Changes

In the majority of adult men, the [[foreskin]] normally retracts to reveal the head of the penis. In newborns, it is common for the foreskin to be fused to the head of the penis by the [[synechia]], thus rendering it non-retractable. The preputial cavity is sealed by the [[synechia]].<ref name="fleiss-hodges-vanhowe1998">{{REFjournal

|last=Taylor

|author-link=John R. Taylor

|last2=Lockwood

|author2-link=

|last3=Taylor

|title=The prepuce: specialized mucosa of the penis and its loss to circumcision

|journal=Brit J Urol

}}</ref> The foreskin usually separates from the glans and becomes retractable with increasing age. There is much uncertainty among health care workers about when the foreskin of a boy should become retractable.<ref>{{REFjournal

|last=Simpson

|last2=Barraclough

|title=The management of the paediatric foreskin

|journal=Aust Fam Physician

The first data on development of retractile foreskin were provided in 1949 by the famous British paediatrician, [[Douglas Gairdner]].<ref name="Gairdner">{{REFjournal

|last=Gairdner

|author-link=Douglas Gairdner

|title=The fate of the foreskin: a study of circumcision

Unfortunately, [[Douglas Gairdner|Gairdner]]’s data are inaccurate,<ref name="Wright1994">{{REFjournal

|last=Wright

|title=Further to the "Further Fate of the Foreskin"

|journal=Med J Aust

}}</ref> <ref name="Hill2003">{{REFjournal

|last=Hill

|author-link=George Hill

|title=Circumcision for phimosis and other medical indications in Western Australian boys

|last=Denniston

|first=George C.

|author-link=

|last2=Hill

|first2=George

|author2-link=

|etal=no

|title=Gairdner was wrong

|journal=Can Fam Physician

|date=2010-10-01

* Fusion of the foreskin with the glans penis<ref name="deibart1933">{{REFjournal

|last=Deibart

|title=The separation of the prepuce in the human penis

|journal=Anat Rec

Kayaba ''et al''. (1996) reported that before six months of age, no boy had a retractable prepuce; 16.5 percent of boys aged 3-4 had a fully retractable prepuce.<ref name="kayaba1996">{{REFjournal

|last=Kayaba

|last2=Tamura

|last3=Kitajima

|etal=yes

|title=Analysis of shape and retractability of the prepuce in 603 Japanese boys

}}</ref> Imamura (1997) examined 4521 infants and young boys. He re-ported that the foreskin is retractile in 3 percent of infants aged one to three months, 19.9 percent of those aged ten to twelve months, and 38.4 percent of three-year-old boys.<ref name="imamura1997">{{REFjournal

|last=Imamura

|title=Phimosis of infants and young children in Japan

|journal=Acta Paediatr Jpn

}}</ref> Ishikawa & Kawakita (2004) reported no retractability at age one, (but increasing to 77 percent at age 11-15).<ref>{{REFjournal

|last=Ishikawa

|last2=Kawakita

|title=Preputial development in Japanese boys

|journal=Hinyokika Kiyo

|last=Ko

|first=Ming-Chung

|author-link=

|last2=Liu

|first2=Chih-Kuang

|author2-link=

|last3=Lee

|first3=Wen-Kai

|author3-link=

|last4=Jeng

|first4=Huey-Sheng

|author4-link=

|last5=Chiang

|first5=Han-Sun

|author5-link=

|last6=Li

|first6=Chung-Yi

|author6-link=

|etal=no

|last=Agawal

|first=Abhnav

|author-link=

|last2=Mohta

|first2=Anup

|author2-link=

|last3=Anand

|first3=Ritesh K.

|author3-link=

|etal=no

[[Jakob Øster]], a Danish physician who conducted school examinations, reported his findings on the examination of school-boys in Denmark, where circumcision is rare.<ref name="Øster1968">{{Template:Jakob_Øster_1968}}</ref> Øster (1968) found that the incidence of fusion of the foreskin with the glans penis steadily declines with increasing age and foreskin retractability increases with age.<ref name="Øster1968"/> Kayaba ''et al''. (1996) also investigated the development of foreskin retraction in boys from age 0 to age 15.5 Kayaba ''et al''. also reported increasing retractability with increasing age. Kayaba ''et al''. reported that about only 42 percent of boys aged 8-10 have fully retractile foreskin, but the percentage increases to 62.9 percent in boys aged 11-15.<ref name="kayaba1996" /> Imamura (1997) reported that 77 percent of boys aged 11-15 had retractile foreskin.<ref name="imamura1997" /> Thorvaldsen & Meyhoff (2005) conducted a survey of 4000 young men in Denmark.9 They report that the mean age of first foreskin retraction is 10.4 years in Denmark.<ref name="Thorvaldsen">{{REFjournal

|last=Thorvaldsen

|last2=Meyhoff

|title=Patologisk eller fysiologisk fimose?

|trans-title=Pathological or physiological phimosis?

Boys usually are born with a non-retractile foreskin. The foreskin gradually becomes retractable over a variable period of time ranging from birth to 18 years or more.<ref name="Øster1968"/><ref name="Thorvaldsen"/> There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health in childhood and no intervention is necessary. Many boys only develop a retractable foreskin after puberty. Education of concerned parents usually is the only action required.<ref>{{REFjournal

|last=Spilsbury

|last2=Semmens

|last3=Wisniewski

|etal=yes

|title=Circumcision for phimosis and other medical indications in Western Australian boys

* Manual stretching<ref>{{REFjournal

|last=Dunn

|title=Non-surgical management of phimosis

|journal=Aust N Z J Surg

}}</ref><ref>{{REFjournal

|last=Beaugé

|title=The causes of adolescent phimosis

|journal=Br J Sex Med

* Application of topical steroid ointment<ref>{{REFjournal

|last=Orsola

|last2=Caffaratti

|last3=Garat

|title=Conservative treatment of phimosis in children using a topical steroid

|journal=Urology

}}</ref><ref>{{REFjournal

|last=Ashfield

|last2=Nickel

|last3=Siemens

|etal=yes

|title=Treatment of phimosis with topical steroids in 194 children

Male circumcision is outmoded as a treatment for non-retractile foreskin, but it is still recommended by many urologists because of lack of adequate information, and perhaps because of the [[Financial Incentive|profit to the doctor]] associated with circumcision. Nevertheless, [[circumcision]] should be avoided because of pain, trauma, cost,<ref name="Van Howe">{{REFjournal

|last=Van Howe

|title=Cost-effective treatment of phimosis

|journal=Pediatrics

}}</ref><ref>{{REFjournal

|last=Berdeu

|last2=Sauze

|last3=Ha-Vinh

|last4=Blum-Boisgard

|title=Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect.

|journal=BJU Int

}}</ref> complications,<ref name="Van Howe"/> difficult recovery, [[Circumcision scar| permanent injury to the appearance of the penis]], loss of pleasurable erogenous sensation,<ref>{{REFjournal

|last=Williams

|last2=Kapila

|title=Complications of circumcision

|journal=Brit J Surg

}}</ref> impairment of erectile and ejaculatory functions,<ref>{{REFjournal

|last=Shen

|last2=Chen

|last3=Zhu

|etal=yes

|title=Erectile function evaluation after adult circumcision

}}</ref><ref>{{REFjournal

|last=Masood

|last2=Patel

|last3=Himpson

|etal=yes

|title=Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly?