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{{GraphicWarning}}[[Image:Side by side retraction.png|right|thumb|A human [[penis ]] before and after retraction of the [[foreskin]].]]

In the majority of adult men, the Infant boys are born with a non-retractable [[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, thus rendering it non-retractable. The foreskin usually separates from the glans and becomes retractable with age. There is much uncertainty among health care workers about when the foreskin of a boy should become retractable.<refname="agarwal2005">{{REFjournal | last=SimpsonAgarwal | first=ET | coauthorsinit=A |author-link= |last2=Mohta |first2= |init2=A |author2-link= |last3=Anand |first3= |init3=RK |author3-link= |etal=no |title=Barraclough P.Preputial retraction in children | trans-title=The management of the paediatric foreskin |language= | journal=Aust Fam PhysicianJ Indian Assoc Pediatr Surg |location= |date=2005-04 |season= | volume=2710 | issue=42 |article= | pages=38189-38391 | url=https://journals.lww.com/jiap/fulltext/2005/10020/preputial_retraction_in_children.5.aspx |archived= | quote= | pubmedID= | pubmedCID= | DOI= | date=199810.4103/0971-9261.16468 | accessdate=2024-06-26}}</ref> The mistaken belief that the '''development of retractable foreskin was supposed to be retractable at the time of birth of the infant has led to ''' occurs gradually over a characterization widely-variable number of the genitalia of most infant males as defective at birth. This has led to many false diagnoses of [[phimosis]], followed by unnecessary [[circumcision]], when, in fact, the foreskin is developmentally normalyears.

In the majority of adult men, the [[foreskin]] normally retracts to reveal the [[glans penis| head of the penis]]. In newborns, it is normal for the foreskin to be fused to the head of the penis by the [[synechia]], thus rendering it non-retractable.<ref name="agarwal2005" /> The [[preputial sac]] is sealed by the [[synechia]].<ref name= From "fleiss-hodges-vanhowe1998">{{TaylorJR LockwoodAP TaylorAJ 1996}}</ref> The [[foreskin]] usually separates from the glans and becomes retractable with increasing age.<ref name="agarwal2005" /> There is much uncertainty among health care workers about when the foreskin of a duplicate page boy should become retractable.<ref>{{REFjournal |last=Simpson |init=ET |last2=Barraclough |init2=P |title=The management of the paediatric foreskin |journal=Aust Fam Physician |volume=27 |issue=4 |pages=381-383 |url=http://www.cirp.org/library/hygiene/simpson1/ |quote= |pubmedID=9613002 |pubmedCID= |DOI= |date=1998-05 |accessdate=2019-10-17}}</ref> The mistaken belief that the foreskin was supposed to be retractable at the time of birth of the infant has led to a characterization of the genitalia of most infant males as defective at birth. This has led to many false diagnoses of [[phimosis]], followed by unnecessary [[circumcision]], when, in fact, the [[foreskin]] is developmentally normal. There is no one correct age for the foreskin to become retractable.<ref name="agarwal2005" />

Normally, developmental non-retractability does not cause any problems, in fact, it is protective of the [[glans penis]] and protects against [[meatal stenosis]]. <ref name="agarwal2005" /> Non-retractability may be deemed [[pathology|pathological]] if it causes problems, such as difficulty urinating or performing normal sexual functions, but even then, this is rare, and, if the non-retractability itself is not caused by pathological inflammation, it cannot be called "pathological" or "true phimosis." A foreskin that is so narrow it will retract very little or not at all, but is not the result of a pathological imflammationinflammation, is accurately termed [[''preputial stenosis]]'' (narrow prepuce), and will respond to treatment including [[steroid]] creams, manual [[stretching]], and changing [[masturbation]] habits.

