urologist recommending circumcision for my 4.5 year old :( - Mothering Forums

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#1 of 28 Old 05-02-2011, 06:02 PM - Thread Starter
 
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Hello everyone, I'm hoping for some wisdom about how to handle this situation. A few months ago, our family doctor referred my son to a urologist because she was concerned that his foreskin wasn't retracting. He has had a few instances where his penis has become slightly swollen and red/inflamed, usually with some discharge, but I was under the impression this is normal for an intact boy and nothing to worry about. It always cleared up on its own within a few days. Other than those few instances he has never complained of pain (while urinating, with an erection, etc). At the appointment today, the urologist pulled back his foreskin as far as was comfortable for my son (only enough for the tip of the glans to be exposed) and showed us a white ring of what he described as scar tissue. He said the scar tissue would always prevent the foreskin from retracting completely, and that although we didn't have to do anything now, surgery to remove the foreskin was his recommendation. We want a second opinion. We really want to avoid circumcision at all costs. I've read that the white ring indicates a "true" case of phimosis, but I've also read that lots of urologists aren't informed enough about the range of norms in the foreskins of young boys. Obviously we'd like to try other treatment options as well. Any advice/recommendations are welcome.
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#2 of 28 Old 05-02-2011, 06:10 PM
 
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He's only four and a half? Most boys are nowhere near retraction at that age... the doctor does not need to be touching his penis, or at least not pulling the foreskin back. The retraction by anyone other than your son is what could damage it and cause scar tissue. The foreskin is supposed to be tight at that age and will retract on its own, often as late as the teenage years.

 

If he can urinate, and as you say it is painless, he is perfectly fine. There is nothing wrong with him. The foreskin is fused to the penis at that age to *protect* it, that's why it's "tight," and never needs to be pulled back to be cleaned until later... I know I'm not a doctor, but I would suggest talking to a foreskin friendly pediatrician in your area, especially about the discharge, the ring, or anything else. That way you'll be talking to a knowledgeable person who isn't going to blame everything on the foreskin. http://www.thewholenetwork.org/intact-friendly-doctors.html

 

Good luck.

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#3 of 28 Old 05-02-2011, 06:19 PM
 
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The reason he saw a white band of tissue is because his foreskin has a sphincter at the tip and when not in use it closes down tight like the anus and when someone is messing with it it will clamp down even tighter.

At his age only a very few boys are retractable. The avg. age of retraction is 10.5yo the urologist is not up to date on the intact penis.

This is one of the main reasons we tell parents here to not allow Dr. to touch their ds's penis because it leads to needless worry and can cause damage if they are to ruff trying to retract it.

Your ds is normal for his age if after he is fully into puberty and he still cant retract and is complaining then the proper thing to do is steroid cream with stretching. If that dosnt work then a simple tiny slit is made to allow for retraction. Even manual stretching using a balloon or even just hands with local anesthetic can be done before circ is even considered. In no way is circ indicated for tight foreskin until all other options have been tried.

This link http://www.cirp.org/library/normal/ is a good one to read and this one which is from the UK where they dont circ without real cause http://www.norm-uk.org/circumcision_alternative_treatments.html goes into detail about ways to fix true phimosis without circ.
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"True" phimosis --- better termed "preputial stenosis," because "phimosis" has so many different definitions it now is devoid of any useful meaning --- occurs in less than 2% of intact males.

Of these 2%, 85-95% will respond to topical steroids. Of those who fail this, at least 75% will respond to stretching under local anesthesia, either manually or with a balloon.

 
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#4 of 28 Old 05-02-2011, 06:23 PM - Thread Starter
 
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This is exactly what I'm worried about Lory - that it's totally normal and my doctors are being way too aggressive. Unfortunately, I'm in Canada so your list won't help me. I wonder if there's a similar one I could find.
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#5 of 28 Old 05-02-2011, 06:28 PM
 
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I think Marilyn Milos would be happy to talk to you! I called her once and she was really friendly. I'm sure she would help someone outside of the U.S.. it's not the same as finding a doctor to go to, but she is an RN and she'll answer your questions. (415) 488-9883

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#6 of 28 Old 05-02-2011, 06:41 PM
 
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She may still be able to help you with a Dr. name and at least give you good reliable advice.
NOCIRC(Maralyn Milos)
PO Box 2512
San Anselmo
CA 94979-2512
info@nocirc.org
Phone: 415-488-9883
Fax: 415-488-9660
www.nocirc.org

 
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#7 of 28 Old 05-02-2011, 07:22 PM
 
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You know the saying about when the only tool you have is a hammer, every problem looks like a nail? Unfortunately, even in Canada, which now has much lower circ rates than the US, most urologists that you will find were trained in the era when circumcision was the hammer for every nail. UTI? Circ. Phimosis? Circ. Inflammation? Circ. Yeast infection? Circ. Looks funny? Circ.  So the problem that you have even if you go to find another doctor is that you are asking for a solution to a problem that does not exist. At age 4.5, your son by definition does not have phimosis. And even if he were 20 and not retracting, circumcision would not be the answer! There are far less invasive solutions to real phimosis (which is very rare), including steroid creams, stretching exercises, and at maximum a dorsal slit.

