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#1 of 31 Old 05-07-2009, 04:53 PM - Thread Starter
 
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Hello, I am looking for some information and advice. My son Alasdair has a fairly severe infection in his penis. I am feeling horrible about it because thinking back I realize it probably started a month ago when he was having trouble getting to the bathroom in time, but when it improved I brushed it off. Anyway, yesterday at bedtime I noticed it was quite red and this morning it was leaking pus Obviously we went to the doctor asap.

As it turns out, the infection is a result of phimosis, which is when the foreskin is too tight at the opening to retract over the glans. I'm not surprised by this, really, because twice as an infact his doctor had to do a minor procedure to widen the opening for him. As an infant it's not a huge issue because the unretracted foreskin can't harbour bacteria. Now however the foreskin has retracted (my doctor checked at his 3 year visit and it was tight but possible), but the opening has closed tighter again, so it is now impossible to actually clean under his foreskin properly.

We're going back in a week to check that the infection is gone, but it's almost certain we'll be referred to a pediatric urologist at that point. My Doctor advised me that the usual treatment for phimosis is circumcision. While of course I will do what is necessary for my son's health, I was told that some people here may have information about things to try before taking that step. I would be grateful for any advice or experience you have to share. Thank you!
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#2 of 31 Old 05-07-2009, 04:56 PM
 
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How old is he?
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#3 of 31 Old 05-07-2009, 05:03 PM - Thread Starter
 
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He is 3.5
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#4 of 31 Old 05-07-2009, 05:20 PM
 
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Nak.

You will get great advice here.

There is no need for him to be retractable at 3.5 years old. It is completely normal for boys not to be retractable until much later (10, 12, 15). Your doctor has no business checking anything and performing any procedures. What did he do, btw?

There is no need to clean under foreskin at 3.5 either. The opening closed because that is what it is supposed to do. Once separation starts naturally, it will widen, but if it's manually retracted, stretched, etc. - the opening will tighten back.

How was this infection diagnosed?

Other posters will give you more info, I'm sure, but most likely these issues are a direct result of the doctor messing with things that don't need his "help".
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#5 of 31 Old 05-07-2009, 05:38 PM - Thread Starter
 
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I think I must have been unclear. At Dair's 3 year appointment my Dr checked whether the foreskin was retractable. She very gently pulled, and it retracted - obviously it had naturally loosened by that point. Since then no one but Dair has touched it.

It is now 7 months later and Dair has developed an infection. It was diagnosed by the yellow pus oozing from it. His entire penis is inflamed and there is a lot of pus. He is on antibiotic to get rid of the infection.

The reason the doctor mentioned circumcision is because in Dair's case the foreskin can and has retracted but the opening is not large enough for the glans to pass through and therefore there is no way to properly clean the glans. This is the source of the current infection.

I do not think my doctor is to blame here. I am not looking to place blame. I am looking for ways to help my son.

edited to add: Dair's foreskin balloons when he pees and always has - I know this is an additional point of concern.
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#6 of 31 Old 05-07-2009, 05:42 PM
 
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It doesn't need to be cleaned. There's absolutely no reason to be retracting his foreskin. The glans is a self-cleaning organ. Has she cultured the pus coming out? Is she even sure it's pus? The only legitimate reasons for circumcision are gangrene, cancer, frostbite, and severe injury.

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#7 of 31 Old 05-07-2009, 05:51 PM - Thread Starter
 
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It is pus. There is a ton of it, there is no question. He has a raging fever. I am not questioning the existence of infection, and if you saw my child you would not either.

Once the foreskin has retracted, cleaning the glans and under the foreskin is indeed required. Mild soap and water are ususally all that is required. As I indicated above, my son's foreskin has NATURALLY retracted already and bacteria can therefore be harboured between the glans and foreskin. And obviously is, at the moment.

