Steroid Cream to Treat Complications of Preputial Stenosis ("Phimosis") in Children - Mothering Forums

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#1 of 16 Old 06-18-2010, 03:57 PM - Thread Starter
 
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Hello! I’m hoping that this (very long) post might be helpful to parents of uncircumcised boys who are experiencing significant medical problems (repeated infections, urinary urgency or frequency, urological pain, chronic penile skin irritation or inflammation, etc.) as a result of an excessively tight or constricted foreskin (preputial stenosis). We recently went through this with our son, and we had an extremely good outcome with steroid cream. We discovered a variety of methods that, in our opinion, maximized the probability of a successful outcome, and I want to somehow pass that information along to other parents.

I’m writing this post anonymously because we’re a fairly observant Jewish family, and in that context, I’m very committed to protecting my son’s privacy until such time as he’s able to decide for himself with whom to discuss the issue of circumcision.

My hope is that in writing this post, I can offer more information about using steroid cream to treat “phimosis” in young boys, as well as reassurance to distressed moms. At times, in this forum, I’ve seen posters state that steroid cream should never be used with young boys, that it thins the foreskin (thereby making future adhesions more likely), and that even if it’s successful in loosening the foreskin, the foreskin will tighten up again post-treatment. None of these statements are supported by the research literature, as far as I know (and if anyone knows of any studies that do support those statements, please let me know). To the contrary, all the studies I’ve read suggest that steroid cream is a highly effective, non-invasive, non-surgical option in treating so-called “phimosis” in young boys.

(I’m putting “phimosis” in quotes because obviously, a tight, non-retractable foreskin is normal in young boys. As such, steroid cream should never be used to treat a tight foreskin in and of itself, because that’s not a medical problem – it’s normative. However, if the foreskin causes chronic medical problems, then – and only then – would the cream become appropriate.)

I really want to emphasize that, given my son’s level of distress and physical discomfort, if I hadn’t been reassured that steroid cream was an option with a high likelihood of success, or if I had been dissuaded from using the cream, I would have considered circumcision. I would have done anything to end my son’s pain and fear. I now believe that a significant percentage of childhood circumcisions performed for “medical reasons” are actually performed because the parents were inadequately informed about steroid cream (by similarly ill-informed physicians), were not prepared by their physician to give it an optimal chance for success, and were understandably upset by their child’s pain and anxiety. I’m hoping that this post might reach at least one mom who’s as scared and sad as I was, and let her know that she does not necessarily need to circ her little boy.

(1) First, there’s now a substantial number of empirical studies showing that steroid cream (usually in the form of Betamethasone 0.5) is a highly successful, low-cost, non-traumatic, non-surgical treatment for preputial stenosis in young boys. It works by accelerating the normal growth and expansion of the foreskin that occurs over several years. Follow-up studies conducted 3-5 years post-treatment have found no thinning of the skin, no increased incidence of adhesions, no return to a non-retractile state, and – in the majority of cases – no need for further or repeated applications. If you’re interested in the research, a good place to begin is this page: http://www.cirp.org/library/treatment/phimosis (the studies under “Topical Medication” are particularly helpful; the citations can lead you to other, similar studies).

(2) We had a very bad experience with the first physician we consulted. He gave us the cream with very few instructions, no information about success rates, and a few comments about circumcision being the only option if the cream failed. We were confused and devastated. We then had the incredible good fortune to be redirected to a different physician – another religious Jew, ironically, who we know from our community – who presented the cream in an entirely different light. He explained that the cream has an 85-95% success rate, and that the success rate could be even higher with uniformly correct application. He wisely advised us to “use the cream until it works.” The first physician had given us a 2-week time frame in which the cream might work; in contrast, our second physician stated that we needed to give it as much time as we could – up to 2 months prior to another medical consult - and he expressed every confidence that it would work. So please pass along the information to other parents that the cream has a very high probability of success if used in a reliable, consistent, thorough manner.