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 | first=D. | coauthors= | title=The fate of the foreskin: a study of circumcision | journal=Br Med J | volume=2 | issue= | pages=1433-7 | url= | quote= | pubmedID= | pubmedCID= | DOI= | date=GairdnerDM 1949 | accessdate=}}</ref> His data have been incorporated into many textbooks and is still being repeated in the medical literature today. [[Douglas Gairdner|Gairdner ]] said that 80 percent of boys should have a retractable foreskin by the age of two years, and 90 percent of boys should have a retractable prepuce by the age of three years.<ref name="Gairdner"/>

Unfortunately, Gairdner’s [[Douglas Gairdner|Gairdner]]’s data are inaccurate,<ref name="WrightWright1994">{{REFjournal | last=Wright | firstinit=JE | coauthors= | title=Further to the "Further Fate of the Foreskin" | journal=Med J Aust | volume=160 | issue= | pages=134-135 | url=http://www.cirp.org/library/normal/wright2/ | quote= | pubmedID=8295581 | pubmedCID= | DOI= | date=1994-02-07 | accessdate=2019-10-17}}</ref><ref name="HillHill2003">{{REFjournal | last=Hill | firstinit=G. | coauthorsauthor-link=George Hill | title=Circumcision for phimosis and other medical indications in Western Australian boys | journal=Med J Aust | volume=178 | issue=11 | pages=587 | url= | quote= | pubmedID=12765511 | pubmedCID= | DOI= | date=2003-06-02 |accessdate=2019-10-17}}</ref> <ref name="denniston-hill2010">{{REFjournal |last=Denniston |first=George C. |init=GC |author-link= |last2=Hill |first2=George |init2=G |author2-link= |etal=no |title=Gairdner was wrong |journal=Can Fam Physician |date=2010-10-01 |volume=56 |issue=10 |pages=986-7 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954072/ |quote= |pubmedID=20944034 |pubmedCID=2954072 |DOI= | accessdate=2019-10-17}}</ref> so most healthcare providers have been taught inaccurate data.<ref name="HillHill2003"/> Retractability usually occurs much later than previously believed.<ref name="WrightWright1994"/> This page provides accurate data, derived from newer and better studies, for healthcare providers.

Almost all boys are born with the inner [[foreskin ]] mucosa fused with the underlying [[glans penis]] by the [[synechia]]. <ref name="agarwal2005" /> Most also have a narrow [[foreskin ]] that cannot retract. Non-retractile foreskin is normal at birth and remains common in the normal range until after puberty (age 18). <ref name="agarwal2005" /> The non-retractile [[foreskin]] is nature's way of protecting the young boy from [[meatal stenosis]] and [[infection]] in the [[preputial sac]].  Some boys develop retractile foreskin earlier, and about 2 percent of males have a non-retractile foreskin throughout life. Non-retractile foreskin is not a disease and does not require treatment.

* Fusion of the [[foreskin]] with the [[glans penis]]<ref name="deibart1933">{{REFjournal |last=Deibart |init=GA |title=The separation of the prepuce in the human penis |journal=Anat Rec |date=1933 |volume=57 |issue= |pages=387-99 |url=http://www.cirp.org/library/anatomy/deibert/ |quote= |pubmedID= |pubmedCID= |DOI=https://doi.org/10.1002/ar.1090570409 |accessdate=2019-10-07}}</ref> * [[Frenulum breve ]] (which is rare and cannot be diagnosed until the previous two reasons have been eliminated) .

The first two reasons are normal in childhood and are not pathological in children. <ref name="agarwal2005" /> The third can be treated conservatively, retaining the [[foreskin]].

