4-year old just diagnosed with phimosis today. Please help? - Mothering Forums
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#1 of 88 Old 02-12-2009, 06:18 PM - Thread Starter
 
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Hi. My four-year-old son Jack is intact and because of a bacterial infection in his penis that was diagnosed on New Year's Eve, we took him to a pediatric urologist today. He had an ultrasound and a VCUG done. (The VCUG was horrible. My baby was very brave.) Then we saw the urologist and (after being very respectful and thorough with answers to our questions) he said Jack had phimosis and recommended circumcision. He said most boys are able to fully retract their foreskin by his age, and his hasn't retracted at all. He described Jack's foreskin as very tight, and it would probably only get worse. He told us to think about it, gave us some steriod cream to put on his foreskin daily to see if it would soften the skin and start retracting it (meaning Jack would do the retracting himself, not us), and told us to come back in a month with a decision.

My husband and I put so, so much thought into whether or not to have a circumcision done on our son in the first place (we now have another son, and he is not circumcised either). But now that one bacterial infection has occured--with no definite answer as to what caused it--the urologist's case sounded compelling today. We just need help deciding what to do. I am so confused. We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2. Oh geez, I'm just desperate about what to do. Has anyone had a similar experience with their son? I would be so grateful to hear other stories and how they turned out. Thanks.
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#2 of 88 Old 02-12-2009, 06:44 PM
 
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It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.

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#3 of 88 Old 02-12-2009, 06:53 PM
 
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It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.
Ditto.

Think about these two questions. If there was ONE bacterial infection with no known cause, why would you think it sounded compelling? Do we traditionally lop off the outer labia of girls when they have ONE bacterial infection?

I'd be willing he has an extremely high number of circumcision referrals. If it were me, I'd tell him no way and give him a paper with references on ages of retraction, what TRUE phimosis is, and the often unnecessary circ recommendations for so-called phimosis and why it's harmful.

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#4 of 88 Old 02-12-2009, 07:05 PM
 
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Does your son still have the bacterial infection? I'm assuming not. If not, the Phimosis is not a negative condition rather just the 'state' of your son's penis. Some boys can retract at your son's age, others can't retract until puberty. 'Only get worse?' Worse meaning the opening will get tighter? The likelihood of that is rare. Just make sure you or your son rinses himself with plenty of water when bathing but my unprofessional opinion is you do not need a cream to force your son's foreskin to do something it will do in it's own good time. There is a rare condition called paraphimosis (spelling) where the foreskin retracts and becomes stuck, but this can usually be manually corrected and does not need to be corrected with circumscision. Sorry for any typo o's. I'm not wearing my glasses. I live in a state where none of the doctors or nurses seem to circumcise their kids so this encounter with the urologist seems kooky to me. I'd do some research and get another opinion. You might want to also make sure the soap you are bathing your child with is gentle and that you rinse well. Once the foreskin is retractable, rinsing with water should be all that is needed for cleaning. The penis usually takes care of itself as long if you don't fuss with it too much!! If your son does still have the infection, circumscision is still not the cure. Ditto to all the other replies. Great advice!
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#5 of 88 Old 02-12-2009, 07:14 PM
 
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Go to www.cirp.org/library/normal. There is the truth about retractability. This doc is just plain ignorant. And what bacterial infection? Did he culture it? Bacterial infections are rare in intact boys. Usually any inflammation is due to contact with an irritating substance such as high pH in a pool or bubble bath soap. From what I have read in this group it can also be caused by separation of the foreskin from the glans. My sons did not retract fully until 8.5 and 11. Look at the chart in the Kayaba article at cirp.org. It shows how many boys are just like your son. This is NORMAL.
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#6 of 88 Old 02-12-2009, 07:17 PM
 
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Circumcision for "phimosis" is a "billable proceedure." It is very easy for the urologist and very lucrative.

Being nonretractable is normal at 4 yo and harmless anyway.

Steroid creams are for older teenagers and adults who are bothered by phimosis and have already tried stretching excersises without results.

Do not return to this "Dr."

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#7 of 88 Old 02-12-2009, 07:49 PM
 
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Also, how did the doctor diagnosis a bacterial infection - what was going on that made the ped think of a bacterial infection did he look and diagnose or did he use swabs.

my boy is 4 1/2 and partial retractable and the average child of most retraction to occur is 10-12 sometimes even older.

So far no one has found a foreskin educated doctor in utah yet!

