My son was born in 1997, and I elected not to have him circumcised.
He confided in me that he has recently become sexually active with his girlfriend. While talking about the use of condoms, the risk of pregnancy and disease, and the emotional connectedness that sex brings, I asked him if his foreskin had retracted yet. He said it didn't. So I took him to the pediatrician to have a check-up.
Today she said he'd probably have to have a circumcision, and referred us to a pediatric urologist. That appointment is three weeks away.
I'm reading that 90% of boys' foreskins retract by the time they reach puberty on one website, and 45% by age 14 on another. I don't know whether to trust the pediatrician and urologist, or do my own research--seems that nobody knows what to do with an intact penis these days! Who knew I'd have THIS problem on the other end?
It is not unusual for the foreskin not to retract until 18 or 19 years old. There are even a few cases that go over 20 years old. That is not an instant indicator of a need for circumcision.
The important thing is to determine why it is not retracting. Two things must happen before retraction. The opening of the foreskin must be elastic. In the normal course of events, the tissue in the opening is not elastic at birth. Over the years, this non elastic tissue is replaced with elastic tissue. At birth and for years, the foreskin is attached to the glans with synecchia, the same tissue that bonds the fingernails to the nail beds. Over the years, this tissue is broken down by the body and is expelled. If there is any remaining bonded adhesions, it's simply not time for retraction.
If these two things haven't happened yet, it is simply not time but the time will come. Just be patient. He can still have enjoyable sex and even make you a Grandma! (I bet you wanted to read that! LOL!)
Went to visit the pediatric urologist, and he did an examination and said that yes, indeed he does have phimosis--He said it was "true phimosis" not the more common kind that goes away with development. He said there is a tight white ring of scar tissue at the opening of the foreskin. (I haven't seen it, but apparently it's a prominent white ring.)
Yes, it's called pathological phimosis. But, is this a valid diagnosis? Did you retract his foreskin to clean when he was a baby? If not, the liklihood of pathological phimosis is remote. It doesn't "just happen." There is always a root cause. If there is no root cause, it's the developmental phimosis that virtually all male children have
He prescribed a topical steroid cream, which my son is supposed to apply once in the morning and once at night. He said this usually resolves things, but that his situation looked like it might not resolve on its' own.
Yes, betamethesone .05% creme. This is the correct prescription for phimotic foreskins. Results should be seen in 30 days or less. However, if it is not time for the foreskin to retract, the normal and natural phimotic condition will return when the therapy is discontinued. But not to worry, when the time comes, the foreskin will become retractile on it's own.
He said there are other options, slitting the skin, in a minor way, which my son seemed to favor, if we decide to go that route.
Yes, the "slit" can work but the frenular band (that surrounds the preputial opening is a sensory organ and responds (sexually) to stretching. The slit disables this stretch response. I recommend you try to avoid it if possible.
For now all I'm doing is trying to get him to actually apply the cream. (Nothing more awkward than following your 14 year-old kid around with a tube of steroid cream for his penis...I keep leaving it in more and more obvious places: bedside table, bathroom sink. It's now next to the bathtub. He's totally not applying it regularly, because I have asked. Twice.)
Apparently, this is a more important issue for you than for him. There is no rush. When he is ready, he'll do it.
We're supposed to go back after six weeks of treatment with the ointment.
That's how long it takes to see a resolution or at least significant progress. Now, if it is too early, the phimotic condition will return until his body is ready for this.
I don't know what we're going to do. I'm leaning towards the wait-and-see approach. He's only 14. Maybe if he applies this on and off for the next few years, it will resolve on it's own.
14 years old is well within the range of normal and normal for him may be several years away. I don't see a need to rush it. The glans is a pressure receptor primarily, not a friction receptor as many people think. It is designed to respond to the female partner's clenching vaginal muscles. Even with a non-retractile foreskin, he will get the pressure from his partner's clenching vaginal muscles and that will be well enough to trigger his orgasm nicely.
The only way someone is taking a knife to his penis is if he asks me for it, and he's mature enough to make a life-long decision. I'm not sure that's going to happen before he's 18. Playing it by ear...
And that's the way it should be played. You protected him when he was a baby. You can continue to protect him by being sure he is mature enough to make the decision to radically modify his body. He might not like it but that is the prudent choice. He has the rest of his life (60+ years) if he wants it done.
Thanks for your response. I am glad to hear it can be a 'normal' thing for a man to have a non-retractable foreskin. Why hasn't it retracted, I wonder? I guess I'm a little sad. I hoped that my son would have an intact penis that functioned the way it was designed to function~with a nice little retractable foreskin. :( I didn't know that penises could develop a hard white ring of scar tissue that could prevent them from retracting. How did it get there?