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]].<refname="kayaba1996">{{REFjournal | last=Kayaba |init=H, |last2=Tamura |init2=H, |last3=Kitajima S, et al. | firstinit3=S | coauthorsetal=yes | title=Analysis of shape and retractability of the prepuce in 603 Japanese boys | journal=J Urol | volume=156 | issue=5 | pages=1813-1815 | url=http://www.cirp.org/library/normal/kayaba/ | quote= | pubmedID=8863623 | pubmedCID= | DOI= | date=1996-11-01 | accessdate=2019-10-19}}</ref> Imamura (1997) examined 4521 infants and young boys. He re-ported reported 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.<refname="imamura1997">{{REFjournal | last=Imamura | firstinit=E. | coauthors= | title=Phimosis of infants and young children in Japan | journal=Acta Paediatr Jpn | volume=39 | issue=3 | pages=403-405 | url= | quote= | pubmedID=9316279 | pubmedCID= | DOI= | date=1997 | accessdate=

| last=Ishikawa |init=E, Kawakita M. | firstlast2=Kawakita | coauthorsinit2=M | title=Preputial development in Japanese boys | journal=Hinyokika Kiyo | volume=50 | issue=5 | pages=305-308 | url= | quote= | pubmedID= | pubmedCID= | DOI= | date=2004 | accessdate=2019-11-08}}</ref> NonKo et al. (2007) examined 59 newborn Taiwanese boys. Not one had a retractable [[foreskin]].<ref name="ko2007">{{REFjournal |last=Ko |first=Ming-Chung |init=MC |author-link= |last2=Liu |first2=Chih-Kuang |init2=CK |author2-link= |last3=Lee |first3=Wen-Kai |init3=WK |author3-link= |last4=Jeng |first4=Huey-Sheng |init4=HS |author4-link= |last5=Chiang |first5=Han-Sun |init5=HS |author5-link= |last6=Li |first6=Chung-retractile foreskin is Yi |init6=CY |author6-link= |etal=no |title=Age-specific Prevalence Rates of Phimosis and Circumcision in Taiwanese Boys |trans-title= |language= |journal=Journal of the more common condition in this age groupFormosan Medical Association |location= |date=2007-04 |volume=106 |issue=4 |pages=302-7 |url=https://www.sciencedirect. Compare Gairdner’s datacom/science/article/pii/S0929664609602564?via%3Dihub |quote= |pubmedID=17475607 |pubmedCID= |DOI=10.1016/S0929-6646(09)60256-4 |accessdate=2019-11-08}}</ref>

Non-retractile [[File:Kayaba.jpg|left|frame|Percentage of boys with tight ring totally non-retractile foreskin according to Kayaba et al.]]is the normal, expected, and more usual condition in this age group.<br clearref name="allagarwal2005"/>Harmless [[ballooning of the foreskin]] may occur in this age group.

[[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="ØsterØster1968">{{REFjournal | last=Øster | first=J. | coauthors= | title=Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys | journal=Arch Dis Child | volume=43 | issue= | pages=200-3 | url= | quote= | pubmedID= | pubmedCID= | DOI= | date=OesterJ 1968 | accessdate=}}</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="ØsterØster1968"/> 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 11-15.5 <ref name="kayaba1996" /> Imamura (1997) reported that 77 percent of boys aged 11-15 had retractile foreskin.6 <ref name="imamura1997" /> Thorvaldsen & Meyhoff (2005) conducted a survey of 4000 young men in [[Denmark]].9 They report reported that the mean age of first foreskin retraction is 10.4 years in [[Denmark]].<ref name="Thorvaldsen">{{REFjournal | last=Thorvaldsen | firstinit=MA | coauthorslast2=Meyhoff |init2=H | title=Patologisk eller fysiologisk fimose? |trans-title=Pathological or physiological phimosis? |language=Danish | journal=Ugeskr Læger | volume=167 | issue=17 | pages=1858-1862 | url=http://www.cirp.org/library/normal/thorvaldsen1/ | quote= | pubmedID= | pubmedCID= | DOI= | date=2005 | accessdate=2019-10-17

