Care instructions for the young Johnson?
August 14, 2016 6:15 PM   Subscribe

What do I need to know to properly take care of our 2-year-old's uncircumcised penis, and when/how do we start cleaning under the foreskin?

I'm circumcised, but my son isn't.

How should we clean and otherwise take care of his penis? I know that as a newborn, we were supposed to leave his foreskin alone, and that adults need to clean themselves under their foreskin... but there's a lot of time between birth and adulthood, and as usual for anything vaguely medical or child-rearing related, everything I've found/read is conflicting.

When should we (or he) start to clean under his foreskin? Is it uncomfortable? Is it uncomfortable when you don't? And most importantly, how do you best do it?
posted by toxic to Health & Fitness (16 answers total) 6 users marked this as a favorite
I'm in the same boat as you. I campaigned to leave our son uncircumcised so my wife told me it'd be up to me (to educate him on the issue). I mentioned it to him briefly a few times when he was about 8. He seemed to get the idea. I told him to pull the foreskin back a little bit and clean underneath. So far, so good, I guess.

I think it's at least a little important to remember that for almost all of mankind's history, every man has been uncircumcised, cleanliness has been a distant 9th priority, and for the most part everyone came out OK.
posted by RustyBrooks at 6:19 PM on August 14, 2016 [1 favorite]

Best answer: You don't. The advice I was given is to clean it like you would a finger. He will retract it on his own when he is older (8-12-ish) and you don't ever want to retract it forcibly.

Don't clean under his foreskin, just let him know when he's older that he can clean a little more thoroughly.

And don't be alarmed by a "ballooning" foreskin when he pees - that happens to my youngest, but isn't a big deal. My youngest is the only one who has had a UTI, but he also went on a potty strike and refused to drink any water at the same time so frankly, he brought it on himself and it cleared up without medical intervention.
posted by annathea at 7:01 PM on August 14, 2016 [10 favorites]

Oh, and be forthright about it with caregivers - I told all of my boys' babysitters what I just told you, and I had to stop a pediatrician from trying to retract my oldest's foreskin. She simply didn't know, she doesn't have a lot of uncircumcised boys in her practice. I've also put up with a lot of shit about not circumcising them but if your son is already two I'm sure you've either heard some of it or don't live in a rural area in the Midwest. :)
posted by annathea at 7:02 PM on August 14, 2016 [2 favorites]

Best answer: the Pediatric Society of New Zealand has this guide.

I have a foreskin, and I don't remember there being any real hygiene issues down there until 5th or 6th grades. That article says that at some point, the foreskin detaches from the glans. While I don't exactly remember this process, I'm pretty sure it's 8-10 years old, not under 4, when you'll be helping him wash a lot.

Don't ever try to retract the foreskin forcibly.
posted by Llamadogdad at 7:10 PM on August 14, 2016 [1 favorite]

Lots of good advice here; just wanted to let you know my kiddo is also not circumcised, he's 10, and not particularly clean (in typical 10-year-old fashion) and so far has not had problems. We did not try to clean under it when he was small.

(I'm glad you posted this, though, because I should get the husband to talk to him soon about when/how he needs to do that kind of cleaning. I'm sure he doesn't want to hear it from me).

You can still talk about basic hygiene, of course, just to avoid rashes and other unpleasantness. We made "fresh underwear every day" the rule when he started dressing himself. And general "You must take a shower/bath every x days/when you stink" rules and so on. That honestly takes care of a lot of it.
posted by emjaybee at 7:36 PM on August 14, 2016

I have three uncircumcised sons, none of whom have ever had any penis problems, and all we did was leave them alone and as they cruised into late childhood, mentioned the concept of cleaning more deeply. Seconding to make sure his caretakers are on board, a lot of people have never even seen an uncircumcised penis, and will decide that it needs to be retracted.
posted by glitter at 9:05 PM on August 14, 2016 [2 favorites]

It gets a little odd when your son is uncut and you are and he notices and you explain it and boy cups himself defensively while his mouth forms a perfect circle as you describe exactly what happened to you, but we've yet to experience any of the horrors that the smegma article on Wikipedia describes. Not even going to link because that picture is of something else.