This may be something else. Did the doctor mention "lichen sclerosis" by any chance? This is a fungal infection that is often asymptomatic (no symptoms) and is quite rare. It is characterized by this whitish appearance. I would recommend contacting Marilyn Milos at www.nocirc.org for information. Marilyn is a former nurse and has dedicated her life to saving foreskins. Years ago, I spoke with her on the telephone and somehow lichen sclerosis came up. She has a simple homeopathic cure for it using simple home products.
No one talks about this stuff. I think it's pretty rare, but maybe it's why circumcision became a tradition in earlier cultures.
No, circumcision became a tradition in early cultures (only a few world wide) for reasons that are simply unbelievable.
I have no idea. I've been laissez-faire with many of my parenting decisions, with mostly beautiful results. I guess I'm feeling a little guilty--that I may have put my son in this situation.
No, the human being is a quite remarkable being. Through what ever you beleve is our origins, the human body has been crafted to deal with our environment and it probably does it better than any animal on earth. As advanced beings, we have learned how to help it along to extend our average life span. However, some of the things haven't helped at all and probably have hindered us at times. Your laissez faire style of parenting was totally appropriate. The human being doesn't need massive intervention.
Wish I had more support. My mother told me I should have circumcised at birth...I haven't even mentioned the latest development, I can hear her 'I told you so' already...
Yes, mothers will do that. They have experience and they have taken care of you all of your life. Your mother is from a different time and a different place. She is trying to do the best she can for you but her reality is not your reality as it will be with your son and his family. My Mom wanted to control me, my life and my relations and I'm really independent. It was a constant struggle for both of us. For example, I wanted to buy a convertible and she was opposed. But I had the cash money and was about to turn 18 so she couldn't really stop me. Once I had mine, she went and bought one for herself. She had always had 4 door sedans before. She thought she was a hot number in that convertible.
Likewise, when I decided to buy my first house, she wanted me to buy on the southside of Atlanta because the real estate prices were better there and that was where she grew up. I ended up buying in Roswell and after she saw the house, she decided I had made a good decision.
You can find tons of support here.
Thanks for your response. I am glad to hear it can be a 'normal' thing for a man to have a non-retractable foreskin. Why hasn't it retracted, I wonder?
It's probably just becasue it's not time yet. It is highly variable.
I guess I'm a little sad. I hoped that my son would have an intact penis that functioned the way it was designed to function~with a nice little retractable foreskin. :(
It will get there when the time is right.
I didn't know that penises could develop a hard white ring of scar tissue that could prevent them from retracting. How did it get there? No one talks about this stuff. I think it's pretty rare,
The white somewhat concerns me. "The white" may be no more than hardened smegma or it could be lichen sclerosis. Ask your doctor about this. It is very rare but is treatable.
but maybe it's why circumcision became a tradition in earlier cultures. I have no idea. I've been laissez-faire with many of my parenting decisions, with mostly beautiful results. I guess I'm feeling a little guilty--that I may have put my son in this situation.
No, you didn't put your son in this situation any more than you made him susceptible to painful hang nails for not cutting his fingers off at birth. The origins of circumcision are rooted in sexual perversion (pre-Biblical times).
"Scar ring." I didn't know that's what it was called. New information, thank you.
There would be no scar ring if he hasn't been circumcised.
There have been no infections that I am aware of, unless they were silent. He never complained of pain, itching, discomfort of any kind.
There is a possibility of asymptomatic infections. They are rare simply because the foreskin is highly enervated and vascularized. If you have a concern, go to the doctor and specifically ask that samples for a culture be taken. This is a test where two cotton tip swabs are used to collect samples from the suspect area. The samples are then transferred to a "growing medium" where they will multiply very rapidly so they can be seen with the naked eye and positively identified and a medication can be prescribed that is known to be effective on that particular pathogen.
Is it possible that my DS tried to retract it, because of something I said or something his Dad said? I can remember when he was little, mentioning that he should pull it back to clean it.
It's not likely that he would have done any damage. He would have stopped at the point of pain/damage.
As I said, I'm leaning towards the "let it be" approach. How many men have this problem, I wonder? I'd never even heard of it!
If it is lichen sclerosis, it is very rare. I've only heard of a couple of cases in the last decade. However, it is emminently treatable and a good outcome can be expected without surgery. One thing that is important to remember is that pathogens (bacterials, fungals and virals) can not discern or discriminate between male and female cells. Short and simple, this means that all of the infections males contract are the same as those females contract. The same treatments work equally well on either sex and the expected outcome is the same. Now, think about it . . . When was the last time you heard of a female having part of her genitals cut off because of/in treatment of an infection? Just doesn't happen and shouldn't happen with males either. With males, it's just socially acceptable while it's not for females. That's the only difference!
I dont know any real numbers but I know I have read enough about it online to think that it is not exactly common but happens a fair amount.
