Help, 5 yr old DS might need circ - Mothering Forums
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#1 of 26 Old 10-15-2009, 04:24 PM - Thread Starter
 
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Ok, first of all, you do not need to convince me NOT to circ my son. I have 3 sons, none of them circ'd. The issue is DS1. He is almost 6 yrs old and my DH has been concerned for the past couple of yrs that something is wrong with my son's foreskin. My other two boys do not have this issue, but DS1 has forskin tip that is very, very narrow in diameter. He still, "balloons" when he pees and shows no signs of retraction anytime soon. My DH's main concern is that my son's foreskin is so narrow at the tip, that it basically cannot retract over his penis. I have to admit, he has a good point. However, I still prefer to wait longer to see what happens before getting him circ'd. So, my DH mentioned it to our ped during DS3's well baby appt and the ped referred us to a urologist. I ended up cancelling the appt, b/c I want to do more research. ARE there situations where children do end up needing circ for situations like my sons? He has never had any hygiene/infection issues. Do boy sometimes have situations where they cannot retract their foreskin due to it being too narrow? I don't want to put my son through this, but my DH keeps saying that if this is an issue, we should have him circ'd sooner than later. I want to hear opinions from you about this situation and if is is one that warrants medical intervention.
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#2 of 26 Old 10-15-2009, 04:51 PM
 
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My understanding is that some boys don't become retractable until their late teens. There is a wide age range at which it happens so I certainly wouldn't worry in a 6 year old. If he's peeing fine it's not a problem.

If it is still not retractable at a much later age or it's causing him pain during erections there are non-surgical options (primarily stretching and steriod creams, I believe)

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#3 of 26 Old 10-15-2009, 05:15 PM
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Only about 50% of boys retract by the age of 10. Nothing to worry about. Balloning is normal.
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#4 of 26 Old 10-15-2009, 05:21 PM
 
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I'm not at my usual computer, but someone will be along shortly with links, I'm sure.

But it's completely normal and nothing to worry about. The average age for retraction is 10 or 11, with many boys not being able to retract until puberty. If he's not retractable after puberty, there is a steroid ointment that they'll prescribe with some gentle stretching exercises.

Here's the link to the cirp page. Contains baby penis pictures.

http://www.cirp.org/library/normal/
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#5 of 26 Old 10-15-2009, 05:41 PM
 
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Your son is way too young to be diagnosed with phimosis. Some boys do not become retractable until well after puberty. There are men who have never been able to retract their foreskins and are perfectly happy that way.

Should your son still not be retractable AFTER PUBERTY, and wish to become so, there are many ways to achieve retractability without resorting to circumcision.

Please read: www.cirp.org/library/treatment/phimosis - which explains the use of steroid creams to aid in stretching as well as techniques in preputioplasty, where surgery is used to widen the foreskin, but NO tissue is removed.

and: www.biomedcentral.com/1471-2490/8/6 - This illustrates one method of treating phimosis with spectacular results - see the pictures - and again, with NO loss of tissue.

You can relax for at least another ten years !!
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#6 of 26 Old 10-15-2009, 05:47 PM
 
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I was going to say what l olive said- that circ would be a LAST resort. There are the steriod creams that will help the skin to loosen up, stretch more so that he will be able to retract. I don't think that circ should be considered till after the creams have tried and failed. Does your son have any issues that he expresses? Like pain or discomfort or a feeling he really can't explain? If he is OK, and there is no discomfort- no infections I would just wait. I don't think I would be talking about steriods or Circ at this point.

Hope you get some good links and good info! Keep us updated, I'm always curious about how these situations turn out.

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#7 of 26 Old 10-15-2009, 06:45 PM
 
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There is nothing wrong with your son's penis.

It is NORMAL for the foreskin to balloon with urination in some boys. This just means it has separated to some degree underneath, but that the outlet it still tight (which is also normal). The ballooning will resolve on its own in time, and does not require any treatment.

It is NORMAL to have a very small opening. Two things have to happen for the foreskin to become retractable. One is the separation of the inner foreskin from the glans, and the other is the loosening of the naturally very tight outlet. As a boy develops toward adulthood the inelastic tissue at the outlet becomes more elastic, stretchy, and loose. You do not need to do anything to make this happen. It happens on its own, in its own good time.

It is NORMAL for a boy not to be retractable at your son's age. As others have said, the average age at full retractability is about age 10. That means half of boys will not be fully retractable till sometime after that, and indeed for some it may take into early adulthood.

See the following link for more info on development of the intact penis.
http://www.cirp.org/library/normal/

My older son was not retractable AT ALL till he was about 8. The outlet of his foreskin was literally about as large as a pin head. The only trouble this caused him was occasionally peeing in funny directions. Then when he was 8, his foreskin opening started getting looser and looser, and almost over night he became fully retractable.