Don't let him pick the underwear you buy. Been round and round on that with the ex and finally just started throwing it away and sending him back to his mom in sensible penis attire. You can buy underwear that is 100% cotton and you'd think it would breathe and it is so cute, but the dye on the superhero underwear clogs that cotton up and you might as well paint him with latex and mix some limburger in with it.
posted by Mr. Yuck at 9:44 PM on August 14, 2016 [2 favorites]

Response by poster: Quick followup.

- Our pediatrician hasn't said anything about the topic since the newborn visits, but we haven't asked. I'll probably bring it up, though it sounds like that's premature.

- I am aware that 2 is still too young to start retracting it, and certainly wouldn't do that forcibly (ouch!). I was looking more for guidance on when that changes... since about the only thing I know on the topic is that sometime before adulthood, it does.

- His caregivers are primarily Russian and Ukranian expats, and many of his peers at daycare are children of similar expats. Uncircumcised penises are not likely to be unusual for them, but I will mention it just in case. Thanks for that, as neither of us had thought about it.

- We're in San Francisco, where non-religious circumcision is far less common than most people realize. (The City actually considered banning the practice on infants in 2011). We've gotten essentially no grief about this choice (though we know some family members disagree with it, they've been very respectfully silent). Honestly, I'm surprised that in 2016 anyone would actually raise an eyebrow on anything other than religious grounds.

In fact the only comment I've heard was from the mother of a similarly aged boy. She made a joke about how much longer he looked than her son. She's the kind of friend where that's in no way awkward or carries deeper meaning.

Thanks everybody so far. Looking forward to answers that roll in when Europe wakes up, too.
posted by toxic at 9:50 PM on August 14, 2016

They usually become retractable sometime between four and fourteen, often at or around puberty. Pulling back a little to get water around the meatus should be fine. Sometimes soaps (or a specific soap) can be problematic with a foreskin, so be aware if there's irritation, but mostly they're fine.

One thing to do (when he's older) is to let him know more about what he's going to experience. First, let him know that the foreskin is supposed to be retractable. This may seem obvious, but a surprising number of young men make it to adulthood without knowing this. If it's not freely retractable a year or two after he hits puberty, there are steroid cremes that can help loosen it up.

After a lifetime of being covered, any direct contact with the glans is overstimulating, to the point of pain (think of the way that many women react if you touch their clit directly). Some boys/young men don't retract their foreskins because of it. Knowing that it's likely to happen and is something that he'll acclimate to may help reassure him.
posted by Candleman at 10:04 PM on August 14, 2016 [1 favorite]

At my 7 year old's last pediatric visit the doctor noted that he will probably start pulling on it naturally and his penis was checked to make sure it was progressing as normal. I also live in a place where few circumcise.
I don't understand the above comment about underwear. My child generally wore gymboree brand undies with the occasionally cheaper cartoon or whatever characters pair now and then. He now wears a mix of Gymboree and Hanna Andersen. I've never had any issues with any of these.
posted by k8t at 10:47 PM on August 14, 2016 [2 favorites]

Seconding. My uncut kiddo has experienced zero issues through six years of Target's finest.
posted by chesty_a_arthur at 6:16 AM on August 15, 2016

Everyone thus far seems to be on team Toddler Foreskins Do Not Retract, Ever. I'll offer a brief counterpoint - many kids' foreskins do retract earlier; our son's has retracted smoothly since birth. Obviously don't tug on it, but penises are reasonably durable (have you SEEN what toddlers do to them in the bathtub??) and it's certainly not out of line for you to check gently to see where your kid falls on the spectrum between fully adhered and fully retractable.

In our case, since the foreskin does retract, we have always cleaned under it. When he was in diapers, I did find the occasional poop particles up in there, so I typically did a quick retract-and-wipe while changing dirty diapers. In the bathtub, we'd sort of retract-and-swish quickly. No scrubbing needed, though. His foreskin did once get swollen and inflamed (called balanitis, in this case probably dirty-diaper related) and we had to take him to the doctor, but a few days of warm water soaks a couple times a day cleared it right up. It wasn't a major problem.