Boys usually are born with a non-retractile foreskin. <ref name="agarwal2005" /> The [[foreskin ]] gradually becomes retractable over a variable period of time ranging from birth to 18 years or more.<ref name="ØsterØster1968"/><ref name="Thorvaldsen"/> There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health in childhood and so 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 |init=K, |last2=Semmens |init2=JB, |last3=Wisniewski ZS. et al. | firstinit3=ZS | coauthorsetal=yes | title=Circumcision for phimosis and other medical indications in Western Australian boys | journal=Med J Aust | volume=178 | issue=4 | pages=155-158 | url= | quote= | pubmedID=12580740 | pubmedCID= | DOI= | date=2003-02-17 | accessdate=2019-10-17}}</ref>

Care-givers and healthcare providers must be careful to avoid [[forced retraction|premature retraction]] of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause [[infection]], is likely to generate medico-legal problemsissues, and may cause [[paraphimosis]], with the tight foreskin acting like a tourniquet. The first person to retract the boy’s [[foreskin ]] should be the boy himself.<ref name="WrightWright1994"/> <ref name="agarwal2005" /> <ref>{{REFweb

* Manual [[stretching]]<ref>{{REFjournal | last=Dunn | firstinit=HP | coauthors= | title=Non-surgical management of phimosis | journal=Aust N Z J Surg | volume=59 | issue=12 | pages=963 | url=http://www.cirp.org/library/treatment/phimosis/dunn1/ | quote= | pubmedID=2597103 | pubmedCID= | DOI=10.1111/j.1445-2197.1989.tb07640.x | date=1989 | accessdate=

| last=Beaugé | firstinit=M. | coauthors= | title=The causes of adolescent phimosis | journal=Br J Sex Med | volume= | issue=Sept/Oct | pages=26 | url=http://www.cirp.org/library/treatment/phimosis/beauge2/ | quote= | pubmedID= | pubmedCID= | DOI= | date=1997 | accessdate=2019-10-18

* Application of topical steroid ointmentto assist the stretching.<ref>{{REFjournal | last=Orsola |init=A, |last2=Caffaratti |init2=J, Garat JM | firstlast3=Garat | coauthorsinit3=JM | title=Conservative treatment of phimosis in children using a topical steroid | journal=Urology | volume=56 | issue=2 | pages=307-310 | url=http://www.cirp.org/library/treatment/phimosis/orsola1/ | quote= | pubmedID=10925099 | pubmedCID= | DOI=10.1016/s0090-4295(00)00576-8 | date=2000 | accessdate=2019-10-18

| last=Ashfield |init=JE, |last2=Nickel |init2=KR, |last3=Siemens DR, et al. | firstinit3=DR | coauthorsetal=yes | title=Treatment of phimosis with topical steroids in 194 children | journal=J Urol | volume=169 | issue=3 | pages=1106-1108 | url=http://www.cirp.org/library/treatment/phimosis/ashfield1/ | quote= | pubmedID=12576863 | pubmedCID= | DOI=10.1097/01.ju.0000048973.26072.eb | date=2003-03 | accessdate=2019-10-18

See [[Phimosis]] for more information. ===Fixing a fused foreskin=== In a few cases, the [[Synechia| synechial]] fusion of childhood lingers past puberty. After puberty, the synechial fusion should be about ready to spontaneously release the [[foreskin]] from the [[glans penis]]. One may try gently peeling the [[foreskin]] away from the glans penis by using one's thumbs. It may take one several tries to get it all separated. Do ''not'' force anything and do ''not'' cause cause yourself pain. Apply petroleum jelly after separation occurs for about two weeks to prevent re-adhesion.  If one is unsuccessful, then one may need to consult a urologist. ===Issues with circumcision as treatment=== [[Adolescent and adult circumcision| Male circumcision ]] is outmoded as a treatment for non-retractile foreskin, but it is still recommended by many [[Issues with American urologists and the practice of male circumcision| urologists ]] because of lack of adequate information, and perhaps because of the fees [[Financial Incentive|profit to the doctor]] associated with circumcision. Nevertheless, [[Adolescent and adult circumcision| circumcision ]] should be avoided whenever possible because of [[pain]], [[trauma]], cost,<ref name="Van Howe">{{REFjournal | last=Van Howe | firstinit=RS | coauthorsauthor-link=Robert S. Van Howe | title=Cost-effective treatment of phimosis | journal=Pediatrics | volume=102 | issue=4 | pages=e43 | url=https://pediatrics.aappublications.org/content/102/4/e43.full | quote= | pubmedID= 9755280 | pubmedCID= | DOI= | date=1998-10 | accessdate=2019-10-17

