[ ARC forum 2 ]

Help now, help in future

Written by Paul B. at 25 May 2003 00:20:06:

As an answer to: please help written by jacey at 24 May 2003 22:24:12:

> my ten year old son is in alot of pain, espeacialy when urinating,

The first important question here, is where is the pain? Is it in fact in the penis head, and is this tender to touch as well, or is it felt inside his body and the whole of the urethra (runs underneath the penis) is in fact tender? The significance of the latter possibility, is that it would define a urinary infection, rather than an infection of the foreskin and penis head, and require antibiotics by mouth.

If in fact it is the penis head (and the foreskin over it) only that is sore and tender to touch, then yes, it may indeed be a fungal infection - as girls get quite frequently. An important question regarding that - does his foreskin "balloon" when he pees (and if so, has this only happened recently)?

Also particularly important - exactly what parts, if any, appear to be red (or more red than they should be)?

> i took him to the doctors yesterday and his forskin doesnt retract, the hole that he pee's out of is so small i cant even see it.

If you are his mother, you probably can't see your own either, but it still works, so that doesn't mean it isn't adequate for the job.

> the doctor said he probally had a fungal infection and gave us a prescription for a anti fungal topical ointment,

May indeed be correct.

> also did a urinalysis which was negative.

It is important to perform a mid-stream urine collection using sterile procedure and sent to a laboratory for culture before it can be concluded he does not have a urine infection.

> the doctor is referring us to a urologist but my son wont be seen for over a week.

The urologist is not really an important part of the treatment and is highly likely to recommend circumcision, which would be inappropriate if you are at all concerned about your son's future sexual function. Speaking of which, it is not at all unlikely, that this trauma is the unfortunate and accidental result of some form of exploration of masturbation - not that he's very likely to admit to that (and nor should he be criticised for it in any way)!

In fact, there may be no infection at all, he may simply have separated the "synechiae" which attach the foreskin to the penis head at birth, and left a raw area underneath which is painful until it heals over again. This would be evident if his foreskin "balloons" now when he pees, where it did not before (or not to the same extent). In which case, if it now balloons fully and evenly, the discomfort will not happen again.

> I have been appling the ointment but it hasnt relieved the burning sensation at all, i dont see how it would since the foreskin completly covers the head of his penis, and the ointment cant reach inside.

You're right of course. There's a little trick here which requires the use of a small (3 ml) plastic syringe - but naturally, no needle! You get your son to "pinch" the foreskin tip on each side with thumb and forefinger of opposite hands, and pull it forward. Doing this creates a little "tunnel" into which you insert the nice smooth plastic ("Luer") tip of the syringe, loaded with a half ml only of the cream, then you "inject" it inside, slip the syringe out, and have him "massage" it around underneath the foreskin.

Be warned that the antifungal cream may itself be somewhat irritating - in which case you might prefer to use plain Zinc and Castor Oil cream instead, which is soothing but waterproofing and will still promote rapid healing. The anti-fungal cream is best used after peeing, but the Zinc and Castor Oil can be used before, to make it more comfortable (I do not recommend using both simultaneously by this method), and as often as desired. And of course, if it is only the separation of the foreskin that has caused this discomfort in the first place, the Zinc and Castor Oil is the correct management anyway.

This presumes that the foreskin does in fact "balloon" when he pees - if it fails to do so, then you do the same, but use much less cream.

> every time he has to urinate he jumps up and down paces back in forth, cries, untill he cant hold it anymore, he just is so scared of the burning pain,

And at the age of ten, that is perfectly natural, the discomfort is mostly from the need to pee. Give him a urinary alkaliniser - sold as effervescent "fruit saline" in both pharmacies and supermarkets, one serve (one teaspoon; one glass of water) three or even four times a day.

> IT WILL BE OVER A WEEK BEFORE WE GET IN TO SEE THE UROLOGIST

If you can resist his lure to respond to this single episode by cutting your son's whole foreskin off (a rather absurd approach, which would never be considered for any other part of the body, or if he were a girl instead - that is actually illegal), and which would itself be at least as painful as the current episode, then you can obtain the further suggestions for teaching your son - over a period of time - to stretch this foreskin to a proper and functional size.

You might also need to master the techniques I have detailed in case the irritation recurred in the meantime - some effort is involved, but the result is very much worthwhile.


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