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We've all been there: you're changing a diaper and realize that the tip of your son's foreskin is red or irritated. Or perhaps your child is complaining that his penis hurts, and it seems to be itchy, inflamed, or sensitive. Don't worry! This is common, and depending on the cause, can resolve itself very quickly.


In Infants:

It is important to remember that the very tip of the foreskin (the preputial orifice) is normally rose-colored. This is because the tissue starts to change from an outer skin to an inner skin. However, when the tip of the foreskin becomes extra red or inflamed in an infant, the culprit is usually irritation from diapers. This is very common and not a concern, especially since the baby is not usually bothered by it. When the tip of the foreskin is red, it is protecting the glans and urinary opening (meatus). The cause must be determined. Causes include infrequent diaper changes, bubble baths, chlorinated water (swimming pools), soap on the foreskin, harsh soap or detergent on diapers or underwear, antibiotics, and concentrated urine from dehydration.

Drinking water, soaking in soap-free bath water a few times per day, bacterial replacement therapy (liquid Acidophilus culture both ingested and applied to the foreskin 4-6 times a day), and plenty of air will all help healing. Some parents will apply a moisture barrier, such as coconut oil, to the penis until it clears up. Usually, this will resolve in 24-48 hours.

In Toddlers/Children:

As said before, the very tip of the foreskin is normally rose-colored. With toddlers, extra redness or irritation could be from multiple factors. As listed above, the culprit could be diaper irritation or any of the other factors, such as soaps or chlorine.

However, as boys become older, it could be likely that the symptoms are from the natural separation of the foreskin from the glans (head). While the average age for this to happen is 10 years old, it is possible to happen to boys who are younger.

When the foreskin starts to naturally separate, it is not uncommon for there to be slight discomfort in the form of itching, redness, or extra sensitivity. These symptoms are caused by the natural process of the fused tissue breaking down and separating. Some boys do not seem to be bothered by natural separation, and others might be more sensitive. Either way, rest assured that it won't last long and will resolve on its own.

When Could it be a Problem?

While the majority of boys with redness are simply experiencing slight irritation, it is important to keep an eye out for other symptoms, such as fever or extreme discomfort (especially when urinating.) It could be possible that they are experiencing a urinary tract or yeast infection. If this is the case, you might want to schedule an appointment with your doctor. Be aware that your doctor will likely want a urine sample, so be sure to read our information on catheters and intact boys before you go in for a visit. We also have a list of intact-friendly doctors if you would like to try to find one in your area.

For a Yeast Infection: First, stop using bubble baths, soaps, and/or shampoos in the bath. Then, purchase liquid Acidophilus culture (the active ingredient in yogurt but more concentrated in this form) from your natural food store and apply it to your son's foreskin six times a day for three days and his foreskin should return to health by the end of the time. If not, continue this therapy for a couple of more days. This is called "Bacterial Replacement Therapy". Yeast overgrowth occurs when normal bacteria are destroyed by items such as bubble baths, soaps, antibiotics, and chlorinated swimming pools. We suggest to add healthy bacteria back onto the tissue rather than medicine to kill yeast. The yeast will subside when the bacteria are growing back on the tissue. When boys are able, you can pour a couple teaspoons into a cupped hand and have the boy dip his foreskin to the liquid and let it drip dry.  Remember, don't use soap on a boy's foreskin! Over-the-counter yeast medications, or creams prescribed by your doctor, can also cure the yeast infection. Be sure to consult your doctor if the condition doesn't improve.

For a Urinary Tract Infection:  You can provide relief for your son by having him place his penis in a warm cup of water while urinating. D-Mannose has been known as a natural remedy for urine infections, and as always, it is important to drink plenty of water. As stated earlier, a liquid Acidophilus culture (both ingested and applied to the foreskin 4-6 times a day) will help balance out the natural flora. Breast milk also helps fight UTIs (and prevent them, as well), so be sure to offer it often (if available). As always, antibiotics prescribed by your doctor will take care of the infection, as well, so be sure to consult your doctor if the conditions don't improve. As said above, be aware that your doctor will likely want a urine sample, so be sure to read our information on catheters and intact boys before you go in for a visit. We also have a list of intact-friendly doctors if you would like to try to find one in your area.