For one bacterial infection with a diagnosis of phimosis i think the doctor wants to get his yacht payment.
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#8 of 88 Old 02-12-2009, 07:54 PM
 
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neither of my boys are retractable..they are aged 4 and 2. The urologist is trying to make money out of you by soliciting and unnecessary procedure.
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#9 of 88 Old 02-12-2009, 08:23 PM
 
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Originally Posted by JacksonsMom View Post
Hi. My four-year-old son Jack is intact and because of a bacterial infection in his penis that was diagnosed on New Year's Eve, we took him to a pediatric urologist today. He had an ultrasound and a VCUG done. (The VCUG was horrible. My baby was very brave.) Then we saw the urologist and (after being very respectful and thorough with answers to our questions) he said Jack had phimosis and recommended circumcision. He said most boys are able to fully retract their foreskin by his age, and his hasn't retracted at all. He described Jack's foreskin as very tight, and it would probably only get worse. He told us to think about it, gave us some steriod cream to put on his foreskin daily to see if it would soften the skin and start retracting it (meaning Jack would do the retracting himself, not us), and told us to come back in a month with a decision.

My husband and I put so, so much thought into whether or not to have a circumcision done on our son in the first place (we now have another son, and he is not circumcised either). But now that one bacterial infection has occured--with no definite answer as to what caused it--the urologist's case sounded compelling today. We just need help deciding what to do. I am so confused. We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2. Oh geez, I'm just desperate about what to do. Has anyone had a similar experience with their son? I would be so grateful to hear other stories and how they turned out. Thanks.
I agree with the previous posters. You are right, the doctor is wrong. There are a couple of questions that have been asked but I'll repeat that we need to know.
  • How was the original infection diagnosed? By sight or did he do a culture?
  • How was it treated?
  • Does he currently have an infection? Or has it been successfully treated.

With regard the diagnoses of phimosis the most important question is simply
  • Can your son urinate properly? That is to say is there good 'flow'. Ballooning is normal just FYI.

At your son's age not many boys will be retractable, as has been said by other posters the average age is about 11. You can read quite a bit about the normal development at this site:

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

You might want to read a bit more about phimosis here:

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

Now I want to underscore that it is very unlikely that your son has a condition that requires circumcision. Circumcision is only necessary in cases where there is significant trauma or scarring of the foreskin and even then it might not be necessary. There is a less invasive option known as prepuceplasty that can be used in place of circumcision, you can read a bit about that here: http://www.biomedcentral.com/1471-2490/8/6 But I want to reiterate that the need even for that is rare.

I think your son is probably just fine and if there isn't any obvious problem (like really obstructed urine flow) I would not bother.
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#10 of 88 Old 02-12-2009, 08:37 PM
 
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What every one else said the Dr. just dosnt know what he is talking about. Do you really want to risk your ds's life going under GA and watch him suffer over the next weeks for no reason? Of course not.

Why did he have a VCUG done by the way? Did you make sure no retraction happened during the test?

My ds is the same age yours is and he is no where near retractable and it is 100% normal.

Do not use that cream it is meant for teenagers and adults who can do stretching exercises to go with it.

A thread you may find helpful now and in the future http://www.mothering.com/discussions...d.php?t=764732

 
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#11 of 88 Old 02-12-2009, 11:02 PM
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Well, my older son wasn't retractable at 4 and was retractable at 7. My younger son is partially retractable at 4, about the same amount he has been since he was about 2. Eventually he'll be retractable, too. My brother says he started getting retractable by 9 and was fully retractable by 13. He's now in his mid-twenty's and has no problems with his genitals.

Boys become retractable at different ages. It's perfectly normal for a 4 year old to be completely non-retractable. I would see if you can find a recommendation for a foreskin-friendly doctor in your area and get a second opinion. Phimosis is perfectly normal for a 4 year old.
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#12 of 88 Old 02-12-2009, 11:29 PM
 
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Please don't believe the doctor that your son should be retractable by now, or that he has phimosis. I was told the same garbage about my 15-MONTH old son by a pediatric urologist who wanted him circumcised. He later told us that his opinion about the foreskin is "the sooner you get rid of it, the better"

Your instincts are guiding you correctly here, mama. Don't let the doctor hurt your son!

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#13 of 88 Old 02-13-2009, 01:14 AM
 
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I am speechless...

No, I'm not. Your son had one suspected bacterial infection and a VCUG was done? And an ultrasound too? Tell me that this was a persistant and recurrent infection. It wasn't just one infection, right?

