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phimosis (too tight foreskin)

post #1 of 18
7/21/08 at 12:04pm
Thread Starter 
My brother suffered from congenital phimosis and had to be circumsized when he was three (after the foreskin cut off his circulation and his penis turned blue). This may be one of those rare times when it was actually warrented. The nurse prac at my peds office told me my baby's foreskin is very tight and I need to work it up and down to loosen it .... this goes against what I have learned so far ..... anyone know anything about this?

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post #2 of 18
7/21/08 at 12:23pm
Quote:
Originally Posted by Serenyd View Post
My brother suffered from congenital phimosis and had to be circumsized when he was three (after the foreskin cut off his circulation and his penis turned blue). This may be one of those rare times when it was actually warrented. The nurse prac at my peds office told me my baby's foreskin is very tight and I need to work it up and down to loosen it .... this goes against what I have learned so far ..... anyone know anything about this?
Well first of all concerning your brother's issue we need to bring some perspective in this because circumcision is such a common practice. But really, circumcision is an amputative surgery, and in any other situation, on any other part of the body, amputation ONLY occurs when that part of the body is dying or has been destroyed in some way. In cases of the foreskin I that means something like gangrene, or a severe case of BXO that want months without being treated, leaving the foreskin a lump of scarred tissue.


As the medical community is willing to accept more information, they get a little better. In your case thankfully they are not suggesting circumcision. But they still are only half there. Babies foreskins are generally fused to the head for many years after birth, so of course it will seem "tight". Your doctor may not understand basic male anatomy and since the foreskin does not retract, thinks there must be a problem.


As long as he is peeing normally and not in pain then there is no problem to deal with anyway, so just don't worry about it. And you might want to consider changing doctors.
post #3 of 18
7/21/08 at 12:26pm
Tight? A baby's foreskin is adhered to the glans many times all the way until puberty. This is normal, and should NEVER be interfered with. I guess I'm not sure what she's talking about, but all babies would seem to have "tight" foreskins because of this. I'm not sure you are getting good advice...to me it kinda sounds like this person just doesn't understand how an infants foreskin is supposed to be. ---I could be wrong though..
post #4 of 18
7/21/08 at 2:01pm
Thread Starter 
Quote:
Originally Posted by gabysmom617 View Post
Tight? A baby's foreskin is adhered to the glans many times all the way until puberty. This is normal, and should NEVER be interfered with. I guess I'm not sure what she's talking about, but all babies would seem to have "tight" foreskins because of this. I'm not sure you are getting good advice...to me it kinda sounds like this person just doesn't understand how an infants foreskin is supposed to be. ---I could be wrong though..

I think you're right. I read that phimosis can be treated by steriod cream or stretching of the foreskin and it doesn't have to be circumcision. She (The nurse practitioner) also told me they get clumps of hard stuff under the foreskin and you have to get it out .. i read this is called smegma and it isn't harmful so I really don't think she knows what she is talking about. I'm glad I didn't hurt him messing with it! My other son is circ'd so this is my first time dealing with these issues. Thanks for the input guys!
post #5 of 18
7/21/08 at 2:42pm
Quote:
Originally Posted by Serenyd View Post
I think you're right. I read that phimosis can be treated by steriod cream or stretching of the foreskin and it doesn't have to be circumcision. She (The nurse practitioner) also told me they get clumps of hard stuff under the foreskin and you have to get it out .. i read this is called smegma and it isn't harmful so I really don't think she knows what she is talking about. I'm glad I didn't hurt him messing with it! My other son is circ'd so this is my first time dealing with these issues. Thanks for the input guys!

Sounds like you are right on the money Momma! That NP is definately out of date on her information. Have you read the Fleiss article in the "Mothering Articles" sticky? It has great info on dealing with ignorant medical professionals.

From your origional post, it sounds like your brother had paraphimosis: http://www.cirp.org/library/treatment/paraphimosis/ Paraphimosis can be a result of forced retraction. Forced retraction and cleaning was recomended care for an intact infant in our generation(and sadly some docs still instruct parents to do this).

Follow your instincts, it really isn't as difficult as that NP is trying to make it out to be.

Take care,
Tara
post #6 of 18
7/21/08 at 2:55pm
My neighbor's son was just circumcized on Friday for paraphimosis after a bunch of bad advice from a non foreskin friendly doctor led him to try and retract when he was not able to. He is 16. I am still sad about it. She had a second opinion, but no other options besides circ. were mentioned. Even in a severe case of paraphimosis there is steroid cream or even cutting a slit in the foreskin, I've heard.

Some people's foreskins naturally don't retract much, ever. As long as they can pee comfortably , its not a big deal.
post #7 of 18
7/21/08 at 8:37pm
Quote:
Originally Posted by Serenyd View Post
My brother suffered from congenital phimosis and had to be circumsized when he was three (after the foreskin cut off his circulation and his penis turned blue). This may be one of those rare times when it was actually warrented. The nurse prac at my peds office told me my baby's foreskin is very tight and I need to work it up and down to loosen it .... this goes against what I have learned so far ..... anyone know anything about this?
Actually Serenyd, nearly all baby boys suffer from congenital phimosis. As has been previously posted in this thread, most boys are born with the foreskin tightly adhered to the glans and the tip is cinched tight. Boys can develop pathological phimosis which is the kind that may require treatment. I know its nit picky but the distinction is important. The condition your brother had certainly required intervention, whether that was a circumcision or not it's hard to know but if his penis is blue that is of course an emergency.

