Answers to Your Questions About
Your Young Son's Intact Penis

The Foreskin

Our bodies are covered with skin. The skin on our noses goes to their tips and the skin on our fingers and toes goes to their tips. The penis, too, is covered with skin. The fold of skin that covers and protects the glans (head) of the penis is sometimes called the prepuce, but is more commonly known as the foreskin.

The inside fold of the foreskin is mucous membrane and keeps the surface of the glans soft, moist and sensitive.

The foreskin contains a concentrated number of blood vessels and nerve endings. The frenum which secures the foreskin in its forward position, is continous with the frenar band. This band of specialized tissue encircles the foreskin where the inside and outside folds meet (at the mucocutaneous junction) and is extremely sensitive.

Care

The intact penis of an infant or child needs no special care.

A child's foreskin should never be retracted by force.

During the first few years of life, the foreskin and glans are connected by a common membrane called the synechia (just as the fingernail is attached to the finger). This connective tissue dissolves naturally - a process that should never be hurried.

The foreskin can be retracted when its inside surface separates from the glans and the opening widens. This usually happens by age 18. Even if the glans and foreskin separate naturally in infancy, the foreskin still may not be retractable because the opening in an infant's foreskin may be just large enough for the passage of urine.

The first person to retract a child's foreskin should be the child himself. Once a boy discovers that his foreskin is retractable (a wondrous discovery for an intact child), he can easily learn to care for himself. A simple explanation of "how to" may be helpful:

• Gently slip the foreskin back.
• Rinse the head of your penis and the inside fold of your foreskin with warm water.
• Slip your foreskin back in place over the glans.

Answers to Your Questions:

What causes my son's foreskin to be red?

Sometimes the tip of the foreskin becomes reddened. This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive glans and urinary meatus (the opening for the passage of urine and semen).

When bacteria in the feces react with urine, they produce ammonia, which burns the skin and causes ammoniacal dermatitis, commonly known as diaper rash.

Common reasons for a reddened foreskin are:

• Too much exposure to soiled diapers
• An inbalance of skin bacteria caused by:
  • -too many bubble baths
  • -swimming in highly clorinated water
  • -soap on the genitals
  • -laundry soap or detergent on clothing
  • -antibiotic therapy (microbial flora can be restored by eating yogurt with live culture.)
• Concentrated urine because the boy is not drinking enough water.

Drinking water, soaking in warm baths, and letting children run around with bare bottoms to air their genitals helps healing.

What is the white lump under my son's foreskin?

The white lump is made up of the cells that once attached the foreskin to the glans. As new cells form on the glans and the foreskin's inside fold, old cells form pockets that eventually work their way to the tip of the foreskin, where they are discharged and can eventually be wiped away. The space they occupied becomes the preputial space between the foreskin and the glans. So, if you see a white lump under the foreskin you know that the separation of the glans is occurring naturally.

What is phimosis?

The greek word phimosis means muzzled and refers to a foreskin that cannot be retracted because its opening is too small to expand over the head of the penis. This is normal during infancy and childhood. The foreskins of some males are not retractable until they are in their late teens.

Why does my son's foreskin "balloon" when he urinates?

This is another indication that the natural separation of the glans is occurring. One elderly Irishman tells how, as a boy he and his friends would stand in a row, urinate, then squeeze the balloon to see who could "shoot the farthest. As the preputial opening widens, most boys decrease their chances of winning the game, but increase their ability to retract their foreskins.

What happens if someone retracts my son's foreskin prematurely?

Forcing the foreskin back can cause pain, as well as problems.

Tearing the foreskin from the glans leaves an open wound which can lead to infection.

Raw surfaces touching each other can heal together and form adhesions between the foreskin and the glans.

Small tears in the opening of the foreskin can heal to form non-elastic scar tissue, passibly causing acquired phimosis.

The foreskin can get "stuck" behind the glans (paraphimosis). By squeezing the glans, the foreskin can be brought forward again, without circumcision.

How do I teach my son to wash?

When a boy is old enough to bathe himself, he can wash his penis just as he washes any other part of his body.

When a young boy pulls at his foreskin, he usually pulls it outward. This is normal and natural and no cause for concern; he won't hurt himself. One day, he'll pull his foreskin back, and you can discuss retracting, washing, and returning the foreskin to its forward position over the glans. Telling your son about retractablility beforehand will keep him from becoming alarmed the first time his foreskin retracts.

At puberty, you can let him know what with hormonal activity comes new responsibility, including genital hygiene.

NOCIRC has information about hygiene written especially for intact boys.

Many doctors don't know how to care for an intact penis and recommend circumcision for any and every problem. The National Organization of Circumcision Information Resource Centers, which is dedicated to preserving and protecting children's normal natural wholeness, will be happy to direct you to a doctor who understands the foreskin's functions and importance.

The information in this pamphlet is not intended to replace the advice and care of your pediatrician.

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