phimosis vs. forcible retraction
August 7, 2009 2:13 PM   Subscribe

Should I be encouraging my 9 year old son to retract his foreskin? Is cortisone cream to thin the skin, prescribed by his original pediatrician, a good idea?

I'm circumcised, so have no personal experience as a guide. His (male) pediatrician until last year expressed concern when the child was 6 or 7 about child's inability to retract child's foreskin for cleaning and prescribed gentle self-administered stretching and application of cortisone cream. We live in the USA (Wikipedia's references leads me to believe a Dr. in Germany or the U.K. might have different advice).

When retracted, the tip of child's glans is visible with a diameter of perhaps 5 to 8 millimeters.

After reading other Ask Mes & Wikipedia on phimosis and forcible retraction, it seems that full retractibility might not be expected until puberty and it should be left alone. The doctor suggested circumcision as an eventual course if retractibility is not achieved "soon."

We moved last year & the new (woman) pediatrician was not worried by this advice, but we relayed it to her as if we weren't worried about it either: just a FYI on her patient's condition & medications. I'll ask her for her opinion at our next visit.
posted by anonymous to Health & Fitness (15 answers total) 2 users marked this as a favorite
Yes and yes. When I was a kid, I pinched the tip of the foreskin while peeing to inflate the whole apparatus like a balloon then pulled the foreskin back to wash it afterward. Circumcision is totally not an option, IMAO.
posted by torquemaniac at 2:34 PM on August 7, 2009

Why is circumcision not an option? Thats what I would have recommended (even though its a 9 year old kid...oh poor kid).
posted by hal_c_on at 2:38 PM on August 7, 2009

Did the doctor you spoke with give you an specific reason why retraction/cleaning is necessary?

Retraction is necessary to stretch the skin and make it possible to achieve erection later in life. Cleaning is necessary to get rid of the smegma that accumulates under the foreskin, which can be achieved by my aforementioned tactic of pinching and ballooning - urine is great as a cleansing product.
posted by torquemaniac at 2:55 PM on August 7, 2009

My son turns 7 soon and is uncircumcised, unlike his father. Anyway, he developed a yeast infection a few months ago that was easily treated with an anti-fungal.

When I asked the (older, white-male, bearded, detached) doctor at the walk-in clinic about how to prevent this from happening in the future, he said, "It's probably time for circumcision."

Yeah, right, whatever buddy.

Anyway, most of the resources that I've read state that the foreskin must be retracted for *cleaning* starting at about the age of 5 or so.

Nothing I've ever read states the foreskin must be retracted in order to achieve erection in later life, and I doubt that my friends who retained their foreskins as children were instructed by Mom and Dad to pull their foreskin back to get wood. It just doesn't make sense.

Encourage cleanliness and personal hygiene, and let nature take its course.

In case anyone is wondering why we chose not to have our son circumcised, it's because, frankly speaking, having a foreskin seems like it would prevent a lot of unnecessary chaffing.
posted by KokuRyu at 3:43 PM on August 7, 2009 [1 favorite]

On a personal note, when I was about that age, my mother was freaking out over my foreskin not retracting completely. She kept threatening me with circumcision for several years onwards, and I can only guess that her complacency about getting me to the doctor saved my foreskin. I still remember her mimicking scissors with her fingers while onomatopoeically saying "Snip, snip!" I'm pretty sure that that episode was the reason for my very pronounced discomfort, early on, with people touching my junk in a sexual context.

Naturally, the moment I started masturbating with any regularity, that motherfucker pulled right back.

So my advice is to let the kid be, and to not talk about it. If it does become an issue, he'll most certainly notice and let you know. It's never too old for a circumcision anyway: Abraham was circumcised at the ripe old age of 99, and he managed to father two whole civilizations!
posted by Mons Veneris at 3:53 PM on August 7, 2009 [6 favorites]

Adding to the pinch, balloon, wash gang here. The fun you can have with a foreskin :-)
posted by merocet at 4:08 PM on August 7, 2009

Wow, uncircumsized here as well, and I've never done the "balloon" trick! Fascinating!