 

 

 

 

 

 

Here is another good page for you to read through, from Doctors Opposing Circumcishttp://www.doctorsopposingcircumcision.org/info/retraction.html

 

 


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#8 of 28 Old 05-02-2011, 07:24 PM
 
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Ugh, sorry, this message board is acting really wonky tonight! I meant to add: my advice is, just don't go to another doctor. Don't seek a second opinion. Because there's nothing wrong with your son. Do the research and have confidence that yes, in fact, you do know more than your doctor, who's practicing 19th century medicine and is simply not educated on the normal penis and its normal functions. This guy's advice, although he may be wearing a white coat and he may speak authoritatively, is not any more advanced than the doctor from 300 years ago who advised bloodletting for a fever because of an imbalance in humours.


 


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#9 of 28 Old 05-03-2011, 02:07 PM - Thread Starter
 
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Thank you so much, all of you. You confirmed what I suspected and the resources you pointed me too were so helpful. My husband and I have decided we will be doing nothing about this, since we are convinced there is nothing wrong! The most I will consider at this point is a second opinion, but that's mostly because I'm an information junkie and I'd like to find an informed, foreskin-friendly pediatrician who can provide us with any other information that will help going forward. Honestly, a circumcision as the first method of treatment is so extreme that I have no faith in the urologist who recommended it. Crazy.


 

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#10 of 28 Old 05-03-2011, 02:14 PM
 
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Good choice, and welcome to Mothering. I agree with the other posters that your son sounds perfectly normal and the doc should be told to keep their hands off.


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#11 of 28 Old 05-03-2011, 02:39 PM
 
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Welcome to the board smile.gif I am glad you found information that helped you make a decision. It is so hard sometimes to find reliable health care not only on this issue but others. I hope you are able to find a Dr. who is knowledgeable if you choose to get a second opinion.

 
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#12 of 28 Old 05-16-2011, 01:01 AM
 
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I'm sorry that you're having issues that are worrying you.  The last thing you need is confusing and contradictory advice from medical professionals.  It seems that you have also reached this conclusion, but my advice would be to seek out a foreksin friendly pediatrician for a second opinion.  This might take some work on your part in asking some questions.  Well meaning forum folks who have not examined your son, telling you that everything is fine is not a substitute for a good medical opinion, especially if you feel that there might be an infection.  Additionally, other posters are absolutely right when saying that all other options should be exhausted before circ is even considered.  The fact that you are doing your own research and informing yourself is the most positive thing you can do.

 

Best wishes,

 

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#13 of 28 Old 05-29-2011, 07:52 AM
 
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Peter, I have to say I respectfully disagree. When a doctor has diagnosed something that's a non-issue in the first place, I don't see that it's worthwhile to move heaven and earth to find another doctor to debunk the first one. We see this all the time -- an ignorant doctor (unfortunately more prevalent than the enlightened kind when it comes to foreskins) diagnoses "infection" or "phimosis" when it's normal separation irritation, normal age-appropriate phimosis, etc. I don't think it does much good to tell parents to get a second opinion for a non-issue when the majority of doctors in the US or Canada did not receive correct information or training on the normal penis. When medical education and training catches up, then a second opinion would be worthwhile, but to me this falls into the category where it's entirely appropriate to do your own research, satisfy your own mind, and then let it go. Particularly because I think it's very inappropriate to keep subjecting a young boy to further penis manipulation by a health care professional in search of a non-problem.

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#14 of 28 Old 05-29-2011, 01:49 PM
 
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While I understand the sentiment and your very good intentions, (believe me, my son has been on the receiving end of an uneducated Ped himself) I just cannot agree.  If you are not a trained medical professional yourself, it would be unwise to diagnose any symptoms as a 'non-issue' and to just let it go.  This is not good advice to parents who may have a son with an infection that requires treatment, or corrective procedure.  I would also not encourage others not to seek medical advice, particularly when I do not personally have a firm grasp of the specific situation.  I wholeheartedly endorse your view to do as much research as you can, but there is a limit to how far you take self-medication and self-diagnosis borne out of a mistrust of Drs.  This can create a situation in which more damage is done in the long term.  The answer is to educate yourself, and seek out a competent medical professional, who can advise you without subjecting your son to an unnecessarily invasive examination.  Armed with the correct knowledge regarding the anatomy and development of the penis, you are in the best position possible to make your wishes clear to the Dr, and to ask specific questions regarding the concerns you have.