You do not need to do anything, you do not need to see a urologist, you do not need to worry. Every boy is different, and the process leading to fully retractability is very variable. Your son is NORMAL. Sit back and relax and his body will take care of itself.

Gillian
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#8 of 26 Old 10-15-2009, 06:45 PM
 
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Part of the issue is that the sphincter at the end of the foreskin turns into elasticized tissue LATER. Right now its only function is to stay closed, keep stuff out and let urine pass. Later, hormones and erections slowly change the sphincter into more of an elastic band so that it WILL some day be able to stretch over the glans.

That's one of the big reasons why forceful retraction on a child is a no-no - yes, it can cause tears and infections, but it also can wound that sphincter and cause scarring. Elastic tissue cannot form in scar tissue so if this is done repeatedly, the adult man has an "elasticity" issue and the foreskin may not be able to retract. Make sense?

Also, if it truly is the case that later (puberty +) he cannot retract his foreskin, circumcision is the most invasive of all the procedures to treat it. He can use steroid creams and stretching exercises, or opt for a simple dorsal slit (a tiny slit made in the end of the foreskin to allow it to stretch open better). So, even if he does have true phimosis as an adult (you can't diagnose it in kids because phimosis is normal) circumcision wouldn't be required to fix it anyway, unless he really wanted that.

Right now, as long as he can pee fine, he's just as he should be.

Be at peace.
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#9 of 26 Old 10-15-2009, 06:50 PM
 
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Does your son's urine stream seem fine? Or is it just a trickle? As long as the urine flow is fine, there is absolutely nothing wrong and you do not need to do anything. IF the urine is only coming out in a trickle, this would still be absolutely no indication for circumcision, but it might be possible that the tip is too constricted - in that case, it can usually be easily resolved with steriod cream - but again, most likely this is NOT indicated.

The American Academy of Pediatrics states the foreskin may not retract until after puberty, this is perfectly normal, and it should never be rushed. Some boys may have loose foreskins and retract very early, others don't.

Unfortunately, most pediatricians and urologists are not aware of normal foreskin development.
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#10 of 26 Old 10-15-2009, 07:47 PM
 
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Everyone is correct unless your ds cant urinate at all he dosnt need circ and at his age he is still to young to fully retract. The ballooning shows that he has seperated but the sphincter at the tip is still tight doing its job keeping stuff out.

Have you seen this thread http://www.mothering.com/discussions...d.php?t=764732

I am not sure how you and your dh know he isnt retractable unless you asked him because no one should be trying to retract his foreskin unless it is him.

IMHO you should keep your ds as far away from a urologist as possible since 99% of the time they see $$ and will say yep needs circ.

Bottom line your ds is 100% normal for him. The only reasons for circ are frostbite, gangrene and cancer none of which your ds has so he does not need circ.

 
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#11 of 26 Old 10-15-2009, 08:06 PM
 
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I have a son who at 10 is just starting to get slightly retractable. At 6, I was worried about him and I mentioned it to my husband and father in law who are both intact. Both laughed and said that they weren't retractable until early puberty and said "Don't worry, it'll retract when the time comes." His opening was so small that I really worried about it, but left it alone and forgot about it. I just had my husband ask him about his penis, if it's retracting and asked him to tell him how to take care of it (no soap, etc.) Turns out, it's almost there. Big change from when he was 6. It's really normal. My 4yo is mostly retractable. Penises vary. If he's in his mid-to-late teens and not retractable, then you may need some intervention.

Also, it may have to do with how often the boy touches his penis. My older son never even seems to realize he has one, but my younger (almost fully retractable) son is always pulling and twisting his. Maybe you could put your son into situations where he can mess with it, like bathing in private every night and wearing jogging pants.

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#12 of 26 Old 10-15-2009, 09:00 PM
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Agreeing with everyone else!!

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#13 of 26 Old 10-15-2009, 09:39 PM
 
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haven't read the other replies but i have an intact ds, and in reading about intact boys, i have seen that some boys are not retractable AT ALL until they are well into their late teenage years. i personally would NOT talk to your ped about it any more, and i DEF. wouldnt see a urologist! ds ballooning is not an issue, and if he's not having any issues, my goodness, don't fix it if it isn't broken! reassure your DH that your ds is perfectly normal, and he will someday be able to retract!

