Care of intact, foreskinned boys

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Care of intact, foreskinned boys provides parents with basic information on the care of intact boys.

Newborn intact boys are easier to care for than circumcised boys because intact boys do not have an open surgical wound.[1]

The foreskin has the duty of protecting the glans penis and meatus, so boys are born with a foreskin that does not retract.[2] There are two reasons that the foreskin of infant boys does not retract:

  • The tip of the foreskin is too narrow to pass over the glans penis.
  • The inner layer of foreskin is fused with the underlying glans penis by a synechia.

These developmental conditions are normal and expected in infancy and childhood.

Forced foreskin retraction is harmful and must be avoided.

Introduction

After many decades of excision of the foreskin at birth, American and Canadian healthcare providers lost the knowledge of how to care for the normal, intact, foreskinned boy's penis.[3] Therefore, it has been necessary to establish an educational program for both parents and physicians on the normal care of the intact penis.[3]

Parents of intact boys in the United States have an additional responsibility of protecting their intact, foreskinned son from harmful, painful premature forcible foreskin retraction (PFFR) by ignorant doctors and nurses.[4]

Discussion

The intact foreskin has protective and immunological functions that work best when the foreskin is left alone. Only the outside of the foreskin should be washed as one washes a finger.

The preputial mucosa of the foreskin is fused with the glans penis by the synechia in infancy and childhood so the foreskin cannot be retracted. No attempt to retract the foreskin should be made. Forcible retraction is harmful. Wright (1994) advises that the first person to retract the boy’s foreskin should be the boy himself.[5]

Thorvaldsen & Meyhoff (2005) conducted a survey of 4,000 boys in Denmark where most boys are intact. They reported that the mean age of first foreskin retraction is 10.4 years in Denmark.[6] Øster (1968) reported that some boys will not develop retractable foreskin until after puberty.[7]

Behavior of young intact boys

Parents observe that many young, intact boys will pull and tug on their foreskin. Some parents express concern that the boy may be hurting himself, however that is not the case. The boy would not do that if it caused him pain.[8] The foreskin has many Meissner's corpuscles,[9] which are specialized nerves that sense motion and stretching as pleasurable. Such behavior is normal and parents need not be concerned.

Intact, foreskinned boys should give their (usually non-retractile) foreskin a gentle tug away from their body to get the wrinkles out prior to urination, so that the urine flows out in a smooth stream.

Spontaneous disintegration of the synechia

The inner foreskin is fused from birth with the glans penis by a synechia. The synechia spontaneously disintegrates to release the foreskin.[10] The disintegration usually occurs in childhood but will persist into adolescence in a few cases.

When a young boy urinates, the foreskin may balloon slightly and the pressure will tend to lift the foreskin away from the glans penis.

Some intact boys will report pain when they urinate during the period in which separation is occurring. The condition is temporary and will end when separation is complete.[11] It does not require a visit to a doctor or any kind of care.

Mayo Clinic information should be rejected

Mayo Clinic provides information on the care of foreskinned boys. This advice is not recommended. The language indicates Midwestern prejudice against intact boys, a lack of understanding of the immmunological and protective functions, and lack of current information on development of foreskin retraction.

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See also

External links

References

  1. ↑ REFweb (2 August 2021). How to Care for Your Baby's Penis, American Academy of Pediatrics. Retrieved 18 August 2024.
  2. ↑ REFjournal Agarwal A, Mohta A, Anand RK. Preputial retraction in children. J Indian Assoc Pediatr Surg. April 2005; 10(2): 89-91. DOI. Retrieved 26 June 2024.
  3. ↑ a b REFjournal Bollinger D. The Penis-Care Information Gap: Preventing Improper Care of Intact Boys PDF. Thymos The Journal of Boyhood Studies. 2007 (fall); 1(2): 205-19. Retrieved 15 July 2023.
  4. ↑ REFweb Anonymous (1916). Wrongful Foreskin Retraction, Doctors Opposing Circumcision. Retrieved 27 June 2024.
  5. ↑ REFjournal Wright JE. Further to the "Further Fate of the Foreskin". Med J Aust. 7 February 1994; 160: 134-135. PMID. Retrieved 17 October 2019.
  6. ↑ REFjournal Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? [Pathological or physiological phimosis?] (Danish). Ugeskr Læger. 2005; 167(17): 1858-1862. Retrieved 14 November 2019.
  7. ↑ REFjournal Øster J. Further Fate of the Foreskin: Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys PDF. Arch Dis Child. 1968; 43(228): 200-3. PMID. PMC. DOI. Retrieved 18 June 2024.
  8. ↑ REFweb (4 June 2020). How To Care For Your Child's Foreskin, KidsHealth of New Zealand. Retrieved 25 January 2023.
  9. ↑ REFjournal Winkelmann RK. The cutaneous innervation of human newborn prepuce PDF. J Invest Dermatol. January 1956; 26(1): 53-67. PMID. DOI. Retrieved 12 July 2023.
  10. ↑ REFjournal Deibart GA. The separation of the prepuce in the human penis. Anat Rec. November 1933; 57: 387-99. DOI. Retrieved 16 August 2023.
  11. ↑ REFweb (February 2018). Foreskin separation, The Royal Children's Hospital Melbourne. Retrieved 15 August 2023.
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