Please could you calm down and stop being so aggressive with me. I am not about to circumcize my child without making sure it is the last resort. Someone told me that people here had some good information about other possible therapies and that is what I am hoping to hear about.
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#8 of 31 Old 05-07-2009, 05:57 PM
 
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It does sound like an infection, and if it is, antibiotic is the only therapy needed.

I don't think anyone (myself included) is meaning to sound aggressive, we just get exasperated with lack of education with health care providers. You'd be surprised how many times someone has said their doctor misdiagnosed smegma as pus, or gave an antibiotic for a yeast infection. In your case I'd get an antibiotic to clear up the infection and then, if you're confident he's completely retractile, have him retract and swish the glans in water every time he takes a bath (no soap!).

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#9 of 31 Old 05-07-2009, 06:04 PM
 
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Sorry to be brusk, but need to go pickup DS from school.

Since your sure it's an infection, then I would worry it was caused by the retraction that the Dr did at the 3 yo checkup.

Give him the antibiotics, but make sure no further retracting is done till your DS chooses to himself. Wash in plain water, no soap, no bubble bath, just swish.

Make sure his fingernails are clean and short, so if he sticks them in there (yeah, boys do this ) they don't cause damage.

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#10 of 31 Old 05-07-2009, 06:08 PM
 
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You absolutely do not have to clean under the foreskin. Smegma, for example, is a natural self-cleaning lubricant. It does not cause infections. What causes infections is if you try to force the foreskin back to forcibly clean down there. That's a big no,no. The only person that should be doing that is your son. There is also no such thing as a "too tight opening." The only time the opening would be too tight if it would constrict urination. Phimosis cannot be also diagnosed in a 3 year old child. Your doctor is misinformed. If your son's glans cannot fully go through the opening; that's perfectly normal and is normal until late teens. The average age of complete retraction is 10-11 years old, with some kids not being able to do it until early adulthood. Again, all normal. I am sure people here will give better advice on the infection business than I can; however if you have urgent questions, please feel free to contact Doctors Against Circumcision (DOC). I am sure they will give excellent advice without having your son undergo something as radical as a circumcision for what's probably a none-existant problem.
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#11 of 31 Old 05-07-2009, 06:08 PM
 
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Ballooning is also completely normal, it doesn't lead to problems. All it means is that the foreskin has detached from the glans, but the opening is small enough to create pressure inside the foreskin. My older boy ballooned until he was 12 and became fully retractable.
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#12 of 31 Old 05-07-2009, 06:11 PM
 
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Since your sure it's an infection, then I would worry it was caused by the retraction that the Dr did at the 3 yo checkup.
the op said the check up was 7 months ago. i highly doubt that the retraction at the check up so long ago is to blame.
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#13 of 31 Old 05-07-2009, 06:11 PM
 
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We get frustrated with doctors damaging our baby boys. You mentioned that your son had a procedure twice to widen the opening. That is a huge mistake that could cause future problems like phimosis. If he was able to pee there was no need to do this.

Here is a link that might help. It has a "Prepuce “Problems” and How to Care for Them" You'll have to scroll down a bit.

http://www.doctorsopposingcircumcisi...iansguide.html

Wife to DH, Mom to my Intact Boys DS1: Born 02 Pain Med Free Hospital Birth, BF'ed for 9 Months, Partially Vax'd DS2: Born 06 via UC, BF'ed 3 years 10 months, and UnVax'd
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#14 of 31 Old 05-07-2009, 06:13 PM
 
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Originally Posted by Rockprincess View Post
edited to add: Dair's foreskin balloons when he pees and always has - I know this is an additional point of concern.
Didn't mean to upset you. Just get frustrated with doctors.

Ballooning is a normal process. Nothing to be concerned about. It will resolve in its own time. The only thing your son needs his penis to do is pee right now.