 

So I guess we'll just have to agree to disagree on this one Quirky, but with every respect to your position and view.

 

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Originally Posted by PeterJ View Post

 If you are not a trained medical professional yourself, it would be unwise to diagnose any symptoms as a 'non-issue' and to just let it go.  This is not good advice to parents who may have a son with an infection that requires treatment, or corrective procedure.  I would also not encourage others not to seek medical advice, particularly when I do not personally have a firm grasp of the specific situation.  I wholeheartedly endorse your view to do as much research as you can, but there is a limit to how far you take self-medication and self-diagnosis borne out of a mistrust of Drs.  This can create a situation in which more damage is done in the long term.  The answer is to educate yourself, and seek out a competent medical professional, who can advise you without subjecting your son to an unnecessarily invasive examination.  Armed with the correct knowledge regarding the anatomy and development of the penis, you are in the best position possible to make your wishes clear to the Dr, and to ask specific questions regarding the concerns you have.

 

So I guess we'll just have to agree to disagree on this one Quirky, but with every respect to your position and view.

 

Peter

I get what you're saying, but there are no "symptoms", according to the OP. The referral was made, because the boy isn't retracting yet.  That's not a symptom. It's a biological norm.
 

 

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#16 of 28 Old 05-29-2011, 05:23 PM
 
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That's what I was about to say:  there were no symptoms.

 

What they did to this boy is the same as a doctor examining a 4yo girl and claiming that her hymen was obstructing the vaginal opening and referring to a specialist.

 

My son was fully retractable from a young age, and so what?  We are really hoping he holds way off in needing that function in a practical way.

 

How many times should a child have someone looking at and touching his or her normal junk?

 

I agree that she should find a foreskin-normative, foreskin-friendly ped, and go there the next time he actually needs medical care.  You guys got any Indian doctors up there?

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#17 of 28 Old 05-29-2011, 05:25 PM
 
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I get what you're saying, but there are no "symptoms", according to the OP. The referral was made, because the boy isn't retracting yet.  That's not a symptom. It's a biological norm.
 

 


yeahthat.gif: in this particular case there is no problem other than a Dr. who has no idea about the natural foreskin.

 
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#18 of 28 Old 05-30-2011, 12:01 AM
 
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amen. if it ain't broke, don't "fix" it.

AND you are under no obligation to partake of the "recommended treatment." 

but you already know this!


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#19 of 28 Old 05-30-2011, 09:48 AM
 
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Is it really normal for a child's penis to become swollen and inflamed with discharge, multiple times in the first 4 years of life?  I fail to see how that is "no symptoms".  I don't think that's the norm for an intact penis, it certainly hasn't been my son's experience.

 

I think the OP is right to ask about this, and also right not to jump to the conclusion that circumcision is the solution, simply because one doctor said so. 

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#20 of 28 Old 05-30-2011, 11:04 AM
 
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Is it really normal for a child's penis to become swollen and inflamed with discharge, multiple times in the first 4 years of life?  I fail to see how that is "no symptoms".  I don't think that's the norm for an intact penis, it certainly hasn't been my son's experience.

 

It doesn't happen to everyone, but it's not uncommon at all. (It hasn't happened to either of my boys - well, if it happened to ds1, he never mentioned it, anyway, and ds2 was retracting at about 3.5 - but it comes up here a lot.) In any case, the OP said that her doctor made the referral, because her son isn't retracting yet. That is not a symptom of anything.

 

I think the OP is right to ask about this, and also right not to jump to the conclusion that circumcision is the solution, simply because one doctor said so. 

 

I think we got different impressions of the OP. I didn't get the feeling the OP was questioning anything - only that the ped was worried about the fact that her son isn't retracting "yet".



 


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#21 of 28 Old 05-30-2011, 11:11 AM
 
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He has had a few instances where his penis has become slightly swollen and red/inflamed, usually with some discharge, but I was under the impression this is normal for an intact boy and nothing to worry about. It always cleared up on its own within a few days.
Yes this can be totally normal for some boys and since it cleared up on its own within a few days it obviously didnt need any treatment from a Dr. As the separation process moves along the foreskin releases slowly from the glans this can cause area's of irritation and smegma, discharge to show up for a few days.

