How to Care for the Foreskin of the Baby.

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How to Care for the Foreskin of the Baby.

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The foreskin is the sheath of skin that covers the head (glans) of the penis.

At birth, the foreskin is fully attached to the penis.

In time, the foreskin separates and can be retracted (pulled back).

This can usually be done by the age of about two. Sometimes, the foreskin separates later.

Occasionally, the foreskin doesn’t separate evenly and areas remain stuck to the glans.

These attachments almost always resolve by puberty.

Circumcision is a surgical procedure to remove the foreskin.

In Australia today, less than 10 per cent of boys are circumcised.

The procedure is mostly performed on babies for family, religious or cultural reasons.

Circumcision is sometimes recommended for older boys and men who have ongoing foreskin problems, such as infection, that don’t respond to other forms of treatment.

General foreskin care – babies and young boys

Foreskin care is important and young boys should be taught how to care for their penis.

Suggestions include:
Treat a baby’s penis like any other body part when you give him a bath.

Don’t worry about cleaning under the foreskin.

Simply wash the penis with soap and rinse.

Do not forcibly pull back a baby’s foreskin.

Doing so may cause pain, bleeding, infection or scarring.

Change your son’s wet or dirty nappies as soon as possible to reduce the risk of infection.

Retract the foreskin for cleaning once it has separated.

Wash with soap and rinse well.

Roll the foreskin back over the glans afterwards.

Teach your son how to clean underneath his foreskin.

Common foreskin problems

Conditions that may affect the foreskin include:

Inflammation – sore and red foreskin.

Common causes include forced retraction, irritants such as bubble baths or dirty nappies.

Infection – the most common include posthitis and balanitis.

Posthitis is infection of the foreskin, usually caused by fungus thriving in the hot and moist conditions.

Balanitis is infection of the foreskin and glans, and is usually caused by poor hygiene.

Smegma encourages the growth of infection-causing germs.

Chronic infections – for some males, posthitis or balanitis tends to recur.

A complication of chronic infections is scar tissue, which could stick the foreskin to the glans and make retraction impossible.

Chronic infections of the penis and foreskin also increase the risk of urinary tract infections.

Repeated kidney infections can affect kidney function.

Phimosis – the foreskin is abnormally tight, which prevents it from retracting.

This can cause recurrent balanitis because good hygiene is difficult or impossible.

An erection may cause the foreskin to split and bleed.

The tight foreskin can also hinder urination – in some cases, the foreskin fills up with urine like a little balloon.

Phimosis is the most common reason for circumcision after infancy.
Paraphimosis – permanently retracted foreskin.

The foreskin gathers like a tight rubber band around the penis, causing swelling and pain.

This condition is the second most common reason for adult circumcision.

Tumour – rarely, abnormal growths develop on the foreskin.

In some cases, the tumour is cancerous.

Penile cancer is extremely rare in circumcised men.

Zipper trauma – the foreskin (or other parts of the genitals, commonly the scrotum) gets caught in a zipper.

Wearing underpants is the best prevention.

Treatment of foreskin problems

Treatment depends on the condition but may include:

Inflammation – avoid irritants such as bubble bath lotion or harsh soaps.

Wash gently under the foreskin.

Nappy rash cream or hydrocortisone ointment may be recommended.

Infection – the doctor may prescribe antifungal or anti-inflammatory creams, oral antibiotics and pain-killing drugs.

Try soaking in a warm bath to relieve painful or difficult urination (dysuria).

In severe cases, intravenous antibiotics are needed.

Chronic infections – the doctor may recommend circumcision as a permanent solution.

Phimosis – the doctor may suggest that you attempt to stretch your foreskin by retracting it regularly, such as when showering and every time you urinate.

The stretching process may take a few weeks.

Regular use of steroid creams may also help.

If the foreskin remains tight, you may need circumcision.

For men who are opposed to circumcision for ethical or political reasons, it may be possible to keep the foreskin but surgically widen it.

The cut made along the topside of the foreskin is called a ‘dorsal slit’.

Paraphimosis – the doctor attempts to manually roll the foreskin over the glans.

This may involve the application of anaesthetic cream and compression of the penis head (by the doctor’s hand or with a tight wrapping of cling film) to reduce the swelling.