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#14 of 26 Old 10-15-2009, 11:06 PM - Thread Starter
 
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I had to chance to do some research online which resulted in similar results as to what you are all saying. So, thank you. And yes, his urine stream is normal. As for retraction, no, it has never been retracted, but my DH is just worried that since it is a size of a pin hole (other other two boys don't seem to have this issue), that it would lead to problems in the future. We didn't realize that the foreskin could continue to grow even more (in relation to its current size to the penis). So, I had no intention of taking him to the urologist, it was my DH having penis worry for our son. I'm glad that this is not an atypical issue. We'll just leave it be. Thanks for the info!
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#15 of 26 Old 10-15-2009, 11:15 PM
 
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To relax your husband you could ask your son to pull GENTLY back on his foreskin whenever he is in the shower or when he is urinating. This will gently encourags stopped her e the foreskin to stretch with no pain. When ds1's doctor started mentioning that his skin seemed tight this stopped her mentioning the dreaded C and it worked.
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#16 of 26 Old 10-15-2009, 11:17 PM
 
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I thought your ds was 8! At 5 he should be left alone! As long as you watch out that he stays clean your fine!
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#17 of 26 Old 10-15-2009, 11:34 PM
 
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My ds was at least 10 before he was able to retract and he had a tiny pinhole. Not sure how long he ballooned (wasn't looking much past a certain age) but I know he ballooned into his school years.

Relax-it's a natural process that takes time sometimes. All kids develop differently-some faster, some slower.

I've never "watched out that my sons stayed clean" any more than I did my girls. I just made sure they had a bath every now and then.
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#18 of 26 Old 10-16-2009, 12:03 AM
 
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This article http://www.mothering.com/health/prot...advice-parents should help ease your DH's mind if he is still worried.

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#19 of 26 Old 10-16-2009, 12:55 PM
 
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Your son is urinating. There is no emergency.

When HE wishes to become rectractile, surgery would only be warranted AFTER months of gentle stretches with steroidal ointment had not shown progress.

The appropriate surgery to remedy this is NEVER EVER circumcision. It is dorsal slit with transverse closure, which loosens the preputial spincter without amputating anything. If your doctor has not peformed it, you have no business discussing this issue with that doctor.

Also, make sure you are not discouraging the boy from manipulating his own skin. His own curious manipulations are what normally cause the prepuce to eventually be retractable.

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#20 of 26 Old 10-19-2009, 02:44 AM
 
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Just adding in-I have a 9.5 year old that isn't even remotely retractable yet too! Let him know too that my ds' pedi never even asks. The one time it was mentioned (at 7, due to an injury in the area) she just said ok. She's never been concerned with it, though she seems to have much less to do with my kids genitles in general compared to some of the docs I've read about on here!

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#21 of 26 Old 10-19-2009, 03:48 AM
 
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My son (4.5) has a similar problem and were referred to a urologist. The way his foreskin is, is that the hole is at the top rather than the tip, so when he urinates sitting down, he ends up peeing under the toilet lid and it goes all over the floor. This has been quite embarassing for him and he feels bad, although we don't make a big deal out of it. The urologist told us that the problem is that his foreskin is too long, so he recommends circ'ing him. When he gets an erection, there's still so much foreskin there that it could cause problems down the road. He told us about steroid cream as well, but that takes a lot of upkeep, as he has to put it on and make sure to gently retract the foreskin several times a day, and if he stops doing it, it could grow back or something. I'm leery about the whole thing, as I know that the skin is not retractable until much later, however I would almost rather he gets snipped now, rather than it cause problems later on down the road and have to get it done. Atleast now he won't quite understand, but I don't want him thinking there's something wrong with him and feel ashamed. I'm at a loss and will probably ask for a second opinion as I don't want to circ' unless I know there really is no other option. Keep us posted!

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#22 of 26 Old 10-19-2009, 06:57 AM
 
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Originally Posted by masja View Post
My son (4.5) has a similar problem and were referred to a urologist. The way his foreskin is, is that the hole is at the top rather than the tip, so when he urinates sitting down, he ends up peeing under the toilet lid and it goes all over the floor. This has been quite embarassing for him and he feels bad, although we don't make a big deal out of it. The urologist told us that the problem is that his foreskin is too long, so he recommends circ'ing him. When he gets an erection, there's still so much foreskin there that it could cause problems down the road. He told us about steroid cream as well, but that takes a lot of upkeep, as he has to put it on and make sure to gently retract the foreskin several times a day, and if he stops doing it, it could grow back or something. I'm leery about the whole thing, as I know that the skin is not retractable until much later, however I would almost rather he gets snipped now, rather than it cause problems later on down the road and have to get it done. Atleast now he won't quite understand, but I don't want him thinking there's something wrong with him and feel ashamed. I'm at a loss and will probably ask for a second opinion as I don't want to circ' unless I know there really is no other option. Keep us posted!

Masja - the problem with this is that at 4.5 years old, he's nowhere near finished growing, for all you know by the time he's undergone puberty things may look completely different down there foreskin length-wise.

