Advice About Circumcision
First, there is the fact that the American Academy of Pediatrics’ position on circumcision has evolved quite a bit over the years. In 1971, they stated that there are no valid medical indications for circumcision in the neonatal period. That changed to there being “no absolute medical indication for routine circumcision” in 1975 and to saying that “data are not sufficient to recommend routine neonatal circumcision” in 1999. The latest AAP policy statement on circumcision, issued in 2012, states that “evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.” The AAP does also state that “health benefits are not great enough to recommend routine circumcision for all male newborns,” even though it is usually well tolerated with infrequent complications. They urge parents to “to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices.”
Care of the Uncircumcised Penis After Retraction
Once they get past the decision on whether or not to circumcise their baby boy, many parents who don’t choose circumcision are unaware of what to do with their child’s uncircumcised penis. And it does seem that one of the biggest problems that lead to children needing a circumcision later in life is improper care of their uncircumcised penis, with this improper care usually involving a parent being told to retract their child’s foreskin before it is ready to be retracted. The best advice that a parent can follow is to simply ’leave it alone’ until it begins to retract on its own. Once the foreskin does retract from the tip of the penis, often by the time your child is four or five years old, when he takes a bath or shower, your child should:
Pull the foreskin back as far as it will go.Wash and then rinse the tip of his penis with soap and water.Push the foreskin back over the tip of the penis.
Since the foreskin sometimes begins to retract at a much earlier age, by age one or two years, you can likely try to gently retract your child’s foreskin when changing his diaper or giving him a bath every once in a while. Not cleaning or not rinsing properly when cleaning the uncircumcised penis can lead to balanoposthitis or inflammation of the foreskin and tip of the penis. Symptoms of balanoposthitis can include redness, pain, and a discharge. Treatment might include an antibiotic cream, steroid cream, or antifungal cream, etc., depending on the underlying cause. Similarly, children can develop meatitis or inflammation of the opening at the tip of the penis. This can happen in circumcised children too, though.
What You Need to Know
The foreskin sometimes doesn’t retract until some boys are well into puberty. Smegma is the white, cheesy discharge that normally builds up under the foreskin and can sometimes also normally be found in circumcised boys who have penile adhesions, which occurs when foreskin that remains after a circumcision begins to stick to the tip of the penis. Phimosis is the condition for when the foreskin can’t be retracted. Although it is sometimes a reason for older children to get circumcised, it can often be treated with a medium or high potency steroid cream to break underlying adhesions that might be preventing the foreskin from retracting. Paraphimosis occurs if the foreskin is retracted, but then can’t be replaced over the tip of the penis. It is considered a medical emergency. It can be a complication of balanoposthitis.
Remember that you should never forcibly retract a child’s foreskin before it is ready to be retracted. Your pediatrician and/or a pediatric urologist can be helpful if you think that your child’s foreskin is not retracting when you think that it should.
