What normally happens to the foreskin?
At birth the foreskin is normally attached to the head of the
penis (glans) by a layer of cells. The glans at birth is delicate
and easily irritated by urine and feces. The foreskin protects the
glans. Over the next 5 or 10 years the foreskin will naturally
separate from the head of the penis without any help. It gradually
loosens up (retracts) a little at a time. Normal erections during
childhood probably cause most of the change by stretching the
foreskin.
What problems can occur?
The foreskin generally causes no problems. However, forcing the
foreskin back before it has fully loosened can cause it to get
stuck behind the head of the penis, causing severe pain and
swelling. If retraction causes bleeding, scar tissue may form and
interfere with natural retraction. Occasionally, the space under
the foreskin becomes infected. Most of these problems can be
prevented.
How can I take care of my child?
In general, the foreskin requires minimal care. The following
suggestions will help maintain good hygiene.
During the first year of life, clean only the outside of the
foreskin. Don't try to retract the foreskin. Don't put any cotton
swabs in the opening.
Gentle, partial retraction can begin when your son is 1 or 2 years
old. It can be done once a week during bathing. Gently pull the
skin on the shaft of the penis downward toward the abdomen. This
will make the foreskin open up, revealing the end of the glans.
During retraction, clean the exposed part of the glans with water.
Wipe away any whitish material (smegma) that you find there.
Smegma is just dead skin cells that are normally shed from the
glans and lining of the foreskin throughout life. Do not use soap
or leave soapy water under the foreskin because this can cause
irritation and swelling. After cleansing, always pull the foreskin
forward to its normal position. (Note: A collection of smegma that
is seen or felt through the foreskin, but which lies beyond the
point to which the foreskin is retractable, should be left alone
until normal separation exposes it.)
Avoid vigorous retraction because this can cause pain, bleeding,
or the foreskin to become stuck behind the head of the penis (this
is called paraphimosis). Retraction is excessive if it causes any
discomfort or crying.
By the time your son is 5 or 6 years old, teach him to retract his
own foreskin and clean beneath it once a week during baths to
prevent poor hygiene and infection. Gentle reminders are necessary
in the early years.
In general, foreskin retraction is overdone. Any degree of
foreskin movement is normal as long as your boy has a normal urine
stream. There should be no rush to achieve full retraction. Full
retraction always occurs naturally by puberty. As the foreskin
becomes retractable on its own, your son should cleanse beneath it
to prevent infections.
When should I call my child's healthcare provider?
Call IMMEDIATELY if:
- The foreskin is pulled back and stuck behind the head of the
penis.
- Your child can't pass any urine.
- Your child starts acting very sick.
Call within 24 hours if:
- The foreskin looks infected (yellow pus, spreading redness or
streaks).
- You have other concerns or questions.
Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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