(3) We found that long, warm baths were helpful in alleviating pain and urinary discomfort. Soaking in a baking soda bath – one entire box of baking soda in the bath, with the child soaking for up to an hour and urinating while in the tub – was very reassuring to our son. Also, I made baking soda poultices by mixing a paste of baking soda and water, then spreading on 4”X4” gauze and placing against my son’s penis. Baking soda is helpful because it’s amphoteric, which means that it behaves as a base in acidic medium and as an acid in basic medium (in other words, it’s uniquely effective at balancing pH levels).

(4) Our first physician instructed us to apply the cream 2 times per day. We quickly found that was insufficient. For the first week, we applied the cream every time our son urinated. We would blot the tip of his foreskin with toilet paper, to remove any residual or "trapped" traces of urine (the source of his problem), and then apply the cream. Fortunately, our second doctor instructed us to USE GAUZE when applying the cream, or else it will immediately rub off on underwear or clothes. So we applied the cream, then placed a small piece of gauze as a barrier between our son’s penis and his underwear, to “hold” the cream in place. Also, don’t dab the cream on – really slather it on the penis, covering the entire tip liberally.

(5) The ultimate goal when using steroid cream is to get the cream under the foreskin, since that is where it will loosen the foreskin and correct the condition that’s causing the symptoms in the first place. Our son’s foreskin was so tight that we were initially unsuccessful in getting any cream into the foreskin. However, if this happens to you too, please do not give up on the cream. We had the following idea, which very quickly and successfully resolved our son’s symptoms:

Get a small syringe (just to be clear, you’re not going to use a syringe with a needle – THERE SHOULD BE NO NEEDLE ON THE SYRINGE. Instead, use an empty syringe, like one you would use to squirt food into a small animal’s mouth). Make sure that the syringe tip is clean (we wiped it down with an alcohol pad). Suck up steroid cream into the syringe. BALANCE (do not press) the syringe, very gently, against the tip of the foreskin. NEVER FORCE OR PUSH IT IN. You are NOT aiming to place the syringe under the foreskin, but rather to rest it lightly against the tip of the penis. You will be using NO strength or force – you will simply be balancing it (if your arm is tense at all, do not try this - wait until you’re loose and relaxed). Gently balancing the tip of the syringe against the tip of the penis (you might need to rest the tip of the penis and the tip of the syringe across your finger, in order to get them into close proximity), slowly press the syringe plunger. Due to the placement of the syringe tip, microscopic bits of cream should lodge in the very first part of the foreskin opening.

Our son experienced intense symptom relief almost immediately after we began this technique. Within one week, his foreskin was visibly, if minimally, looser. This slight increase in skin elasticity stopped the cycle that had caused the problem in the first place. We continued with the cream for one more week, just to complete the treatment, but all of his painful and distressing symptoms were gone.

Since that time, he has had no recurrence of symptoms, no re-tightening of his foreskin (which is loose enough to prevent medical problems, but not completely loose), no adhesions, and no other problems. After leaving our first doctor’s office convinced that we may be forced to circumcise our son in order to end his physical discomfort and anxiety, I was amazed to learn that a simple cream could do it, with great success, in 2 weeks, with full preservation of his foreskin.

I really, really want to get the word out that NOT EVERY DOCTOR IS AWARE of the success rates associated with steroid cream, or of the correct methods for application (including the amount of time potentially needed to see results). If your doctor seems unconvinced of the cream’s capacity to help your son, please seek a second opinion. If the cream does not work for you within a couple of weeks, please give it additional time, using the methods described here. As our second physician said, try to use the cream until it works. There is no reason for a physician to recommend circumcision before steroid cream (and, after that, dilation and stretching in conjunction with the cream) has been given a full opportunity to work.