Since you're giving him antibiotics, make sure you give him a good probiotic too, so that he doesn't get a yeast infection.
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#15 of 31 Old 05-07-2009, 06:14 PM
 
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I want to reply later tonight when I have time. I just want to point out that we do get a lot of people who are told one thing by the doctor and it turns out to be another so don't take offense by a particular comment. I want to also quickly mention that there are alternative treatments to circumcision that are often skipped which I'll bring up later. (or perhaps someone else will).
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#16 of 31 Old 05-07-2009, 06:25 PM
 
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I agree with what everyone has said above. I'm sorry your dr has grossly misinformed you about phimosis. I encourage you to do some of your own research on this issue and bring the research to your dr.

"twice as an infact his doctor had to do a minor procedure to widen the opening for him" This shocks me (well not really considering what I've heard Dr's do)! There was no need to widen the opening unless his urine wasn't coming out.

The antibiotics should be working within 24 hrs. If not, I'd encourage you to have your dr culture the pus to find the appropriate antibiotic. I hope your little man feels better soon.

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#17 of 31 Old 05-07-2009, 06:39 PM
 
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I'm sorry, but this whole situation is just full of, what I would consider to be, TERRIBLE medical advice and misinformation. And I know that I probably sound angry, but please know that's directed at your health care provider (HCP), not at you.

Quote:
Originally Posted by Rockprincess View Post
Hello, I am looking for some information and advice. My son Alasdair has a fairly severe infection in his penis. I am feeling horrible about it because thinking back I realize it probably started a month ago when he was having trouble getting to the bathroom in time, but when it improved I brushed it off.
What leads you to believe that a 3.5 year old not making it to the bathroom in time has anything to do with his foreskin? There are lots of children, both boys and girls, intact and cut, who have difficulty with this.

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Originally Posted by Rockprincess View Post
Anyway, yesterday at bedtime I noticed it was quite red and this morning it was leaking pus Obviously we went to the doctor asap.
Many boys experience symptoms very much like this is described as a normal and natural part of the separation process. Since you've gone on to say in subsequent posts that he has a raging fever, it is quite possible that it was indeed an infection, but without a culture, there's no way to know that for sure.

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Originally Posted by Rockprincess View Post
As it turns out, the infection is a result of phimosis, which is when the foreskin is too tight at the opening to retract over the glans.
Almost all boys have a tight foreskin which is too tight at the opening to retract over the glans, and the average age of natural retraction is around 10 years old. A HCP who says that a 3.5 year old boy should be retractile is completely mistaken and woefully ignorant.

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I'm not surprised by this, really, because twice as an infact his doctor had to do a minor procedure to widen the opening for him. As an infant it's not a huge issue because the unretracted foreskin can't harbour bacteria.
What in the world did your HCP do to your infant son, and more importantly, WHY???

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Originally Posted by Rockprincess View Post
Now however the foreskin has retracted (my doctor checked at his 3 year visit and it was tight but possible), but the opening has closed tighter again, so it is now impossible to actually clean under his foreskin properly.
If your HCP said it was still tight, then your son was forcibly and prematurely retracted. Of course his foreskin has reverted to its previous state -- it's called healing.

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Originally Posted by Rockprincess View Post
We're going back in a week to check that the infection is gone, but it's almost certain we'll be referred to a pediatric urologist at that point. My Doctor advised me that the usual treatment for phimosis is circumcision. While of course I will do what is necessary for my son's health, I was told that some people here may have information about things to try before taking that step. I would be grateful for any advice or experience you have to share. Thank you!
Your son doesn't have a phimosis problem and doesn't need to be circumcised. He may, or may not have had an infection which can be easily treated with antibiotics. Please be aware, though, that a course of antibiotics can often lead to a yeast problem which can also cause redness and swelling -- just like it does in females.

Please read a lot. Here are two great places to start.