 
 
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A closer look at the care of the intact penis and proper hygiene as he grows older.

The male foreskin is fused to the head of the penis at birth (just like the female foreskin- the clitoral hood- is normally fused to the glans of infant and young preadolescent girls). This is the body's way of protecting the genitals against urine and feces. Because it is fused shut, bacteria and other foreign particles cannot invade. 

It is absolutely unnecessary to forcibly retract the foreskin to clean under it, and in fact- this will cause bleeding, scarring, and damage to the penis. Pulling it back before it is ready can also introduce foreign bacteria which can lead to infection.

The first person to retract a boy's foreskin should be the boy himself. Everyone else- hands off. The average age for this to happen is about 10 years old. About that time, the foreskin will start to become detached (although sometimes it is sooner, and sometimes it is later). Until about puberty, the body isn't producing anything that needs to be 'rinsed'. So if he gets especially dirty, sitting in a warm water bath (without soap) should take care of the cleaning. Once he can retract his own foreskin, he just needs to pull it back during a shower, rinse with warm water, and return it to the original position. No soap & no scrubbing under the foreskin.

Occasionally, parents might notice the tip of the foreskin being red or inflamed. Don't worry! This is common, and depending on the cause, can resolve itself very quickly. Please read this article on red foreskins in children to get more information.

If child has been forcefully retracted, the best thing to do is stop retracting and let it heal. Please click here to get more information on what to do now and how to clean. Putting a boy into the bath several times a day helps. The body, air, and water are the best healers. Of course, you must be vigilant about watching for infection beyond the initial inflammation for the first week following forcible retraction.

 
 
Detailed information on the normal development of the foreskin and its natural separation process.

Written by: Doctors Opposing Circumcision
(see the original article here)

Introduction
There is much uncertainty among health care workers about when the foreskin of a boy should become retractable.1 This has caused many false diagnoses of phimosis, followed by unnecessary circumcision, when, in fact, the foreskin is developmentally normal.

History
The first data on development of retractile foreskin were provided in 1949 by the famous British paediatrician, Douglas Gairdner.2 His data have been incorporated into many textbooks and still is repeated in the medical literature today. Gairdner said that 80 percent of boys should have a retractable foreskin by the age of two years, and 90 percent of boys should have a retractable prepuce by the age of three years.2

Unfortunately, Gairdner’s data are inaccurate,3-4 so most healthcare providers have been taught inaccurate data.4 Retractability usually occurs much later than previously believed.3 This page provides accurate data, derived from newer and better studies, for healthcare providers.

Current View
Almost all boys are born with the foreskin fused with the underlying glans penis. Most also have a narrow foreskin that cannot retract. Non-retractile foreskin is normal at birth and remains common until after puberty (age 18). Some boys develop retractile foreskin earlier, and about 2 percent of males have a non-retractile foreskin throughout life. Non-retractile foreskin is not a disease and does not require treatment.

There are three possible conditions that cause non-retractile foreskin:
  • Fusion of the foreskin with the glans penis
  • Tightness of the foreskin orifice
  • Frenulum breve (which is rare and cannot be diagnosed until the previous two reasons have been eliminated)
The first two reasons are normal in childhood and are not pathological in children. The third can be treated conservatively, retaining the foreskin.

Infants and pre-school
Kayaba et al. (1996) reported that before six months of age, no boy had a retractable prepuce; 16.5 percent of boys aged 3-4 had a fully retractable prepuce.5 Imamura (1997) examined 4521 infants and young boys. He re-ported that the foreskin is retractile in 3 percent of infants aged one to three months, 19.9 percent of those aged ten to twelve months, and 38.4 percent of three-year-old boys.6 Ishikawa & Kawakita (2004) reported no retractability at age one, (but increasing to 77 percent at age 11-15).7 Non-retractile foreskin is the more common condition in this age group. Compare these data with Gairdner’s data!