I have only met one boy child who was retractile by age 4. Many, MANY boys do not become retractile until they reach puberty. My oldest is 6 and not retractile. He still has a tight phimotic ring, but it is loosening as he gets older. 4 is not at all unusual. Many, MANY babies are born with a tight phimotic ring. Unless it is getting progressively tighter and is causing him pain and discomfort, it's normal.

I don't know why, but I am still shocked at such ignorance from the medical community.

Mama to Thing 1 and Thing 2.
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#14 of 88 Old 02-13-2009, 02:20 AM
 
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Originally Posted by JacksonsMom View Post
... We've read that most boys can't fully retract until up to age 8 and beyond... then the urologist tells us that it should happen by age 2.
I'm so sorry you're going through this and I hope your son is feeling better. I can't speak from personal experience as my son was retractable by about 2.5 yrs and he's never had any infections. But like many have said, becoming fully retractable can happen at any time and it's not uncommon for boys to be non-retractable until older boyhood or teen years. Your urologist is wrong. Please know that doctors in the US make profit for every surgery they perform. You understand what I'm saying, right? He could say "Boys AND girls get infections all the time and we don't always know why so we just treat it and take a wait and see approach. If your son has multiple infections or still isn't retracting by age 18 then come see me again. We can talk about circumcision or non-surgical options then". He could say that, but then he would not make any money off of your son's circumcision and the one or two post-surgical follow up visits, would he??? I'm sorry to sound cynical about it but I really don't think one infection is reason for surgery. If nothing else, know that your son not retracting is completely normal at age 4 and it would be wise to seek a second opinion with a foreskin-friendly doctor if you you feel like you should go ahead with the surgery.
In countries where intact is the norm and physicians themselves are likely to have an intact penis, circumcision for childhood non-retraction and one infection is practically unheard of.

Good luck to you and your son!

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#15 of 88 Old 02-14-2009, 04:34 PM - Thread Starter
 
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I want to THANK ALL OF YOU for your information, advice, and stories about your own sons. My husband and I read through all of them again and again. Just to answer a few recurring questions:

How was the original infection diagnosed? By sight or did he do a culture?

Jack's pediatrician did a culture--there was a puslike substance coming from his penis and she cultured it. It was positive for bacteria. She did say that was very rare to see a bacterial infection at Jack's age, and she mentioned STD's. (AAAH, red flag). The only time Jack isn't with one of us is when he is at preschool three times a week, two hours a day. No babysitters, no daycare, never. We trust his preschool teacher, and know that Jack would have told us about any unusual or uncomfortable experiences. But the red flag was still waving for us, of course...

How was it treated?

Antibiotics cleared up the infection within a couple of days. He has not had any trouble since that time.

Why did you do a VCUG after just one bacterial infection?

Because we didn't know any better, I guess. And we were scared. We can't go back in time and undo it, it's done. Everything was normal, so I guess all that other "stuff" that could be going wrong was ruled out. (Trying to look for the silver lining.)

I loved the comment that no one has found a foreskin-friendly doctor in Utah yet. I am not surprised. We haven't found another intact boy yet! (Except for Jack's brother, Charlie, 10 months.) It's kind of disheartening to realize that we don't have a lot of support around here, but we have an abundance of ignorance. But we both so appreciate you all taking the time to answer our questions with your real-life stories and experience and knowledge. We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
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#16 of 88 Old 02-14-2009, 05:11 PM
 
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I want to THANK ALL OF YOU for your

I loved the comment that no one has found a foreskin-friendly doctor in Utah yet. I am not surprised. We haven't found another intact boy yet! (Except for Jack's brother, Charlie, 10 months.) It's kind of disheartening to realize that we don't have a lot of support around here, but we have an abundance of ignorance. But we both so appreciate you all taking the time to answer our questions with your real-life stories and experience and knowledge. We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
You're very welcome. I hope you'll stick around and contribute. If you have more questions feel free to ask. And Utah is one of the states that dropped medicaid coverage for circumcision so there may be more boys than you realize who aren't, just perhaps not in your circle of friends.
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#17 of 88 Old 02-14-2009, 05:34 PM
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Please share this knowledge with the urologist who incorrectly diagnosed your 4 your old son Jack with "phimosis" and who recommended circumcision! This doctor will give similar diagnoses in the future and many trusting parents will only agree to his recommendation of unnecessary, harmful amputative surgery. I have a hard time comprehending how this occurs in our country at such an alarming rate in the 21st century.
Bless both you and your husband for doing your research and asking questions to protect your boys.
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#18 of 88 Old 02-14-2009, 05:53 PM
 
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seriously, the urologist is so wrong it's scary. and i realize it's over but why on earth did they put him through a vcug? that's to check for kidney reflux and would only be indicated if he were having recurrent UTIs. weird!

