would ban it in private facilities as well. It is expected to be successful since the bill was initiated and is supported by the medical associations there.

So, I just wanted to clarify that in no way have we ever forced the foreskin past the point that it has naturally allowed us, and the only reason we began to retract it at all was due to the infections (so rest assured that we haven't touched the newborn's), which from what I've read here may not have been infections, which is very annoying. Our doctor prescribed cream & oral antibiotics which seemed to improve the situation, the question niggling in my mind now is whether or not the cream actually worked on the 'infection' or if it was just a timing thing.

Actually, the oral antibiotics may have made the situation worse. These antibiotics are not selective and kill off the "good" bacteria as well as the "bad" bacteria. This is also well known to allow yeasts to flourish. After an antibiotic regimine, it is a good idea to re-establish these bacterial cultures with acidolphus or plain yogurt.

The 'infections' included what we 'fondly' refer to as mushroom penis where the head of the penis was so large, swollen and red, that it looked like a big old mushroom had sprouted down there : He would complain of burning while urinating and be pretty much inconsolable.

While these symptoms are classic symptoms of infection, they are also classic symptoms of separation. The only ways to tell which it it is is to culture it or wait a couple of days to see if the symptoms persist or self resolve. If they self resolve, it can be legitimately concluded that they are due to separation. If they don't, an actual infection should be suspected.

If it is an actual infection, it is important to keep it in perspective. Remember that the infectious pathogens that affect boys genitals are the exact same ones that affect girl's genitals. Both are appropriately treated with the exact same medications and the prognosis for successful treatment is actually better for boys than girls. Surgical amputation is just not a viable option for boys any more than it is for girls. Have you ever heard of a girl getting her "girly parts" amputated as treatment of an infection?



Frank

[MCatLvrMom2A&X]

Have you read this thread http://www.mothering.com/discussions...d.php?t=764732

Also the sticky called The Definition Of Retraction & Why it is BAD http://www.mothering.com/discussions...d.php?t=575627

retracting even gently can cause micro tears leading to infection. Even a tiny bit with no force so that is why you never do it.

There is also a peice in the first link on a retractable penis becoming non retractable.

From your description I bet he wasnt getting infections at all just going through the natural process. It isnt uncommon to see what you described and even if it was a infection retracting to clean is the worst thing you could possibly do since that will allow the infection to spread.

[123]

I'm not sure if it's the same thing, but my ds2 got the mushroom penis thing when he was about two. The end of the foreskin got puffy and red and sometimes his skin got a bit dry and flakey. He had had a diaper rash that went away when we left him diaperless (which resulted in him potty training over the course of several weeks) and so I saw his naked bottom parts quite a lot at that time. I was concerned about it, but it never seemed to bother him much. He didn't stretch it as much as usual, but he still messed with it like boys do. After a while it went back to normal. I think it was just separation since he could retract more afterward, though still not all the way.

I hope everything works out.