I am not in any way saying that Dr's are not needed they are in some cases but in this one the last referral was for the fact that he isnt retracting not the fact he has had irritations in the past. Because this referral is for not retracting he dosnt need to be seen because at his age that is a normal thing.

If he where to have another episode of irritation I would say give it a day or 2 and if it dosnt clear up like it did the first times then you need to take him in for a culture.

Here is a thread about what you might see during the separation process http://www.mothering.com/discussions/showthread.php?t=764732 it explains the difference between what is normal and what is cause for concern.

 
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#22 of 28 Old 05-30-2011, 12:42 PM
 
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The OP was really clear that the urologist considered the problem to be non-retraction. Since the problem of non-retraction does not exist in children, there is nothing to pursue. 

 

If, however, the mom and/or urologist had decided that the problem was the irritation, then our ability to give sound advice would be different due to the normal limitations of lay health advice received on an internet forum.

 

(I hope that there have not been repeated attempts to retract this little boy already)  greensad.gif


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#23 of 28 Old 05-30-2011, 01:08 PM
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Originally Posted by lwills01 View Post

He said the scar tissue would always prevent the foreskin from retracting completely, and that although we didn't have to do anything now, surgery to remove the foreskin was his recommendation.


The urologist also said the bolded part above.

 

There's no reason to get a second opinion at this age. If he's still not retracting when he's 15, worry about it then.

 

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#24 of 28 Old 05-30-2011, 08:29 PM
 
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As the mother of 2 intact son's and another one on the way I will say it's entirely normal at that age. And my intact husband told me his couldn't be retracted until puberty.

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#25 of 28 Old 05-30-2011, 10:48 PM
 
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I think we're getting stuck on the fact that the referral was made because of perceived non-retractibility, which of course I absolutely agree is not a good reason for referral at 4 years and makes the child a totally inappropriate candidate for circumcision, and based on this non-symptom alone I agree that a second opinion is not necessary.  However, there were other symptoms, including possible recurring infection and the white ring scar tissue.  The white ring in particular was a concern for the OP, having arrived at this conclusion after researching.  Again, not having first hand knowledge of the specifics in this case, it is not appropriate to encourage the OP not to seek a good educated medical second opinion.  If the child is one of the 2% who has true phimosis that would respond to non-invasive treatment, save him discomfort and pain later on, and ultimately possibly save the foreskin itself, isn't this enough to warrant further investigation by the parent?

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#26 of 28 Old 05-31-2011, 12:24 AM
 
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I'm sure all the good advice you've been given is correct but there are instances where circumcision is the best and final option. My son suffered for far too long with pain on urination, steroid creams and stretching attempts, infections and antibiotic courses. I had a foreskin friendly doctor who tried everything before she reluctantly suggesting circumcision. He had the white scar tissue at the tip which you describe and it just became worse and spread with every infection. They did a full foreskin removal which went really well and my son has been fine and happy with it ever since. I'm sorry to post negative on this issue amongst all the good optimism but it is best to prepare yourself for the possibility. I wish you well.

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#27 of 28 Old 05-31-2011, 07:24 AM
 
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Originally Posted by pennnyforum View Post

I'm sure all the good advice you've been given is correct but there are instances where circumcision is the best and final option. My son suffered for far too long with pain on urination, steroid creams and stretching attempts, infections and antibiotic courses. I had a foreskin friendly doctor who tried everything before she reluctantly suggesting circumcision. He had the white scar tissue at the tip which you describe and it just became worse and spread with every infection. They did a full foreskin removal which went really well and my son has been fine and happy with it ever since. I'm sorry to post negative on this issue amongst all the good optimism but it is best to prepare yourself for the possibility. I wish you well.



How old was your son when this all happened?


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#28 of 28 Old 05-31-2011, 07:40 AM
 
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to the OP - I would just like to add - not necessarily directly related to circ - TRUST YOUR MOMMY INSTINCTS!!! If  YOU  think there is a problem (and you have made an effort to educate yourself on the symptoms), there probably is! If YOU don't like / don't trust the doctor (specialist or not), then FIND a NEW ONE! Again, this is not directly re: circ, but in your particular case - do YOU honestly feel as though there is a problem / concern with your ds's penis? Do YOU question his "symptoms"? If so, find a second doctor to get a second opinion! If your gut instinct is telling you that his symptoms are normal and the info you've researched concurs, then likely all is well....it will be something, though, that you will likely keep and eye on! :)


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