Pediatric Foreskin Care

Description

At birth the foreskin is normally attached to the head of the penis (glans) by a layer of cells. Over the next five to 10 years the foreskin will naturally separate from the head of the penis. It gradually loosens up (retracts) a little at a time. Normal erections during childhood probably cause most of the change by stretching the foreskin.

The foreskin generally causes no problems. However, overzealous retraction before the foreskin has fully loosened can cause it to get stuck behind the head of the penis, resulting in severe pain and swelling. If retraction causes bleeding, scar tissue may form and interfere with natural retraction. Occasionally, the space under the foreskin becomes infected. Most of these problems can be prevented with good hygiene.

Normal Foreskin Retraction

Some physicians feel that parents should not engage in any attempts at retraction, but this runs the risk of smegma collection and infection. In general, the foreskin requires minimal care. The following suggestions will help maintain good hygiene.

Only the outside of the foreskin needs to be cleaned during the first year. Gentle partial retraction can begin at one or two years of age. It can be done once each week during bathing. Perform retraction by gently pulling skin on the shaft of the penis downward toward the abdomen. This will make the foreskin open up, revealing the end of the glans.

During retraction, the exposed part of the glans should be cleansed with water. Wipe away any whitish material (smegma) that you find there. Smegma is simply the accumulation of dead skin cells that are normally shed from the glans and lining of the foreskin throughout life. Do not use soap and leave soapy water under the foreskin because this can cause irritation and swelling. After cleansing, always pull the foreskin forward to its normal position.

NOTE: A collection of smegma that is seen or felt through the foreskin but that lies beyond the point to which the foreskin is retractable should be left alone until normal separation exposes it.

Avoid vigorous retraction because this can cause the foreskin to become stuck behind the head of the penis (called "paraphimosis.") Retraction is excessive if it causes any discomfort or crying.

By the time your son is five or six years old, teach him to retract his own foreskin and clean beneath it once each week during baths to prevent poor hygiene and infection. Gentle reminders are necessary in the early years.

Call our office immediately if:

• The foreskin is pulled back and stuck behind the head of the penis


• Your child can't pass any urine


• The foreskin is red or tender to the touch


• A fever (over 100 degree F) is present

Call our office within 24 hours if:

• The foreskin is swollen


• Any pus is coming from the end of the foreskin


• The urine stream is weak or dribbly


• You have other concerns or questions

Source: www.aap.org

Reviewed: September 2002

Reviewed By:
Dr. Melaine Klein
Camino Medical Group
Pediatrics