Please do not feel guilty. You protected your son. Feel proud of that! He is far too young for the doctor to make such a diagnosis and I would guess that everything will work out just fine in the end, and if for some reason he decides to go down a surgical route (and I'm not talking circumcision - just preputioplasty) then that is his decision. You gave him the choice. There are millions of men who were denied any option when their parents chose to have them circumcised many of whom will live a lifetime of frustration, anger and regret. Also, heed the pp who stated that her DH has never been able to retract with absolutely no issues arising from that.
You might want to read: www.cirp.org/library/treatment/phimosis and www.biomedcentral.com/1471-2490/8/6 in order to give yourself the knowlege to confidently know that circumcision will never be the desired solution.
14 years old is going a bit past the AVERAGE age of retraction but so do 50%. It is common for retraction to not come until the later teens. I wouldn't be worried at this time. As mentioned above, there are some men who have lived well into their 30's and never retracted. They have had active sex lives and fathered children.
Some years ago, a woman here wrote me privately asking for help. Her husband was 32 years old and had never retracted. He was perfectly happy as he was and was successful at fathering children. It was his wife and only his wife that was concerned. He could'nt care less!
I have helped two women whose husbands have never been retractile. One husband was 22 and the other was 32. Both had children and both had fulfilling sex lives. Both were able to reach full retraction within just few weeks with simple stretching exercises.
After many, many years of personal experience and learning about the issue of foreskin function, I'm not convinced there is such a thing as how it's "supposed" to work. I've known numerous guys whose foreskins are what they'd call "comfortably tight" and they really don't want it any other way. Some can retract fine when flaccid but never do when erect, and some just don't ever pull it back. It's not the hygiene horror that some might surmise; not only is the penis to some extent self-cleaning (maybe less so toward adulthood than in infancy and childhood), but the area under the foreskin gets rinsed pretty regularly just through activities as mundane as showering and swimming. As for resolution, it might happen spontaneously. I read an account of a man who was phimotic throughout high school and college, and even when he married, but 5 years into the marriage his foreskin began slipping back on its own, to his and his wife's total surprise. By then they'd already ben having a successful sex life and had children. Men can very much enjoy sex with a foreskin that doesn't retract; in most cases the glans moves within the foreskin and this provides a lot of pleasure. But it may or may not provide as much sexual comfort and pleasure to the woman if the gliding action of his foreskin is restricted.
A fibrotic ring forming near the preputial sphincter is usually a consequence of mild trauma or an untreated infection. Either way, it's important to keep in perspective that things just as unpleasant, even more damaging and obstructive, can happen to circumcised boys before or after circumcision. The complication rate is always lower in societies that don't circumcise. The trauma that leads to a ring can be as simple as pulling down on the foreskin too abruptly when masturbating. Undetected yeast and other infections can also impact the tissue at the mucocutaneous junction. In the US, doctors have typically reacted by recommending circumcision, even though circumcised men also get similar infections (including BXO) and are treated successfully with steroid creams. It's a double standard bred from our 100-year complacency with circumcision as normal or inevitable. But men and their doctors in other countries don't face this dilemma. Hmmm.
Phimosis is a normal situation of childhood, and the two major components of it resolve naturally and progressively. One is the adhesions between foreskin and glans, which are important for full and proper development of both structures. The other is the normal stenosis of the preputial sphincter, which is another way of saying the hole at the end of the foreskin gets bigger and more elastic with both age and usage. Now, when something goes awry it can lead to a not-natural condition, called preputial stenosis (or foreskin tightness/narrowing). Phimosis may be normal for a given boy right up through high school, maybe even college. If it's not painful or uncomfortable, it's fine. He can begin gentle retraction whenever he's ready. But in the case of stenosis of the foreskin, something has occurred to obstruct the normal loosening development of the foreskin, or afflicts an otherwise previously healthy foreskin. When this is suspected, a visit to a knowledgeable, foreskin-friendly urologist is in order. Well over 90% of these conditions can be successfully treated with a course of antibiotics, steroidal creams, and/or manual stretching. Just about all the rest can be addressed with a simple V-notch or preputioplasty, far less invasive than circumcision. But it's vitally important to know what the underlying cause is, because in certain situations manual stretching can exacerbate a problem.
BTW, there's almost always a white ring visible in the inner foreskin mucosa when a foreskin is tight. It doesn't always mean scar tissue or inflammation. Most times it's just what the skin looks like when it's being pulled tight. Regrettably, some doctors don't distinguish. There's still a lot of gratuitous circumcision of minors and adults, when less invasive options are available, and often more effective.
OP, I hope the steroid cream helps! And either way, hopefully the phimosis will resolve itself. Either way, it sounds like your son has dodged the circumcision bullet for the moment, and three cheers for that. :)