[ ARC forum 2 ]
Written by Paul B. at 08 Apr 2001 00:37:28: Re: Foreskin problem in child
As an answer to: Foreskin problem in child written by Worried Mum at 06 Apr 2001 16:27:17:
> I have just discovered that my 9 year old sons foreskin cannot be
> pulled back yet. I have read a lot on this and other sites about
> circumcision, dorsal slit etc.The first thing that most of us would point out, is that this is an
inappropriate association of concepts. Inability to retract a person's
foreskin should no more directly suggest surgery than the tendency to
build up wax blockage in the ears. The object should be to have the
foreskin pull back, circumcision fails to achieve this so must be the
last consideration of all.> I took him to the doc and she has given me antibiotics in case there
> is infection.This puzzles me not a little. Firstly, I would have assumed from your
term "just discovered" that the inability to retract his foreskin has
been present for some time, so in the absence of other recent signs of
infection (redness, soreness, discharge), there is no connection with
bacterial infection.Secondly, most acute (recent) "infections" under the foreskin closely
resemble those in the corresponding part of girls, that is the vulva
and vagina, and as in those parts are somewhat more likely to be due
to yeast, notably Candida Albicans, than bacteria and this is often
actually provoked by antibiotic use. Should irritation under the
foreskin or in the vulva occur, an anti-fungal such as Clotrimazole
(Canesten) makes far more sense in the first instance.If indeed the suggestion was that a chronic (long-term) infection
might be responsible for the problem, then it becomes absolutely
certain that this would be candidal rather than bacterial.> He has to go back on Monday.
He does have a recent infection then?
> The doc managed to pull it back, with a little force.. (which I am
> not pleased about as I read that shouldn't be done)You need to be careful what you read. Even of myself. (;-) You need
to determine how much sense it makes. In this case, you need to assess
not according to a rigid dictum, but whether the amount of force used
was such as would tear the skin. A little discomfort does not
necessarily indicate harm, but substantial discomfort or bleeding and
pain afterward is undesirable and might indicate harm rather than
benefit.If you have been doing your reading, you will know that there are two
aspects to the problem of non-retractile foreskins - the tightness
of the opening, and whether the foreskin is adherent to the penile
glans. But there is a very elegant way to determine the latter, using
a modestly full bladder and a mess-tolerant area - the shower. He just
starts peeing with the foreskin beyond the glans held closed. If it
inflates to a nice spherical balloon, there are no adhesions, but if
it is obviously "pinched" to the glans on any aspect, it is adherent.Adhesions, if the only limitation to foreskin retraction will most
probably need to be deliberately separated (though progressive
retraction as per the following description is perfectly appropriate
to try) which will be uncomfortable and messy, but a single such
procedure would generally suffice.> ...but anyway, it only went back enough to just see the tip of his
> glans underneath.This means different things depending on where the narrow section
came to at the time. If some loose skin escaped through and beyond the
narrow part when this latter failed to ride over the corona (back of
the glans), this is much closer to retractility than if the narrow
part was at the very tip of the foreskin when pulled back.> I have read that some boys foreskins may not go back until they are
> older, maybe 14-18 sometimes, so what do you guys think.....should I
> leave it longer , a few years maybe, and see if maybe he is just
> developing a little late??This is the hornet's nest of opinion. It is very reassuring to hear
such as the previous poster (below) indicating that there is no need
to panic and, failing to achieve instant success, rush off to surgery.
There is a long time to go before considering that.My feeling is that if the youngster can be enlisted in the project
understanding the aim of full retraction, and that it entails the reward of
a correctly functioning foreskin and that such manipulations are both
permissible and desirable, it can only be beneficial for him to
retract it as far as possible, preferably as far as the doctor did
but in any case to the furthest limit he himself chooses to set, and
on every occasion when this is reasonably possible and particularly
when he has an erection (morning, going to pee, ...)While there is no urgent hurry, developing this as a matter of habit
is most likely to steadily improve the situation over a couple of
months. Failing that, the next additional (sic) step is the use of a
Betamethasone (or Triamcinolone - just as good) ointment applied to the
tight part only during such a stretching manoeuvre, twice a day or so.