Mothering Article on How to Protect your Uncircumcised Son, by Dr. Paul Fleiss

http://www.mothering.com/articles/ne...uncircson.html

The American Academy of Pediatrics Care of the Uncircumcised Penis

http://www.cirp.org/library/normal/aap/
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#18 of 31 Old 05-07-2009, 06:48 PM
 
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Someone told me that people here had some good information about other possible therapies and that is what I am hoping to hear about.
But please hear that what we're saying and the articles that you can find linked to in this thread and the stickies is that your son doesn't need any kind of "therapy" because he doesn't have a problem beyond a possible, and simply treated, infection.

To me, what it sounds like, is that your over-zealous HCP needs to leave his poor penis alone. Maybe you might think about asking your HCP how exactly s/he would treat the exact same type of infection in a female child?
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#19 of 31 Old 05-07-2009, 06:57 PM - Thread Starter
 
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I am listening to what you are saying, and I agree that I need to do more research before making any decisions. I will also talk to the pediatric urologist in depth before I make any decisions.

I do disagree with some of the information some of you are giving however. The widening as an infant was performed because the restriction was so great it caused problems with his urination. The ballooning was not momentary and normal, it was very exaggerated and the urine left the foreskin balloon at a much slower rate than it entered from the urethra. This is a big problem, it can cause repeated UTIs.

I think perhaps we are coming to this issue from different places. I live in Alberta, Canada, where routine infant circumcision is less than 18%. My doctors are very familiar with uncircumcized penises and how to care for them appropriately. My doctor did not say "An infection! You will circumcize him immediately!" he said "Come back when the infection is treated. If there is still a problem we will refer you to the urologist. You should know that sometimes the medical indication for this problem is circumcision."

I am looking for ways to reduce my son's risk of infection in the future. I believe his continued ballooning along with the detached foreskin and narrow opening leave him vulnerable to infection, and I'd like to reduce that without surgery if possible.

Just to address this:
Quote:
What leads you to believe that a 3.5 year old not making it to the bathroom in time has anything to do with his foreskin? There are lots of boys, both intact and cut, who have difficulty with this.
I don't think it has anything to do with his foreskin, I think it has to do with an undetected UTI. My son has been totally potty trained for over a year, and a month ago he started having accidents about twice a day. I thought about UTI at the time, but the accidents only lasted a few days, so I put it out of my mind. That's all.
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#20 of 31 Old 05-07-2009, 07:07 PM
 
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I'm in Alberta too. Being in Canada doesn't protect you from misinformed doctors. I was sent to a urologist with my first son. Luckily he was informed enough to tell me that my doc wasted our and his time by referring us as there was no problem at all. So if your lucky you will get a urologist that is as informed. Just be up front that you will not entertain talk of circumcision.

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#21 of 31 Old 05-07-2009, 09:15 PM
 
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The ballooning was not momentary and normal, it was very exaggerated and the urine left the foreskin balloon at a much slower rate than it entered from the urethra. This is a big problem, it can cause repeated UTIs.
This is perfectly normal. The UTI thing is a red hearing.

The rate in Canada is currently 10%, but this is reccent. Just a generation ago circ was just as common in anglophone areas of Canada as it was in the US. My DH was born in Canada in the early 70's. His mother who barely spoke english (and no french at all) was asked to sign the concent without being informed that it was surgery. She was ery upset afterwards when she discovered what happened.

Many of today's Drs went to medical school then. The teachers in medical school are mostly from back then. You can not count on a Canadian Dr to be that much better informed than a US Dr. (Though I would expect the francophone Drs are a bit better.)

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#22 of 31 Old 05-07-2009, 09:41 PM
 
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To add to the information given above:

The preputial space, the space between the prepuce (foreskin) and glans (head of the penis) that develops as a boy becomes retractable, secretes lysozyme, a beneficial enzyme that is anti-bacterial.

Also, urine is sterile when it leaves the body. In fact, the advice given to intact soldiers in the field when baths aren't readily available is to pee while holding the foreskin closed, to swish the pee around inside the preputial space and wash everything out.

