Development of retractable foreskin: Difference between revisions
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|date=1998-05 | |date=1998-05 | ||
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}}</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> 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]]. Non-retractability may be deemed 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 inflammation, is accurately termed ''preputial stenosis'' (narrow prepuce), and will respond to treatment including steroid creams, manual [[stretching]], and changing [[masturbation]] habits. | 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 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 inflammation, is accurately termed ''preputial stenosis'' (narrow prepuce), and will respond to treatment including steroid creams, manual [[stretching]], and changing [[masturbation]] habits. | ||
== History == | == History == | ||
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== Current view == | == Current view == | ||
Almost all boys are born with the inner [[foreskin]] mucosa fused with the underlying [[glans penis]] by the [[synechia]]. Most also have a narrow [[foreskin]] that cannot retract. Non-retractile foreskin is normal at birth and remains in the normal range until after puberty (age 18). The non-retractile [[foreskin]] is nature's way of protecting the young boy from [[meatal stenosis]] and [[infection]] in the [[preputial sac]]. | 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 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. | 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. | ||
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* [[Frenulum breve]] (which is rare and cannot be diagnosed until the previous two reasons have been eliminated). | * [[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. The third can be treated conservatively, retaining the [[foreskin]]. | 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]]. | ||
== Infants and pre-school == | == Infants and pre-school == | ||
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}}</ref> | }}</ref> | ||
Non-retractile [[foreskin]] is the normal, expected, and more usual condition in this age group.<ref name="agawal2005" | Non-retractile [[foreskin]] is the normal, expected, and more usual condition in this age group.<ref name="agawal2005" /> [[Ballooning of the foreskin]] may occur in this age group. | ||
== School-age and adolescence == | == School-age and adolescence == | ||
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== Discussion == | == Discussion == | ||
Boys | Boys 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="Øster1968"/><ref name="Thorvaldsen"/> There is no “right” age for the foreskin to become retractable. Non-retractile foreskin does not threaten health 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 | |last=Spilsbury | ||
|init=K | |init=K | ||
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== Avoidance of premature retraction == | == Avoidance of premature retraction == | ||
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 issues, 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="Wright1994"/> <ref>{{REFweb | 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 issues, 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="Wright1994"/> <ref name="agarwal2005" /> <ref>{{REFweb | ||
|url=https://www.doctorsopposingforcibleretraction.org/ | |url=https://www.doctorsopposingforcibleretraction.org/ | ||
|title=Doctors Opposing Forcible Retraction | |title=Doctors Opposing Forcible Retraction | ||
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===Fixing a fused foreskin=== | ===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. | 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. | Apply petroleum jelly after separation occurs for about two weeks to prevent re-adhesion. | ||
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}}</ref> and adverse [[Sexual effects of circumcision| sexual]] and [[Psychological issues of male circumcision| psychological]] effects. | }}</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.<ref name="agarwal2005" /> | |||
</blockquote> | |||
==Adult foreskin== | ==Adult foreskin== | ||
===Should the foreskin retract automatically when the penis becomes erect?=== | ===Should the foreskin retract automatically when the penis becomes erect?=== | ||