You should provide this to the urologist:

http://www.doctorsopposingcircumcisi...etraction.html

It's possible you could save other boys from unnecessary circumcisions.

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#19 of 88 Old 02-14-2009, 05:58 PM
 
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We're not returning to a urologist, we're not filling the steroid prescription, and now we can--again--say with confidence that we will not circumcise our Jacky. Thank you all again. Thank you for reminding us why we decided not to circumcise in the first place. Thank you for reminding us what we're trying to do and what our family is about.

And thank you for allowing us to heave a BIG SIGH OF RELIEF!!!
Good for you mama! Please stick around Mothering and help other parents with your son's story. I was in your exact shoes two years ago and owe so much to this board! If you want to do more reading, here is my *big sigh of relief* thread, which also links to my original "please help!" thread. The people here are simply awesome. :

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#20 of 88 Old 02-14-2009, 09:17 PM
 
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It was not your fault that the VCUG was done. Not at all!

Just FYI, most of the time, doing any sort of external culture of a penis is practically useless. IF the swab touches his skin, it will grow bacteria whether there is an infection or not. This is because the skin is normally covered in bacteria. A culture of the penis isn't going to tell them anything usefull.

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#21 of 88 Old 02-14-2009, 09:44 PM
 
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That is funny that you say that pumpkinhead as I was under the impression that was the first step always in finding out what is growing there be it yeast or bacteria. I know it is the first thing we tell parents to have done if they suspect an infection.

I know the skin always has bacteria but on the tests they run I am sure they would know if it was normal or if the numbers where higher than normal and be able to tell if it needs treatment or not.

The only way to get a culture without causing harm is to touch the swab to the tip of the foreskin without retracting. So that is the only possible way to get a culture of possible infection.

 
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#22 of 88 Old 02-15-2009, 03:52 AM
 
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Someone with the Utah Birth Network may know of a doctor in your area who knows about proper care for intact boys.

http://www.utahbirth.net/
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#23 of 88 Old 02-15-2009, 11:19 AM
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The doctor is 100% wrong, most of boys are still not retractable at 4. My son is 3.5 and is not anywhere near to being retractable. It is TOTALLY normal to not retract till much later.

Steriod cream will not help, forskin will reatach as soon as you stop using it and will retract when it is RIGHT TIME for your boy.

If someone manipulated his foreskin (let's say another doctor) it could create micro-tears and actually CAUSE this infection. Even if it is infection, it's easily treatable with antibiotic and does not require amputative sergery (would you amputate your son's finger if it got infected??). If your son is treated with antibiotics, make sure you keep him on good probiotics, at least 10 billions a day for at least a month after that to prevent yeast taking over (it's not just for intact boys, but for all people to keep gut flora healthy while being treated with antibiotics).

Make sure no doctor ever manipulates his foreskin
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#24 of 88 Old 02-15-2009, 12:03 PM
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And one more point. Does your son actually had a discharge from his penis? Did the doctor take a culture it? In case your son just had a swolen, red penis with no discharge, it could be a separation trauma which usually resolves on its own within 48 hours.
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#25 of 88 Old 02-15-2009, 12:04 PM
 
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That is funny that you say that pumpkinhead as I was under the impression that was the first step always in finding out what is growing there be it yeast or bacteria. I know it is the first thing we tell parents to have done if they suspect an infection.

I know the skin always has bacteria but on the tests they run I am sure they would know if it was normal or if the numbers where higher than normal and be able to tell if it needs treatment or not.

The only way to get a culture without causing harm is to touch the swab to the tip of the foreskin without retracting. So that is the only possible way to get a culture of possible infection.
The thing is, even with selective media, a culture of the foreskin is always going to grow something. It's really not a good diagnostic tool. It could grow a whole whack of E.coli or even aspergillus, but these might not be what is causing the infection.

If you can clean the area with alcohol or something and then get a clean swab of only the pus, that might tell you something.

What I am saying is that taking a culture of the foreskin really isn't going to tell you definitively what is causing the infection. As a complete last resport it might be useful, but not as a first step. If you're looking for something that really shouldn't be there like group A strep or chlamydia, a swab and selective media will give you that information.

