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Development of retractable foreskin

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{{GraphicWarning}}
[[Image:Side by side retraction.png|right|thumb|A human [[penis ]] before and after retraction of the [[foreskin]].]]
Infant boys are born with a non-retractable [[foreskin]]. The '''development of retractable foreskin''' occurs gradually over a widely-variable number of years.
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. The [[preputial cavity sac]] is sealed by the [[synechia]].<ref name="fleiss-hodges-vanhowe1998">{{TaylorJR LockwoodAP TaylorAJ 1996}}</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
|init=ET
== 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]].
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.
== Infants and pre-school ==
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
|init=H
|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.<ref name="imamura1997">{{REFjournal
|last=Imamura
|init=E
}}</ref>
Non-retractile [[foreskin ]] is the normal, expected, and more usual condition in this age group.<ref name="agawal2005">{{REFjournal
|last=Agawal
|first=Abhnav
|DOI=10.4103/0971-9261.16468
|accessdate=2019-12-09
}}</ref> [[Ballooning of the foreskin]] may occur in this age group.
== School-age and adolescence ==
[[File:Kayaba.jpg|left|frame|Percentage of boys with tight ring totally non-retractile foreskin according to Kayaba et al.]]<br clear="all">
[[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">{{OesterJ 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]]. They reported that the mean age of first foreskin retraction is 10.4 years in [[Denmark]].<ref name="Thorvaldsen">{{REFjournal
|last=Thorvaldsen
|init=MA
== 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 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="Wright1994"/> <ref>{{REFweb
|url=https://www.doctorsopposingforcibleretraction.org/
|title=Doctors Opposing Forcible Retraction
===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 [[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
|init=RS
|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
}}</ref> and adverse [[Sexual effects of circumcision| sexual]] and [[Psychological issues of male circumcision| psychological]] effects.
==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 condition is believed to be very rare.
 
<i>See [[Foreskin#Foreskin_length| Foreskin length]].</i>
{{SEEALSO}}
* [[Gliding actionAttachment of the foreskin]]* [[Ballooning of the foreskin]]
* [[Forced retraction]]
* [[Foreskin Care for Boys]]
* [[Foreskin sensitivity]]
* [[Gliding action]]
* [[Penis]]
* [[Phimosis]]
* [[Preputioplasty]]
* [[Stretching]]
* [[Synechia]]
* [[Risks and complications]]
|date=2008-11-14
|accessdate=2019-11-08
|format=
|quote=
}}
* {{REFweb
|url=http://www.intactaus.org/information/functionsoftheforeskin/
|title=Functions of the Foreskin
|last=Helard
|first=Lou
|author-link=
|publisher=Intact Australia
|website=
|date=2014-08-01
|accessdate=2020-05-29
|format=
|quote=
|date=2016-07
|accessdate=2019-11-08
}}
* {{REFweb
|url=https://www.tightforeskin.org/my-son.html
|title=Does my son have phimosis?
|trans-title=
|language=
|last=
|first=
|author-link=
|publisher=
|website=www.tightforeskin.org
|date=
|accessdate=2019-11-23
|format=
|quote=
}}
* {{REFweb
{{REF}}
 
[[Category:Education]]
[[Category:Physiology]]
[[Category:Parental information]]
 
[[Category:From Intactipedia]]
[[Category:From IntactWiki]]
[[de:Zurückziehen der Vorhaut]]
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