The rates of circumcision are on the downturn, which means more parents will have questions about how to care for an uncircumcised penis in the future. Parents – and their sons – often have heard confusing, conflicting or just plain wrong information about how to care for the uncircumcised penis. I have seen teen boys who have come in, concerned about whether or not they will be able to have sex in the future, because they aren't circumcised. Let's set the record straight on what's normal, what's a problem and what is an emergency.
A Normal Uncircumcised Penis
When a male child is born, his penis still has an extra layer of skin protection over the head (glans). This layer is called the "foreskin" or "prepuce." At birth, the foreskin is still attached to the head of the penis. This is completely normal, and does not mean there is something wrong. As the boy gets older, the foreskin begins to separate naturally from the head of the penis.
As the foreskin starts to separate from the head of the penis, sometimes a white material builds up under the foreskin. This can look like white pearls under the foreskin. The material is called "smegma," which is made up of the skin cells that slough off during the separation process, and is completely normal.
But the Skin is Stuck!
Parents are often concerned that the foreskin isn't separating fast enough, and will make the mistake of pulling on it to “loosen” it from the head. NEVER PULL HARD ON THE FORESKIN TO SEPARATE IT. This can cause a kind of scar tissue to form between the foreskin and the head of the penis, and this scar tissue can interfere with normal separation. Basically, you are creating a permanent problem by forcing the foreskin back, instead of letting nature take its course. The foreskin should completely separate from the head of the penis by the time puberty hits, although it usually happens by the time the boy is 5 years old.
Care of the Uncircumcised Penis
As your son was growing up, you probably told him to keep his penis clean. The best advice for parents is to encourage your son to keep the outside of the penis clean in general. He can pull the foreskin back to where it feels comfortable and clean the head of the penis that is visible. Make sure that the penis is clean, with no soap residue left over. The soap can be irritating to the sensitive skin on the head of the penis.
When Should I Call the Doctor?
If your son has hit puberty and the foreskin is still stuck to the head of the penis, it may be time to call your pediatrician or family healthcare provider. Your provider can prescribe a steroid cream that can speed up the process of separation. It is a simple treatment that has good results.
If the foreskin ever looks red and/or swollen or if it is painful for your son to urinate, he may have an infection of the foreskin, or a urinary tract infection. It is important for a provider to treat this infection as it can get worse without treatment.
If the foreskin will not retract (move back over the head) at all, it can be one of two problems. One issue is that the foreskin is still attached to the head, as discussed earlier, which can be normal depending upon how old the child is. Additionally, the end of the foreskin can become too tight for it to come back over the head of the penis. These issues, called "phimosis," can also be treated by your provider with a steroid cream or, if necessary, by circumcision depending upon the situation.
Paraphimosis is another problem that can be an emergency. With paraphimosis, the foreskin has been pushed back over the head of the penis, but it becomes stuck behind the head. This can be quite painful, and the tight skin can begin to cut off normal blood flow to the head of the penis. If your son has this problem, it is important for him to see a doctor or provider right away. If your doctor isn't immediately available, a trip to the emergency room will be necessary. With some lubrication, a provider can help get the foreskin back over the head of the penis, or sometimes an emergency circumcision is necessary.
Behrman, RE, Kliegman, RM, and Jenson, HB. Nelson Textbook of Pediatrics, 2004.
Camille, CJ, Kuo, RL, and Wiener, JS. “Caring for the Uncircumcised Penis: What Parents (and You) Need to Know.” Contemporary Pediatrics, 2002, 11:61
Care of the Uncircumcised Penis. American Academy of Pediatrics. January 2, 2009. http://www.medem.com/medlib/article/ZZZRNBDTODD