Finally, please remember that just because your son may be having problems associated with preputial stenosis, that does not mean your initial decision not to circumcise was wrong. There is no reason to cut off healthy human tissue absent compelling medical need, and the vast majority of cases, steroid cream can easily and quickly resolve a child’s symptoms. Having been through this experience with my child, I can say that in the days following his initial diagnosis, I felt terribly guilty and completely responsible for his pain. I was very vulnerable during that time, and had a doctor or family members pressured me, I may well have consented to circumcision. Fortunately, I had the support of both my husband and our (second) physician, both of whom were reassuring and optimistic. It’s my belief that nonjudgmental support, accurate medical information, and a healthy dose of optimism can potentially avert an otherwise preventable circumcision allegedly performed for “medical reasons.”

I hope that this post was helpful.

Be well.
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#2 of 16 Old 06-19-2010, 12:21 AM
 
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Just a question at any time was anyone trying to push his foreskin back Dr, nurse, day care worker, family member etc? The reason I ask is because the odds of the foreskin have any problems at all is very small unless someone is over cleaning it or using soap.

 
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#3 of 16 Old 06-19-2010, 01:07 AM
 
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This is a helpful post.

My son has never been retracted, no soap, no dyes and only cloth diapers and had issues anyway... tight foreskin and often slightly infected... Sometimes yeasty, sometimes bacterial. Sometimes ballooning and red, other times white and sloughing For us we were always using one cream or another. Then a Doctor gently pulled it back while I screamed at him and I learned that my son just had really long foreskin. He was the first to do this and I was really upset.

To be sure, he never exposed the glans, just pulled it back enough to almost see the glans. Now we do this after the bath and put a little bit of polysporin on it so that the nighttime diaper doesn't irritate it and he has been sooo much better. Doesn't tell me that it hurts anymore and that is great for me to hear.

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#4 of 16 Old 06-19-2010, 04:37 AM
 
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Just out of curiosity, how did you know his medical issues were due to phimosis and not due to him naturally starting to separate on his own?

I ask because my son had all those same symptoms, but his was not a phimosis problem, it was a separation issue. Inflamed foreskin, urgency to urinate, pain and stinging when peeing, discomfort, complaining of pain and. burning, etc....all remedied by baking soda baths, soaks in the tub, and time.

And within a few weeks it cleared up on its own as the foreskin naturally loosened.
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#5 of 16 Old 06-19-2010, 05:31 AM
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I'm glad you guys got the wee man's medical issues resolved.

Do you think the steroid cream worked because it loosened the foreskin or because it treated an underlying, unidentified condition that was causing the pain, inflammation, irritation etc?

I ask because I have a background in dermatology and betamethasone is a fairly potent steroid so my thinking was, the majority of 5 yo boys have very tight foreskins (if we agree that the average age of retraction is 10.5 years or so) but very few boys have any issue related to this. Do the boys that do have issues actually have something else (X condition) and the moderately powerful steroid subdues the symptoms and allows the body to heal.

Loosening the foreskin is simply a side effect of the treatment but not the cure, the cure was a decent length of steroid application that treated X condition?

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#6 of 16 Old 06-19-2010, 08:31 AM
 
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My son had a few UTIs at age five, and we used betamethasone cream to treat his 'phimosis'. It loosened and made his foreskin retractable within days and we continued treatment for a few weeks. But after treatment ended he had 'phimosis' again. But it's been over a year and he hasn't had any more infections. He's still totally unretractable, so I just have to keep him away from urologists unless he gets sick again.

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#7 of 16 Old 06-19-2010, 01:47 PM
 
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Originally Posted by GuestMama05 View Post
I would have considered circumcision. I would have done anything to end my son’s pain
Thanks for your detailed account.

I'm not convinced his symptoms had anythying to do with his normal anatomy, or that the loosening of the prepuce had anything to do with symptoms subsiding.

That said, even if you were desperate for immediate relief of the tight foreskin, circumcision is not the standard of care. A dorsal slit with transverse closure is essentially non-amputative surgery that loosens the preputial opening.