When my step-daughter was pregnant, she and her hubby discussed whether they'd circumsize their child if they had a boy, and they both agreed that it HAD to be done, because uncircumsized penises are "weird".

posted by newfers at 4:14 PM on August 7, 2009

I did a bunch of research on leaving my two (soon to be three) boys intact and this is what I have learned through the AMA, the APA, etc.

It is common and entirely normal for the forskin not to retract until puberty. There is very little harm in this. For most kids, there is no harm but there is always a slight chance of infection (as with basically any body part.)

During puberty, when the body changes and the child gets more involved in masturbation, the foreskin will retract if it hasn't done so already. It is extremely, extremely rare for it not to retract to the point where it becomes a problem requiring circumcision. Wash the penis with warm, soapy water. If the child can retract it some, fine, if not, it will still get washed.

My twins are almost five. One's foreskin has retracted (due to his messing with it over time, I imagine) and I do remind him to retract and wash it. The other has not retracted much at all. We have had no problems nor do I foresee any. They have seen two pediatricians in their life. One male, who didn't tell me anything different than the above but I could tell he was a little bothered by the fact that the kids weren't circed. (I imagine it is a thing like convenient access, the doctors just like the convenience of being able to check under the skin so to speak.) The female ped has been in total agreement with what I have learned.

If it ain't broke, no need to fix it. It doesn't sound like anything is broke there.
posted by Bueller at 4:34 PM on August 7, 2009 [4 favorites]

oh, and you can totally get an erection without the foreskin retracting. That's a load of crap. There was just a post about it here like a few days ago, and well...I've seen it happen and its not a big deal.
posted by Bueller at 4:38 PM on August 7, 2009

FWIW, I couldn't fully retract my foreskin till I was about 13 and I had absolutely zero problems from it. I don't understand the circumcision recommendation at all unless problems (infections and the like) arise. Seconding Bueller: If it ain't broke, no need to fix it.
posted by wackybrit at 5:32 PM on August 7, 2009

I'd like to second Mons Veneris's comment. Same story here. The Dr's were worried. My progressive parents were worried. Everyone was talking about knives.

Nature does it's thing.
posted by mmdei at 8:16 PM on August 7, 2009

I am still pretty pissed about being circumcised as a baby. My parents feel bad about it, but were urged to do it by doctors and claim ignorance. You are not ignorant, don't put your kid through this.

It sounds like you have a healthy outlook and if your son is taught proper hygiene, he will figure out how the rest works all on his own. You don't need to do anything unless your son is having problems and phimosis usually doesn't become a problem until full adulthood, at which point he can make his own decisions.
posted by psycho-alchemy at 10:37 PM on August 7, 2009


Practice makes better. More attempts at retraction will make it easier to retract (stretching).

Take care of that peener!
posted by porpoise at 1:11 AM on August 8, 2009

Read the clinical practice guidelines from The Royal Children's Hospital in Melbourne, Australia for a good view of the penis & foreskin.

What is left unsaid in the CPG is to make sure your son knows there is nothing wrong with playing with or examining his penis, especially in frequent warm showers or baths. Let him know it needs to be kept clean under the hood and a little extra non-painful tugging and rinsing may be in order as he gets older.
posted by McGuillicuddy at 1:56 AM on August 8, 2009 [1 favorite]

Disclaimer: I'm female, I don't have children, I've only met two uncircumcised penii in my life.

It strikes me that rather than having a whole big serious "Junior, I need to show you how to do something that's very important, okay?" kind of thing, just take a matter-of-fact, "don't forget to pull this bit back as much as you can when you're washing up and clean under there too."

The thing is, "as much as you can" will probably start to vary over time, as he gets used to handling things there, and that'd probably take care of it. I'm assuming, anyway (again, not TOO clear on the mechanics here, but from what others are saying I'm assuming this is at least plausible). It strikes me that this would be the least fuss and stress involved.
posted by EmpressCallipygos at 6:19 AM on August 8, 2009

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