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Percentage of boys with fused foreskin by age
according to Ă˜ster
School-age and adolescence
Jakob Øster, a Danish physician who conducted school examinations, reported his findings on the examination of school-boys in Denmark, where circumcision is rare.8 Øster (1968) found that the incidence of fusion of the foreskin with the glans penis steadily declines with increasing age and foreskin retractability increases with age.8 Kayaba et al. (1996) also investigated the development of foreskin retraction in boys from age 0 to age 15.5 Kayaba et al. also reported increasing retractability with increasing age. Kayaba et al. reported that about only 42 percent of boys aged 8-10 have fully retractile foreskin, but the percentage increases to 62.9 percent in boys aged 11-15.5 Imamura (1997) reported that 77 percent of boys aged 11-15 had retractile foreskin.6 Thorvaldsen & Meyhoff (2005) conducted a survey of 4000 young men in Denmark.9 They report that the mean age of first foreskin retraction is 10.4 years in Denmark.9 Non-retractile foreskin is the more common condition until about 10-11 years of age.
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Percentage of boys with tight ring totally non-retractile foreskin
according to Kayaba et al.
Discussion
Boys usually are born with a non-retractile foreskin. The foreskin gradually becomes retractable over a variable period of time ranging from birth to 18 years or more.8,9 There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health in childhood and no intervention is necessary. Many boys only develop a retractable foreskin after puberty. Education of concerned parents usually is the only action required.10

Avoidance of premature retraction
Care-givers and healthcare providers must be careful to avoid premature retraction of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.3

Making the foreskin retractable
Occasionally a male reaches adulthood with a non-retractile foreskin. Some men with a non-retractile foreskin happily go through life and father children. Other men, however, may want to make their foreskin retractile.

The foreskin can be made retractable by:
  • Manual stretching11-12
  • Application of topical steroid ointment13-14
Male circumcision is outmoded as a treatment for non-retractile foreskin, but it is still recommended by many urologists because of lack of adequate information, and perhaps because of the fees associated with circumcision. Nevertheless, circumcision should be avoided because of pain, trauma, cost,15,16 complications,15 difficult recovery, permanent injury to the appearance of the penis, loss of pleasurable erogenous sensation,17 and impairment of erectile and ejaculatory functions.18-20

References:

  1. Simpson ET, Barraclough P. The management of the paediatric foreskin. Aust Fam Physician 1998;27(5):381-3. [Full Text]
  2. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949;2:1433-7. [Full Text]
  3. Wright JE. Further to the "Further Fate of the Foreskin." Med J Aust 1994;160:134-5. [Full Text]
  4. Hill G. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust 2003;178(11):587. [Full Text]
  5. Kayaba H, Tamura H, Kitajima S, et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol 1996;156(5):1813-5. [Full Text]
  6. Imamura E. Phimosis of infants and young children in Japan. Acta Paediatr Jpn 1997;39(4):403-5. [Abstract]
  7. Ishikawa E, Kawakita M. [Preputial development in Japanese boys]. Hinyokika Kiyo 2004;50(5):305-8. [Abstract]
  8. Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child 1968;43:200-3. [Full Text]
  9. Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger 2005;167(17):1858-62. [Full Text]
  10. Spilsbury K, Semmens JB, Wisniewski ZS. et al. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust 2003 178 (4):155-8. [Full Text]
  11. Dunn HP. Non-surgical management of phimosis. Aust N Z J Surg 1989;59(12):963. [Full Text]
  12. Beaugé M. The causes of adolescent phimosis. Br J Sex Med 1997; Sept/Oct: 26. [Full Text]
  13. Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology 2000;56(2):307-10. [Full Text]
  14. Ashfield JE, Nickel KR, Siemens DR, et al. Treatment of phimosis with topical steroids in 194 children. J Urol 2003;169(3):1106-8. [Abstract]
  15. Van Howe RS. Cost-effective treatment of phimosis. Pediatrics 1998; 102(4)/e43. [Full Text]
  16. Berdeu D, Sauze L, Ha-Vinh P. Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int 2001;87(3):239-44. [Full Text]
  17. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993;80:1231-6. [Full Text]
  18. Denniston GC, Hill G. Circumcision in adults: effect on sexual function. Urology 2004;64(6);1267. [Full Text]
  19. Shen Z, Chen S, Zhu C, et al. [Erectile function evaluation after adult circumcision]. Zhonghua Nan Ke Xue 2004;10(1):18-9. [Abstract]
  20. Masood S, Patel HRH, Himpson RC, et al. Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly? Urol Int 2005;75(1):62-5. [Full Text]