It is not necessary to retract and wash the head of the penis regularly for fear of infection developing, any more than it is necessary to wash the inside of your vagina. The intact penis is basically self-cleaning.

So there's just really no emergency in terms of "we must get in there to clean or he's going to get repeated infections."

Also, your doctor is misinformed in stating that circumcision is the "cure" for phimosis. That's like saying we should cut a girl's labia off if they become fused (which is a very common problem). There are many, many steps far short of foreskin amputation that can solve the phimosis issue (if there is in fact "true" phimosis which I, too, very much doubt).

Steroid creams could be applied to the foreskin to hasten the loosening process so that it retracts more easily.

Stretching exercises could be done -- although I would be very reluctant to do those myself as a parent, I believe it would be better than forcing my son to suffer an unnecessary circumcision.

At the absolute most, a dorsal slit could be made in the foreskin which would preserve most of its functionality.

But again, I have to say, in agreement with the above posters -- circumcision is absolutely not the answer. EVEN IF your son were undergoing repeat UTIs (which is apparently not the case). Circumcision is no more an appropriate treatment for boys than it is for girls suffering similar ailments, because the foreskin is not disposable.

I hope you can find some answers, and I also hope you will be open to questioning your doctor more, because despite the fact that you live in Canada, he has absolutely given you misinformation.

A good source for good information is www.cirp.org, which is full of medical journal articles on the foreskin and circumcision.

You should especially read through this page on phimosis:

http://www.cirp.org/library/treatment/phimosis/

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#23 of 31 Old 05-07-2009, 10:02 PM
 
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You should especially read through this page on phimosis:

http://www.cirp.org/library/treatment/phimosis/
That's a fantastic link!!! So informative!
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#24 of 31 Old 05-07-2009, 10:39 PM
 
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It is pus. There is a ton of it, there is no question. He has a raging fever. I am not questioning the existence of infection, and if you saw my child you would not either.
Ok, so I wanted to chime in with some thoughts. First, based on what you've shared I agree there is an infection of some kind. You've sighted fever which I think makes it clear. I might ask if the pus smelled, if infected I would expected the smell to be nauseating. I won't question this diagnoses either but do we know if it is a UTI or some other type of infection?

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Once the foreskin has retracted, cleaning the glans and under the foreskin is indeed required. Mild soap and water are ususally all that is required. As I indicated above, my son's foreskin has NATURALLY retracted already and bacteria can therefore be harboured between the glans and foreskin. And obviously is, at the moment.
I am not going to quibble much on this point except to say as an intact guy myself, I have gone long stretches without washing under the foreskin. This is usually when I don't have access to showers or baths which has happened from time to time and I've never had any problem with that. Usually it's other parts of my body that feel or show their wear first as it were. Though I do wash that part when I am in the shower I don't personally consider it critical.

It also seems to me that you're doing it the right way, letting him do it. As far as ballooning that is normal but what you want to watch for is if the flow of urine is very restricted, which I think you said it was but to a point I wouldn't worry at all about it.

Quote:
Originally Posted by Rockprincess View Post
Please could you calm down and stop being so aggressive with me. I am not about to circumcize my child without making sure it is the last resort. Someone told me that people here had some good information about other possible therapies and that is what I am hoping to hear about.
Understand that this is a function of the fact that we often get request for help from people who, while trying to do their best (which is why they are here), have incomplete information. This is usually because their doctor didn't provide or doesn't know all the options. This is more frustration than aggression, we are just trying to help you that's all. I don't think you're in that group I think you've come with a better sense of what's going on than others.

Now to your options. I will provide these to consider only if all other conservative treatments fail. With out knowing the situation first hand I can't say exactly what I would do so I appreciate your predicament. First, read the link that Quirky gave you that has a lot of good information. In addition to 'gentle stretching' there are steroid creams which work in most cases. But if for some reason that doesn't work or your urologist is leaning on circumcision I would get at least two other opinions and also strongly consider sutureless prepuceplasty. It's the least invasive surgical option, you will allow him to retain the foreskin and it will function normally. Read about it here:

http://www.biomedcentral.com/1471-2490/8/6

It's a better option than circumcision but should still be the last resort. I hope that helps you a bit.
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#25 of 31 Old 05-07-2009, 11:52 PM
 
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Ballooning no matter how bad will not cause problems it is part of the normal seperation process.