The steroid cream only requires a "lot" of upkeep because it's not necessary at the age he is. When he reaches puberty the hormones in the cream will be produced by his body naturally and retraction will happen. The cream simulates this process, but in most cases when the cream treatment stops the foreskin goes back to its natural state. It is perfectly normal for him to not be retractable now.

If his opening is in the top rather than the tip, it's not a case of "foreskin being too long" but sounds more like he has hypospadia. Many urologists do recommend circ to repair, but it's also possible to do repairs that conserve the foreskin. These are of course more commonly done in countries where circumcision is not the norm, of course.

If he were my son though I would let him decide when he is old enough to fully understand the implications, it's not really a necessary surgery since he can pee ok, even if he needs to sit down to do it to avoid making a mess.
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#23 of 26 Old 10-19-2009, 08:22 AM
 
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Masja. Like pp said you have no idea what his penis length will be when he hits puberty. His foreskin now is the perfect size. It actually sounds like your dr went to the same med school as the ped my ds's did because he gave me the same bs about ds and I laughed at him because it was so stupid.

Steroid cream is for puberty and later it is never to be used on a child your ds age. I hope that you do more research and realize that unfortunatly you have yet another foreskin ignorent Dr. that are so prevelent here in the USA.

Your ds will have to be put to sleep to do this are you willing to risk even the slightest chance he will die for something he dosnt even remotely need? You say do it now when he dosnt understand well not understanding and remembering are 2 very different things. He will remember the pain, yes it will hurt badly and will always wonder why his penis was allowed to be hurt. Then when he grows up does the research and sees it didnt need to be done he will be very upset and rightly so.

It is very possible that he is peeing up due to the fact that he has become slightly retractable on the top while not on the bottom causing the issue. At 4 he is old enough that if you tell him to gently pull back while going potty the urine stream will go in the proper direction.

Unless your ds cannot urinate or has frostbit, gangrene or cancer his penis needs left alone.

 
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#24 of 26 Old 10-19-2009, 10:35 AM
 
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Originally Posted by masja View Post
My son (4.5) has a similar problem and were referred to a urologist. The way his foreskin is, is that the hole is at the top rather than the tip, so when he urinates sitting down, he ends up peeing under the toilet lid and it goes all over the floor. This has been quite embarassing for him and he feels bad, although we don't make a big deal out of it. The urologist told us that the problem is that his foreskin is too long, so he recommends circ'ing him. When he gets an erection, there's still so much foreskin there that it could cause problems down the road. He told us about steroid cream as well, but that takes a lot of upkeep, as he has to put it on and make sure to gently retract the foreskin several times a day, and if he stops doing it, it could grow back or something. I'm leery about the whole thing, as I know that the skin is not retractable until much later, however I would almost rather he gets snipped now, rather than it cause problems later on down the road and have to get it done. Atleast now he won't quite understand, but I don't want him thinking there's something wrong with him and feel ashamed. I'm at a loss and will probably ask for a second opinion as I don't want to circ' unless I know there really is no other option. Keep us posted!
There is nothing wrong with your son. There is no such thing as having a foreskin that is "too long", he will need that "extra" to grow into when puberty hits. That doc is full of misinformation.

Even in Canada, where intact is the norm, we still have cut happy, ignorant docs......disgusting.

If your son is having aiming problems caused by a misaligned foreskin opening, it is more than likely temporary. Lots of boys go through this as their foreskins are becoming retractible. Just get him to pull back on the skin slightly to get the two holes aligned better when he urinates.

Here is an article full of great information:
http://www.mothering.com/health/prot...advice-parents

Hope that reassures you a bit.
Take care!

Tara Momma to Callum and Gavin
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#25 of 26 Old 10-19-2009, 05:52 PM
 
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My DS pees sorta out of the top too, the top of the tip, if that makes sense. I just make him pee standing and if he sits I make sure he points it down. For him it's just that the forskin is sorter on the topside then the bottom. DH is the same way and has no problems as an adult. I never thought of it as hypospasia or anything. I just thought that was the way it was. All my boys have a pretty long forskin overhang. No doc has ever said anything about it but I never pointed it out either as I never considered it a problem.

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#26 of 26 Old 10-19-2009, 06:02 PM
 
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My eldest has a long overhang as well, no ones said a word about it. I've never heard of such a thing-a foreskin too long?? I mean, neither you nor a doctor has any idea how much your son will grow down there when puberty hits. Maybe he'll be really well endowed and need all of it! (Tell your dh that, haha) If not, he still doesn't need to be circ'd-he'll either be happy with it anyway or, more unlikely, decide he wants the excess removed. Either way, its his penis and he gets to decide.

Also, my baby pees out of the top as well, but we don't see any issue with it. Its just the way his foreskin decided to angle. It'll probably get batter once he's retractable on his own.

Cari-mama to Eriq, Lile, Paikea, Kaidyn, and Mieke is here!! 2/9/10
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