Penis Care – Is circumcision necessary?
Many parents who have chosen not to circumcise their son worry if they have made the right decision and are often confused on how to take care of the penis, especially as a toddler or an infant. Their worry reflects a common North American belief that circumcision is a better option because it is more hygienic and easier to maintain a circumcised penis. This is rubbish.
There is NO MEDICAL INDICATION for routine male circumcision (1). This is not a personal bias, but based on the lack of any solid medical evidence in favour or against of what in most parts of the world is a ritual act associated with religious and cultural beliefs. It is because of this lack of evidence that most Canadian provinces (and most countries with public health systems) do not include routine circumcision on their list of paid procedures. Physicians who circumcise a boy do it to satisfy the religious and cultural beliefs of the parents and families.
What is the foreskin and phimosis?
The foreskin, the part of the penis that is removed during a circumcision, tightly adheres to and covers the glans or the head of the penis in all newborns (2,3). It is supposed to.
The inability to retract the foreskin over the glans is called phimosis. Almost all males have primary or physiologic phimosis. Over years, the adhesions slowly breakdown and the foreskin is easily retracted from the head of the penis(3). By age 5 years but almost always before puberty, boys can fully retract their foreskins. If a young man’s foreskin is still adhered to the head after age 10 yrs, he should be seen. Very rarely, if ever, does the foreskin become so tight that it causes an issue for urination. This does not stop children with physiologic phimosis being one of the most common, and often unnecessary referrals to a pediatric urologist(3).
Caring for your Child’s Penis
Caring for an uncircumcised penis is no different than caring for a circumcised penis or for that matter maintaining basic hygiene(2,4,5). That is, it is generally healthier to keep our body parts clean within reason. So, washing the penis when giving a bath is a good thing. Gentle retraction on the foreskin during urination and bathing are indicated. Indeed, boys as young as 3 yrs should be taught to pullback on the foreskin to urinate (1). Please remember it is your son’s penis, he should be taught how to take care of it early.
Please remember that foreskin like all skin should be cared for judiciously. Over washing is likely not to benefit and will just dry out the skin. Drying the penis after a urinating is also a good thing because urine can irritate. The most common cause of ‘an infected penis’ is just unhappy skin that has been constantly left wet with urine. We teach girls to dry themselves after urinating. The same should be taught to boys.
Parents will often come in concerned about ‘pus’ or white stuff extruding from the base of the penis or from pockets between the foreskin and the head of the penis. This is almost never pus, but is smegma – a combination of dead skin cells, oils and other skin debris that collect in male and female genitalia.
Take home message
In summary, neither the uncircumcised nor the circumcised penis requires special care. Infections of the penile skin or a penis in a non-sexually active male are very rare. Red irritated foreskins are best managed with simple hygiene. My number one recommendation for a child with an irritated angry penis is simple soaks in salt water.
With normal washing, using soap and water, and gentle retraction during urination and bathing, most foreskins will become retractile over time. Do not exaggerate the cleaning, but remember to keep the area dry especially after the child urinates, and the child will enjoy good penile health.
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