Cleaning under his foreskin has never seemed to bother him or cause discomfort. (Our kid is dramatic, we would know.) At worst he would get an erection when we cleaned him but you have presumably spent enough time around your infant/toddler to know that this is a thing that happens pretty regularly and is not an issue unless you make it one.

Finally, we are team superhero undies all the way. Never had an issue.
posted by telepanda at 6:42 AM on August 15, 2016 [1 favorite]

I just want to address this:

And don't be alarmed by a "ballooning" foreskin when he pees - that happens to my youngest, but isn't a big deal. My youngest is the only one who has had a UTI, but he also went on a potty strike and refused to drink any water at the same time so frankly, he brought it on himself and it cleared up without medical intervention.

Ballooning can be a sign of Phimosis (Warning! Wikipedia Penis Photo - NSFW) and/or Hypospadias (possibly also NSFW, but illustrations, not photos this time). Ballooning can also cause urine to back up into the urinary tract, which is what causes the UTIs. If the child's foreskin regularly balloons (ie: fills with urine so that it swells up), it REALLY should be checked by a urologist. My son ended up having multiple UTIs and eventually corrective surgery at the age of about 1 year. Don't ignore this. It's not normal and can be a sign of other, more serious, problems.

To the OP: as your son gets more and more erections, the foreskin will begin to loosen up naturally. At this age, assuming he's in the tub and not the shower, he'll get clean enough. As he gets older, you can teach him to very gently retract the foreskin to clean the penis, but this probably won't be until he's old enough to take a shower himself.
posted by anastasiav at 8:08 AM on August 15, 2016

UK mum here, and of a 3.5yo boy still in nappies due to his autism.

As someone said above, imagine it is a finger. Wash what you can see. NEVER try to retract. It is likely that by the time it needs to be washed you will be verbally instructing him on how to do that, and not helping or even watching.

Regard what is "underneath" (although they are actually joined still, and as such there is no "underneath") as you would a vagina (and i mean vagina, NOT vulva) - as in you wouldn't "do" anything with it (or wash inside it, or think about "germs" in there) unless there was some sign of a problem, and then you'd see a doctor.

The best thing i can impart in my UK-ness is that I only know or have thought about this because i use American and Australian parenting sites. Literally none of the UK mothers i know ever discuss or wonder about the care of a foreskin, and none of us (mothers) have one, so that tells me there is no inherent knowledge, it just doesn't need specific care. And sometimes weird stuff happens - ballooning, big chunks of smegma building up and a day of soreness while they work their way out, random redness. Mostly you can ignore, or pop to the GP for some cream. But then all the Dr's here have seen foreskins and know the care they (don't) need. I can remember my friend's kid having a really swollen sore looking penis with pus coming out, and the GP prescribed a cream. The kid refused to have it put on, mum phoned he GP and he said, "never mind, it'll get better on its own anyway" and it did. The next morning there was a blob of pus in the nappy and the penis looked completely normal again.

Also to add the the addressing of ballooning, it absolutely can be a completely normal part of the separation process. Ballooning is often present in phimosis, but it is very common anyway. A bit like all cases of peyronie's disease begin with a curve in the shaft of the penis, but NOT every curved shaft is the beginning of peyronie's.
posted by intergalacticvelvet at 11:53 AM on August 15, 2016 [1 favorite]

I would also like to offer a counterpoint to the "never retract" approach. When my son was 2, he got an infection under his foreskin, I presume from poo getting under there - I had never retracted it while bathing him. Our doctor told me to gently pull his foreskin back while showering him just to rinse with water to prevent further infections. I still encourage him to do this himself in the shower (he's now 4) but I suspect this probably isn't that necessary now that he's toilet trained. It may be that he was one of those boys whose foreskins do retract easily early on (as per telepanda's answer above) and this is how he got the infection in the first place. I felt awful that I hadn't been washing him properly, I feel rather reassured that not retracting seems to be a common approach.
posted by fever-trees at 1:08 AM on August 16, 2016

Just another piece of anecdata, my 5-year-old son's foreskin retracted just from normal exploration of himself when he was 3 or 4. I've never done more than just a quick wash in the bathtub and we've never had an issue.
posted by rabbitrabbit at 8:56 AM on August 18, 2016

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