-Ron
HIS body, HIS decision.
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#8 of 16 Old 06-19-2010, 10:51 PM - Thread Starter
 
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MCatLvr, no, he had never been retracted at all. I completely agree with you that the rate of problems is very low - in fact, our second (very helpful) physician estimated that in his 20+ years of pediatric practice, fewer than 1 intact boy in 1,000 ever had any issues at all.

Kat, I'm so glad to hear that your little guy is feeling better.

Anastasiya, I can't be sure. We did initially wait 2 weeks, but his symptoms became too acute to wait beyond that. But it's entirely possible that time would have taken care of it as well.

Bea, I don't know the answer to your question, but you may very well be right. And after reading Kat's comment, I wonder if there's some sort of normal variation in foreskin length or thickness that predisposes some children to problems (and if knowing that beforehand could prevent the problems, because parents could simply use baking soda baths a couple of times per week as a preventative measure).

EarthRoots, your post raises Bea's interesting question again - if it wasn't the stenosis in our boys' cases, but rather something else. At any rate, I'm very glad that your guy hasn't had any more problems.

Thanks to all of you for your responses; as I said in my post, my hope is that the information might help other mothers who may be vulnerable to pressure. Certainly, given the fact that we're a Jewish family living in a fairly observant community, I didn't have access to a lot of information about intact penises. When our son was born, we knew that we wouldn't circumcise him, but we also felt as though we were striking out for unknown territory with that decision. When he suddenly began experiencing problems, I wondered if I had done the right thing after all, particularly given that it took a very significant commitment on our part not to circ (i.e. we needed to be extremely resolute with family and friends - unmovable, really, to the point of obstinance - about the initial decision). I think that there may well be other parents out there who, like us, want very much to keep their boys intact, but who lack knowledge and experience. If those parents collide with a pro-circ physician, the outcome will probably be an unnecessary circumcision that confirms the worldview of those who insist that circs are unavoidable. If those parents were told about steroid cream, and assured that they made the right decision in not circ'ing, I think a number of later circs would never be done.

Thanks again for reading.

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#9 of 16 Old 06-25-2010, 05:21 PM
 
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Originally Posted by GuestMama05 View Post
I think that there may well be other parents out there who, like us, want very much to keep their boys intact, but who lack knowledge and experience. If those parents collide with a pro-circ physician, the outcome will probably be an unnecessary circumcision that confirms the worldview of those who insist that circs are unavoidable. If those parents were told about steroid cream, and assured that they made the right decision in not circ'ing, I think a number of later circs would never be done.

Thanks again for reading.
Thank you very much for posting your story. The above paragraph is so true, and tragicaly, many doctors are either unaware of other options or refuse to disclose them to their patients, opting instead to insist that a circumcision is the only answer to whatever the unfortunate boys problem may be.

We endured just this scenario many years ago with our son when he was 11 and suffered an infection of some sort that caused much stinging when he peed. Antibiotics cured the infection in a day or so, but it was revealed that is foreskin was tight like a newborn's, although we knew that he had been retractable at age 7. The urologist basicaly told us that unless he was circumcised he would continue to get infections. The internet had not ben invented yet and information was very scarce. I argued as best I could, but in the end I lost the battle and 5 months later my son lost his foreskin. I feel guilty to this day that I did not absolutely refuse to allow this.

Since the advent of the internet I have learned a LOT. I have also learned that even back then there had been papers written about the use of steroid creams to cure phimosis. Why was this information not passed on to us? What about preputioplasty, as Ron mentions above? The urologists total disregard for the value of a foreskin still makes me angry.

