Retracting Foreskin: What age do you start, if ever?

[Lucky Charm]

Hi everyone,

I have a question that i cant seem to get a firm answer on. I looked in another thread about retraction, and all they say is "dont do it".

I would very much like to know when parents are supposed to start retracting foreskins on their boys. I am an ER nurse who frequently caths kids/babies who are not circumcized. and although their little penises look like an uncirc'd penis "should" look like, when i go to insert the little catherter to get my sample, the foreskin doesnt retract like it does on an un-circ'd adult male. I insert the catherter, but it doesnt look like i am putting it in the meatus. am i making any sense? i never ever force retraction, but i am wondering when it starts being able to be retracted like the men i have cathed. doctors and the other nurses i work with dont have a firm answer. so i figured i'd come to where people really know what they are talking about, MDC!

please, please dont bash or flame me for being and ER nurse and needlessly torturing children, forcing vaccinations and bullying parents and patients. i have an honest to God question!!

[Sustainer]

The people on that other thread were absolutely right. A parent should NEVER retract his or her son's foreskin. Foreskins become retractable at all different ages, sometimes not until puberty, sometimes never.

[hahamommy]

I agree that NEVER is the appropriate response, however, I know you're asking about a specific emergency situation. Should Hayden ever need to be cath'd I would not have a problem with a gentle nurse retracting ONLY to see the meatus/urethral opening ~ I would if someone were to retract to expose the entire glans unnecessarily.
Thanks for asking about this ~ it's nice to know there is ONE nurse working to make this situations easier for our boys

~diana

[Sustainer]

It sounded to me like a general question:

Originally posted by sweetbaby3
Retracting Foreskin: What age do you start, if ever?

Originally posted by sweetbaby3
I would very much like to know when parents are supposed to start retracting foreskins on their boys.

Originally posted by sweetbaby3
i am wondering when it starts being able to be retracted

Catherterization, of course, is a completely separate issue, and one which I am not qualified to comment on.

[AnnMarie]

Originally posted by Devrock

Catherterization, of course, is a completely separate issue, and one which I am not qualified to comment on.

No it's not. It will do just as much damage then. If at all, it should only be pushed back so you can see the tip, but that's not really retraction because it should never go over the glans in that case.

Oh, and for asking. I wish more nurses and doctors would ask questions when they aren't sure.

[Sustainer]

Originally posted by AnnMarie
No it's not. It will do just as much damage then.

I didn't mean they aren't related. I just meant it's an altogether different question than just asking, in general, "when are parents supposed to start retracting foreskins on their boys?"

[Lucky Charm]

Dev, thanks for answering my question. I was looking for a specific age, i guess. but i will take your word and never retract. And i dont think that cathing a boy is a seperate issue, at least not to me. It is usually an urgent, not emergent, situation when i cath a boy. and what i wanted to know is how to teach the uninformed parent, as well as myself, on what to do about retraction. And what i also wanted to know was why the head of the penis didnt emerge.

But HaHamommy answered another question i had in my head without realizing it. I guess i was retracting it a bit, if i could visualize what i thought was the meatus/urethral opening. Its just that when i pulled back the foreskin a tiny bit, i really expected the head/glans penis to "emerge" just like an adult males would, kwim? I guess when it didnt, i felt like something was wrong. Of all the un-circ'd little boys i have cath'd, i have never pulled back on the foreskin forcefully, just till i got 'resistance", and i could insert the cath tube.

I really really appreciate all of your responses.

[AnnMarie]

Originally posted by sweetbaby3
And what i also wanted to know was why the head of the penis didnt emerge.

If it did that would have been retraction. The foreskin is stuck to the head of the penis in almost all young boys. If you had retracted it would have teared the foreskin from the glans......which is what causes the trouble.

Here are a couple good things to read:

http://www.cirp.org/library/normal/

http://www.mothering.com/10-0-0/html...rcson103.shtml

[Sustainer]

Originally posted by sweetbaby3
And i dont think that cathing a boy is a seperate issue, at least not to me. It is usually an urgent, not emergent, situation when i cath a boy.