The nurse practitioner is wrong. You don't need to mess with a boys foreskin to clean it or do anything. I am sure you already got some good links here are some more:

http://www.cirp.org/library/normal
http://www.cirp.org/library/hygiene/
post #8 of 18
7/22/08 at 12:31am
Quote:
Originally Posted by liseux View Post
My neighbor's son was just circumcized on Friday for paraphimosis after a bunch of bad advice from a non foreskin friendly doctor led him to try and retract when he was not able to. He is 16. I am still sad about it. She had a second opinion, but no other options besides circ. were mentioned. Even in a severe case of paraphimosis there is steroid cream or even cutting a slit in the foreskin, I've heard.

Some people's foreskins naturally don't retract much, ever. As long as they can pee comfortably , its not a big deal.
I would sue there is no excuse for him being circed to fix paraphimosis. The most they should have done was cut a slit just large enough to put the foreskin back then stitch it closed again. Steroid cream wouldnt work for paraphimosis but if you look here http://www.mothering.com/discussions...d.php?t=764732 there are 2 links that describe the proper way to fix paraphimosis since it is a emergency when it occures and must be fixed ASAP. I am glad I know what to do so that I can help ds if it ever happens.

The ignorence of Dr's is astonding. :
post #9 of 18
7/22/08 at 12:50am
Quote:
Originally Posted by MCatLvrMom2A&X View Post
fix paraphimosis since it is a emergency when it occures and must be fixed ASAP.
You generally just squeeze the glans and eventually it gets small enough to allow the skin to revert. No cutting. It's a myth.
post #10 of 18
7/22/08 at 1:18am
My son has been able to pull his foreskin foreward ever since he was a baby and could grab it. So obviously it isn't adhered to the glans anymore. Yet he can't (or maybe won't) retract. Is this because the opening of the foreskin is tight? Is this what people think is a problem that needs surgical correction? Won't it loosen up as he ages?
post #11 of 18
7/22/08 at 1:33am
Two things have to happen to allow for retraction:

1) The inner foreskin layer separates from the glans

2) The naturally tight foreskin opening become more elastic/loose

One of these may happen before the other, leading to a lot of variation in the normal process of separation. With time, they will both take care of themselves. You do not need to do anything.

Gillian
post #12 of 18
7/22/08 at 1:34am
Sorry - double posted.
post #13 of 18
7/22/08 at 1:55am
I'm just chiming in to agree with what everyone else said - no need to mess with his foreskin at all. Just leave it alone and it will loosen on it's own in time (may be many years from now). As long as your son can urinate, his foreskin is not too tight.
Trust me, lots of doctors and nurses have misinformation about the proper care of foreskin.
post #14 of 18
7/22/08 at 2:57am
Quote:
Originally Posted by Ron_Low View Post
You generally just squeeze the glans and eventually it gets small enough to allow the skin to revert. No cutting. It's a myth.
Most of the time yes it is easy to fix but if left long enough that the swelling is major then more invasive things may be needed. Usually sugar and ice will reduce the swelling enough to allow the foreskin to come forward but in a few cases that dosnt work. The links in the link I provided goes into greater detail. One technique for resolving paraphimosis is called the Dundee.
post #15 of 18
7/22/08 at 2:59am
Quote:
Originally Posted by knucklehead View Post
My son has been able to pull his foreskin foreward ever since he was a baby and could grab it. So obviously it isn't adhered to the glans anymore. Yet he can't (or maybe won't) retract. Is this because the opening of the foreskin is tight? Is this what people think is a problem that needs surgical correction? Won't it loosen up as he ages?
The foreskin can be pulled forward even when it is still stuck to the glans. The skin just stretches out. Being able to pull forward (away from the body) is not a indication that the foreskin and glans are no longer attached.

The foreskin can be totally free of the glans but the tip, sphincter, can still be to small for retraction that happens usually when puberty comes into the picture and the sphincter releases and stretches out.
post #16 of 18
7/22/08 at 3:08am
Ugh. I want to love the Medical Establishment but most times I hate them! They never met a penis they couldn't try to circumcise. Do y'all know that even if you protect your son's foreskin his WHOLE life, if he is ever in a nursing home, they will neglect that part of his body until it gets infected and then bring in the urologist with his scalpel??? Yes, I have heard this from nurses and CNAs.

They told me to retract my son's foreskin every day and put VASELINE on it every day also at the most prestigious hospital here in CLT, NC. The doctor also said 'phismosis' ominously as she left the room. :roll: They also catheterized him to check for a UTI which I KNEW he didn't have and now I know it is because he is intact (and they are misinformed) that they suspected that! :shock: He was, get ready, NINE MONTHS OLD!

I think phismosis is french for: I want to cut on your son's penis! :evil:
post #17 of 18
7/22/08 at 11:36am
If it were my son I would sue, I would never let circ even be an option for my kids. My neighbor did protect her son at birth--but failed to find a foreskin friendly ped. That is so important! Her 16 yr old son bought into the circ-as-only-solution b.s. and it was "his" decision. I feel bad b/c I haven't asked how he's doing b/c I can't. I've lost so much respect for my friend.
post #18 of 18
7/22/08 at 1:26pm
Yeah, my 8 year old ds is NOT retractable yet, but has always been able to pull the foreskin forward...and a lot...I wondered how it didnt hurt when he was around 2. I swear he'd pull it down to his knees! But when he tries to retract, he only gets a space about the size of a pencil eraser showing (around the urethra) and thats it. Its still attached and/or the opening is still too tight. Either way, its normal and I wont worry about it at ALL until at least puberty. If he's still unretractable at that point, I'll leave it up to him if he wants to try something like steriod cream or stretching or just leave it alone. It is his penis afterall
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