Here is a link you should look over.
http://www.mothering.com/discussions...d.php?t=764732

And no you dont need to clean under the foreskin once it is retractable at all. The only person who should do so is the owner of the penis and if he cant do it on his own it dosnt need doing. This can cause problems.

I am very concerned about your ds having scare tissue due to the "stretching" done to him as an infant. No dr who knows what they are doing would do that to an infant unless he was 100% unable to pee. No more than a dr would stretch the urethra of a infant girl.

 
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#26 of 31 Old 05-08-2009, 12:03 PM - Thread Starter
 
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Fellow Traveller, thank you for the information.

I will read the links provided.
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#27 of 31 Old 05-08-2009, 11:09 PM
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twice as an infact his doctor had to do a minor procedure to widen the opening for him. As an infant it's not a huge issue because the unretracted foreskin can't harbour bacteria.

I'm so sorry, this ignorant doctors was HARMING your son physically and emotionally
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#28 of 31 Old 05-09-2009, 12:27 AM
 
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with the quoted above me, to me, it sounds that whatever the doctor did to your babe as an infant, did damage on your babe and now he has these infections. I highly recommend you to get in contact with Marilyn Milos, she will help you no doubt.

Latina Mama of 3 and Wife of a great man since 1997
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#29 of 31 Old 05-09-2009, 12:34 AM
 
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Something that is very important to understand. The tip of the foreskin is a sphincter just like the anus. When not in use it closes down very very tight like pin hole tight. When the boy urinates it lets loose to allow the urine to flow.

Stretching this sphincter by force can cause scar tissue to form making later retraction difficult.

Can you imagine someone forcing open your anus? well that is the kind of pain that the little guy felt when the Dr did that to him :

It is very important to do tons of research before allowing a Dr. to do any type of treatment on their ds. Yes dr are supposed to know but when it comes to the intact penis they are not taught how to deal with it.

I am not blaming the OP at all here this is the dr's fault :

I pray daily that some day that stories like this dont exist any more


I cannot stress enough that you need to find a Dr. who actually knows what he/she is talking about. For your ds's sake.

Doctorsopposingcirc has a site where you can get in touch with dr's who are truly up to date on all the intact penis issues. Usually the issues like this one are really ignorent dr/healthcare worker issues.

 
SAHMlady.gifread.giflovin' trekkie.giffan intactivist.gifwinner.jpg to loveeyes.gifenergy.gifDD 10/00 & superhero.gifmoon.gifDS 10/04 ribbonpb.gifIf your ds is intact, keep him safe, visit the Case Against Circ forumnocirc.gifCirc, a personal choice, Your sonsyes.gifbrokenheart.gif11/98brokenheart.gif6/99ribbonbrown.gifanti-tobaccoribbonyellow.gifThyroid cancer survivor. With cat.gif& goldfish.gif & (Boxer)dog2.gif wishing 4 whale.gif&ribbonwhite.gifsigncirc1.gifselectivevax.gifdelayedvax.gif

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#30 of 31 Old 05-09-2009, 11:28 AM
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Something that is very important to understand. The tip of the foreskin is a sphincter just like the anus. When not in use it closes down very very tight like pin hole tight. When the boy urinates it lets loose to allow the urine to flow.

I cannot stress enough that you need to find a Dr. who actually knows what he/she is talking about. For your ds's sake.

Doctorsopposingcirc has a site where you can get in touch with dr's who are truly up to date on all the intact penis issues. Usually the issues like this one are really ignorent dr/healthcare worker issues.
:::
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