My way of thinking mirrored yours until recently. I had the opportunity to work in the central infectious diseases micro lab at a local hospital for a 6 month term. I learned a lot.

Mama to Thing 1 and Thing 2.
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#26 of 88 Old 02-15-2009, 12:48 PM
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Originally Posted by Friday13th View Post
It's really, REALLY, REALLY normal for boys to not be retractable at four. Some don't retract until they're teenagers. Assuming he can pee, there is no reason to be using a steroid cream.

Also, urologists in the US pretty much only know how to do one thing with the foreskin-cut it off so I would not be taking his opinion seriously.

Did they do a culture for the bacterical infection? They should have. And btw, not being retractable has NOTHING to do with an infection. I'd run far and fast from that doctor.
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#27 of 88 Old 02-15-2009, 12:49 PM
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PS. Where in Utah are you? Dr. Justin Alvey at WeeCare Pediatrics in Kaysville is foreskin friendly!!!

I personally know five intact Utah boys. It is changing, even in this state. You know how you create more intact Utah boys? You educate pregnant mamas!!

"Our task is not to see the future, but to enable it."
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#28 of 88 Old 02-15-2009, 11:20 PM
 
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I definatly see what you are saying pumpkinhead. Thank you for explaining it more

 
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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#29 of 88 Old 04-03-2009, 04:12 PM
 
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Hi,
I have a 19 mo. old that has a similar problem. He is 19 months old now. At around 1 year he had a UTI, due to trapped urine in his forskin. They suggested then that he would probably need a circumcision. I was really against it, and the doctor gave us an alternative to the procedure, he gave us a cream that was supposed to help loosen the forskin. However, once we stop the cream the forskin becomes really tight.
When our son was born, all the "what to expecting, when you are expecting" books directed us to not touch his forskin or pull it back, so as to not harm it. My husband is circumcised, so we followed those directions. When our son got the UTI, The Doctor told us that our son has a lot of scar tissue (probably due to repeated infections unbeknowest to us) [Maybe we should have lifted the forskin back to get the last dribbles out?] that has developed into a ring, he and his assistant had a hard time finding the opening to the urinary tract when they wanted to test his urine for a culture. The doctor confirmed that it wasn't his kidneys, or anything else. The UTI was probably caused by trapped urine and the resulting bacteria. I've waited 6 months in the hopes that the cream and "massage" helped my son's forskin. However, his forskin once we stop using the cream shrinks into a tiny ring where you can't even see the opening to the urinary tract. He can still pee, but it dribbles to the side.
I don't want my son to get another UTI, last time it was very scary, he had blood in his urine, lots of doctors visits, and just a lot of stress.
I am from a culture/religion that it is very important to stay intact, and i am getting a lot of "peer" pressure from my sister-in-law that the doctor is "full" of it (she hasn't seen my son's ring, she lives far away), and everything i read says that a lot of circumcisions are done unessarily. Some of that literature has confused me, and made me wait this long. I've come to the conclusion that there are a lot of "intact" advocates out there, and when someone (like my son) who really needs this procedure, might be waiting longer than they should.
Does anyone know of some medical literature out there that suggests keeping the forskin when the urinary tract is partially obstructed? Is it possible to keep him intact? Am i doing the right thing by scheduling his circumsion?

Thanks, A.
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#30 of 88 Old 04-03-2009, 04:32 PM
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AleksFeodoraSnyder, let me ask you a question: how could the doctor know about the scar tissue? Did he retract your son??

Also ask your doctor if a little girl came in with a UTI would he blame it on "her urine being trapped in vagina"??? or would he just tell her parents that UTI do happen, give her antibiotics, warn the parents to not let her have bubble/soapy baths and that would have been all there is to it?

By "trapped in the foreskin urine" I assume the doctor meant balloning which is TOTALLY normal (some boys have it others don't, but it is 100% normal stage in a separation process) and does not cause UTIs.

As long as he can pee he's fine. Foreskin does sometimes direct urine into funny directions and this is normal as well.

The opening is SUPPOSED to be tiny in babies/young boys, it opens up a little during urination and then closes back up tightly right after that. This is 100% normal and is a nature's way to protect the glans from bacteria coming in.

As long as your son can pee, he is FINE and NO one should ever mess with his foreskin except him himself.

The doctors doesn’t seem to be knowledgeable on the issue; of course the foreskin would re-adhere back to the glans once steroid cream is discontinued, what else would he expect??? Once again, TOTALLY normal. It will separate in its own time, the opening will loosen up in it’s own time as a last step of the separation process.
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