I also would like to add that for those few cases where steroid creams do not work, there are other optons that fully conserve the foreskin. I found the following article most interesting and the results obtained amazing: www.biomedcentral.com/1471-2490/8/6

How I envy the scandinavians, where only one man in what? 600,000 will die without his foreskin !!
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#10 of 16 Old 07-01-2010, 05:05 PM
 
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Thanks GuestMama!!! I really needed that post!
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#11 of 16 Old 07-02-2010, 08:32 AM
 
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Thanks Guest Mama! Your post was exactly what I needed when I needed it. We have a follow-up appointment for a UTI today, and you've given me all the information I need to present to my doctor if he suggests circumcision as the urgent care doctor did. You also made me feel better about leaving him in tact. As you experienced, when the doctor told me his problem was caused by his tight foreskin, I instantly felt guilty and like I had made a decision that was going to cause trauma for my son. I know a man who insisted that both of his sons be circumcised because he wasn't, and he was traumatized throughout his childhood by infections and finally a painful procedure (I don't know all the details.). I definitely don't want these infections to do that to my son, so I appreciate knowing that I have other options if this continues to be a problem.

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#12 of 16 Old 04-22-2011, 03:34 PM
 
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Hi

 

Your post is extremely helpful.   My son has the same condition and we started using the cream. 

He has shown some improvement , he still has some pain during urination.  He also passed little blood last time and we are worried and got him checked again for infection etc.

 

Is there anyway possible to get your doctors contact ?

 

very concerned mom.

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#13 of 16 Old 04-25-2011, 04:39 AM
 
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I realize this post is very old but wanted to add some resources for parents.

OP- I love your post and think you did a fantastic job explaining everything.

 

Here are additional resources for parents who may be worried about an issue and need more information. 

 

The following article is written by Dr. Fleiss, it is a very thorough list including UTI's, Ballooning, Too tight, Adhered, No longer retracts, Inflammation itching and discomfort, Too long, Cyst, Spraying, Phimosis, Paraphimosis, BXO and other reasons doctors may give for wanting to circumcise. " Below is a list of some of the things that doctors have said to parents in an attempt to convince them to agree to circumcision. After each incorrect statement, I've given the medical facts to help you understand what your doctor may not know about the intact penis and its care, and what you need to know to protect your child from unnecessary penile surgery" http://www.drmomma.org/2009/08/protect-your-uncircumcised-son-expert.html

 

This link gives an overview of the development of the intact male and explains why the diagnosis of phimosis in children and teens is incorrect. It also explains "true phimosis, its proper treatment, and why our doctors are so confused." http://www.drmomma.org/2010/01/phony-phimosis-diagnosis.html

 

This link talk about pain, swelling, ballooning and discomfort that may happen during the natural separation process.

http://www.drmomma.org/2010/01/painful-urination-during-prepuce.html

 

Here is a link explaining how the foreskin protects against UTI's. In Europe the notion that the foreskin causes UTI's is not accepted. http://www.drmomma.org/2009/12/how-foreskin-protects-against-uti.html

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#14 of 16 Old 06-10-2013, 04:13 PM
 
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Hi thanks for the letter, may I ask at what age did you begin applying the cream?
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#15 of 16 Old Yesterday, 01:32 AM
 
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Smile Icoolda phimosis stretcher cure boy's tight foreskin at home with no surgery and pain

"The above paragraph is so true, and tragicaly, many doctors are either unaware of other options or refuse to disclose them to their patients, opting instead to insist that a circumcision is the only answer to whatever the unfortunate boys problem may be."

We agree with these above.It seems that not only the doctors in China do so.Although doctors all over the world do the same,but non-surgical treatment solutions of phimosis now become more and more popular.Among young parents in China now start using a newly invented tiny device to cure boys' tight foreskin at home,3 to 5 days is enough to stretch to be able to pull back son's foreskin easily.We used it on my son of 5 years old for only 3 days.http://www.dhgate.com/product/patent...-3-7|240304945
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#16 of 16 Old Yesterday, 06:15 AM
 
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Hi thanks for the letter, may I ask at what age did you begin applying the cream?

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