I just meant basically what hahamommy said: it's a specific situation. It seemed like you were asking two separate questions. One was a general question that I could answer: When should parents start retracting their son's foreskin? The other question related specifically to catherterization, which I could not address, because I know nothing about it. I did not mean to suggest that one does not apply to the other.

[Lucky Charm]

If it did that would have been retraction. The foreskin is stuck to the head of the penis in almost all young boys.

AnnMarie, I didnt know that. I assumed the head/glans would come out like it does on adult males.

If you had retracted it would have teared the foreskin from the glans......

I didnt know that either.

so when does it emerge like an adult male?

Thanks, Lisa

[Lucky Charm]

Dev, we keep cross posting!!

It seemed like you were asking two separate questions. One was a general question that I could answer: When should parents start retracting their son's foreskin? The other question related specifically to catherterization, which I could not address, because I know nothing about it.

I guess to me it was one and the same.....retracting to cath, and retracting in general. sorry.

Lisa

[hahamommy]

I read once on a great intact board, "Oh the joy of the boy who discovers his own foreskin retracting" or something to that effect. For Hayden, the only intact penis I have regular contact with, his first retraction was about 3.5 ~ completely on his own and he was joyful! Since then, I have only seen him retract it once and that was a few months ago (he is now 5). Even with an erection, his foreskin doesn't completely retract. I'll work this into a conversation with my 15 year old cousin :LOL and see what he'll share with me (Luckily, he is very used to hearing the speil of my circle's intactivism so he may give me the real scoop!), I will happily pass along his experience

I would recommend that you share with these families just what you've learned here ~ it is up to the penis owner to retract if/when it is supposed to happen and in an emergency situation, a gentle, though not complete, retraction will help with the cath.
~diana

PS~Hayden injured his penis when he was 2.5 (slammed in the toilet lid) and I refused to seek medical treatment because of my fears of no one at the ER knowing how to deal with an intact penis. Luckily, his function was fine immediately after the accident and he has healed completely! Again, I'm glad one hospital will have one nurse who cares enough to ask and learn!

[Sustainer]

Originally posted by sweetbaby3
so when does it emerge like an adult male?

There is a HUGE age range for this. Some foreskins don't retract until puberty. Some never do.

[Lucky Charm]

Again, I'm glad one hospital will have one nurse who cares enough to ask and learn!

I appreciate you saying that.

Some never do.

Now i know. Thank you, Dev.

[AnnMarie]

Originally posted by sweetbaby3
AnnMarie, I didnt know that. I assumed the head/glans would come out like it does on adult males.

I didnt know that either.

so when does it emerge like an adult male?

Thanks, Lisa

Usually around 3-5 or so, but not always. It could be late teens, and like someone else said, some never do. It's important to never try to retract for them though. If need be ask them if they can retract and have them do it. Sometimes they don't fully retract yet (it can go a little at a time) and only they know how far is too far. If you haven't had a chance to do so, please take a look at those links I posted.

Oh, and BTW, this is what a lot of doctors use to get parents to circ. They will tell them that their son has phimosis when it's impossible to really diagnose that in a child as it's supposed to be attached. If an adult has true phimosis there is a steriod cream that can be used and also a dorsal slit. Circumcision is almost always unnecessary.

Again, thanks for taking the time to learn! All of us with intact sons really appreciate it.

[Frankly Speaking]

Let me tackle this and see if I can add anything to the discussion. I'm going to do it in three parts, a general description, catherterization and parental retraction.

The infant foreskin is rarely retractible. (98%?) That is because of two reasons. First, the foreskin is bonded to the glans with epithelial tissue just the same as the fingernails are bonded to the nail beds with epithelial tissue. This is the only tissue in the body that is not replaced as it breaks down so there is an natural separation of the foreskin and glans over time. There is also the preputial sphincter that surrounds the opening of the foreskin. In infants and children, this sphincter is not elastic but as the child matures, at some point, it will magically become elastic. As with most things about children, they all develop at a different pace. The separation and elasticity will happen at almost the same time in most cases, but not always and one may be ahead of the other. The best estimates I have seen is that 2/3 of boys will be retractable by 6 years old and 90% will be retractable by 10 years old and the rest should be retractable by late teens. In maybe 2% of all, there may be some problems with retraction by late teens and there are gentle stretching exercises that can resolve the problem in just a few weeks. .05% betamethesone can speed the process but isn't necessary. It should never be painful to the boy.