| last=Berdeu |init=D., |last2=Sauze |init2=L., |last3=Ha-Vinh |init3=P. Blum-Boisgard C. | firstlast4=Blum-Boisgard | coauthorsinit4=C | title=Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. | journal=BJU Int | volume=87 | issue=3 | pages=239-244 | url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1464-410x.2001.02033.x?sid=nlm%3Apubmed | quote= | pubmedID=11167650 | pubmedCID= | DOI=10.1046/j.1464-410x.2001.02033.x | date=2001-02-01 | accessdate=2019-10-17}}</ref>[[Complication| complications]],<ref name="Van Howe"/> difficult recovery, [[Circumcision scar| permanent injury to the appearance of the penis]], extreme loss of [[Foreskin sensitivity| pleasurable erogenous sensation]],<ref>{{REFjournal | last=Williams |init=N, Kapila L | firstlast2=Kapila | coauthorsinit2=L | title=Complications of circumcision | journal=Brit J Surg | volume=80 | issue= | pages=1231-1236 | url=http://www.cirp.org/library/complications/williams-kapila/ | quote= | pubmedID=8242285 | pubmedCID= | DOI=10.1002/bjs.1800801005 | date=1993 | accessdate=2019-10-17}}</ref> and impairment of erectile and ejaculatory functions.,<ref>{{REFjournal | last=Shen |init=Z, |last2=Chen |init2=S, |last3=Zhu C, et al. | firstinit3=C | coauthorsetal=yes | title=Erectile function evaluation after adult circumcision | journal=Zhonghua Nan Ke Xue | volume=10 | issue=1 | pages=18-19 | url= | quote= | pubmedID=14979200 | pubmedCID= | DOI= | date=2004-01-01 | accessdate=2019-10-17

| last=Masood |init=S, |last2=Patel |init2=HRH, |last3=Himpson RC, et al. | firstinit3=RC | coauthorsetal=yes | title=Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly? | journal=Urol Int | volume=75 | issue=1 | pages=62-65 | url=http://www.cirp.org/library/sex_function/masood1/ | quote= | pubmedID=16037710 | pubmedCID= | DOI=10.1159/000085930 | date=2005 | accessdate=2019-10-17}}</ref>and adverse [[Sexual effects of circumcision| sexual]] and [[Psychological issues of male circumcision| psychological]] effects. According to Agarwal et al. (2005):<blockquote>Although circumcision is considered to be a simple procedure devoid of much morbidity, it is associated with many complications like hemorrhage, edema, infection, meatal stenosis, urethral fistulae, unsightly scars, penile curvature, shortness of shaft skin, and partial, or total penile loss. … In view of the various studies including the present one and the versatile use of preputial skin as a graft, it is suggested that circumcision should be avoided as far as possible especially for nonseparation of prepuce in early childhood.<ref name="agarwal2005" /></blockquote> ==Adult foreskin=====Should the foreskin retract automatically when the penis becomes erect?===The answer to this question depends on the relative length of the [[foreskin]] in relation to the length of the [[penis]]. If the foreskin is shorter than the erect penis, then it will retract automatically on [[erection]]. On the other hand, if the foreskin is longer than the erect penis, then automatic retraction will not occur. This condition is not viewed as a problem. A very few of the longest foreskins will not stay retracted when manually retracted. Instead, they will spontaneously [[gliding action| glide]] forward when released. This harmless condition is believed to be very rare.

* [[Forced retractionPenis]]