Now for cathertization. It is normal for the preputial sphincter to be so tight that the opening is only big enough for urine to escape. However, usually the preputial sphincter is lined up with the meatus. Gently flaring the preputial tip will usually give a view of the meatus. If it is not visible, it will take a little "fishing" but can usually be accomplished with out major problems. This flaring of the tip is the most the foreskin should be retracted as stretching the preputial sphincter can cause damage and even though the foreskin can be forced back, it can cause problems with infections later.

Now for parents. There is absolutely no more reason to retract the foreskin than there is to open up the vaginal cavity of a girl. There is no more reason to wash inside the foreskin than there is to wash the vagina of a girl. There is no need for a foreskin to retract until the boy becomes sexually active. Until the boy begins to produce testosterone and gonadotrophins at puberty, there is no hygiene issue. Trying to retract your son can cause trauma to the foreskin or glans that can lead to infection. However, if your son decides he wants to retract his foreskin, let him. Mother nature is whispering in his ear telling him "it is time." Because he can feel the slightest twitch of pain, he will stop before he goes too far. You can not feel that twitch of pain and may injure him.


Did I add anything to the discussion? :LOL





Frank

[Gitti]

Foreskin retraction:

I believe you know by now that the foreskin of a male should NEVER be retracted by anyone but the child himself. He will start to pull, twist, stretch, etc. his penis as soon as he discovers it and never leave it alone again (LOL) until the foreskin has retracted naturally. That is the way it should be.

Usually that happens by the time a child is 5. But it can take longer in some children. Some people have posted that some foreskins will never retract, but there is a problem with that. A grown male with an un-retractable foreskin can not get a comfortable erection. But that is a different subject all together and the solution is often times just a minor stretching under local anesthesia or topical steroids. (Never circumcision)

Even to cath a child, the foreskin should not be retracted.

By retracting the foreskin with even the slightest bit of force, the lining of the foreskin tears and creates small scar tissues. These scar tissues over time will make the foreskin inelastic, creating acquired phimosis.

The reason why many U.S. children have to be circumcised after being left intact in infancy is iatrogenic. In Europe, where doctors are familiar with leaving the foreskin alone, where they learn how to cath an intact infant, circumcision at any age (other than for Jews and Muslems) is virtually unheard of.

Warning not to retract and Intact care...

http://www.cirp.org/library/normal/aap/
http://www.geocities.com/raisingintactsons/
http://www.cirp.org/library/hygiene/

It is so refreshing to have an RN come to this board to ask questions. I have a feeling you are the sort of person who will keep expanding her knowledge.

[Lucky Charm]

Did I add anything to the discussion?

Yes, and thank you!

However, usually the preputial sphincter is lined up with the meatus. Gently flaring the preputial tip will usually give a view of the meatus. If it is not visible, it will take a little "fishing" but can usually be accomplished with out major problems. This flaring of the tip is the most the foreskin should be retracted

This helps me out in a major way. i had no idea. the baby i cath'd saturday, i did pull back gently, and the tiny tip did flare. i put the catherter in, and when i didnt get urine, i immediately thought i was in the wrong spot and pulled it out. i did it again, and i got urine. to me i guess, it just didnt look like other meatuses i have seen.....in baby girls i use a betadine swab, and with a gentle swipe in a downward motion, the meatus "winks" at me, and i get my urine first shot (most times!!). of course, with circ'd boys, its a no brainer.

I am happy to see more and more little boys not being circ'd. i just dont want to hurt them or anger their mom.

[Frankly Speaking]

The best thing to do if the Mom is there is to explain to her what you are going to do. Those that are knowledgeable are likely to go postal on you if they think you are going to retract their son. You could say something like "I am going to insert the catheter and want you to know what is happening. I know that you should never retract a boy's foreskin and I am not going to. I am going to gently flare the foreskin tip so I can see the meatus but I will not retract him at all." This will let her know that you know about intact boys and are educated and is a strong signal that you can be trusted. If you don't let her know, there is always the possibility she will think you are going to retract her son and she may panic and throw a right hook to the jaw.





Frank