If this fails, the doctor may puncture the penis with a needle (to drain the fluid and reduce swelling) or cut the band of foreskin, or both.

If paraphimosis tends to recur, you may need circumcision.

Tumour – the first line of treatment for a tumour is surgical removal.

Cancer treatment may include chemotherapy or radiotherapy.

Zipper trauma – the doctor will apply anaesthetic cream to the foreskin.

The foreskin is freed by either opening the zipper or cutting the zipper with scissors.

Key points to remember about foreskin care

the foreskin is the loose skin that covers and protects the end of the penis

the foreskin and penis of an infant or child need no special care
a child’s foreskin should never be pulled back (retracted) by force
there is no need to clean inside the foreskin in young boys – just wash their penis the same as any other part of your son’s body and be careful to wash off any soap
once the foreskin is easily pulled back, your son should learn to do this as part of normal washing in the bath
make sure he rinses off any soap and pulls the foreskin back over the head of the penis afterwards.

What is the foreskin?

The foreskin is the loose skin that covers and protects the end or head (glans) of the penis.

The inside fold of the foreskin is a mucus membrane which keeps the surface of the head of the penis soft, moist and sensitive.

What care of the foreskin and penis is needed in infants, children and teenagers?

The foreskin and penis of an infant or child need no special care.

A child’s foreskin should never be pulled back (retracted) by force.

During the first few years of life, the foreskin is stuck to the head of the penis by a membrane (called the synechia).

This membrane or connective tissue dissolves naturally – a process that should never be hurried.

The foreskin can be pulled back when its inside surface separates from the head of the penis, and the foreskin’s opening widens.

This process happens naturally in childhood or during puberty and has usually happened by the age of 18.

Even if the head of the penis and the foreskin separate naturally in infancy, the foreskin may still not be able to be pulled back because the opening in an infant’s foreskin may only be large enough for the passage of wee (urine).

When a young boy pulls at his foreskin, he usually pulls it outward.

This is normal and natural and no cause for concern; he won’t hurt himself.

Once the foreskin is ready to be pulled back, your son will most probably discover this for himself.

He should be the first person to pull back his foreskin.

Telling your son about pulling back his foreskin beforehand will keep him from becoming alarmed the first time it happens.

How do I teach my son to wash his penis?

There is no need to clean inside the foreskin in young boys.

Just wash the penis the same as any other part of your son’s body and be careful to wash off any soap.

When a boy is old enough to bathe himself, he can wash his own penis.

Once your son can pull back his foreskin, you can talk to him about pulling back his foreskin and washing.

A simple explanation of ‘how to’ may be helpful:

gently slip your foreskin back
rinse the head of your penis and the inside fold of your foreskin with warm water
slip your foreskin back in place over the head of the penis
Tell him to make sure he rinses off any soap before pulling the foreskin back over the head of the penis.

What happens if someone pulls back my son's foreskin too early?

Forcing the foreskin back before the natural separation of the foreskin from the glans has happened causes tearing of the connective tissue.

This is painful and can lead to problems:

tearing the foreskin from the head of the penis leaves an open wound which can lead to infection
the raw surfaces touching each other can heal together and form areas that stick together (adhesions) between the foreskin and the head of the penis leading to permanent problems with pulling back (retraction)
small tears in the opening of the foreskin can heal to form non-stretchable scar tissue, possibly causing acquired narrowing (phimosis)
the foreskin can get ‘stuck’ behind the head of the penis (paraphimosis)

What is the white lump (smegma) under my son's foreskin?

The white lump (smegma) is made up of the cells that once attached the foreskin to the head of the penis.

As new cells form on the head of the penis and the foreskin’s inside fold, old cells form pockets that eventually work their way to the tip of the foreskin, where they can eventually be wiped away.

So if you see a white lump (smegma) under the foreskin you know that the separation from the head of the penis is occurring naturally.

Why does my son's foreskin 'balloon' when he wees?

This is another indication that the natural separation of the foreskin from the head of the penis is occurring, but the opening of the foreskin is still narrow.

Ballooning can be normal but if it is severe so the flow of wee is restricted you should seek advice from your family doctor.

Encouraging boys to gently try and pull back their foreskin as part of daily hygiene can help.

Sometimes a course of steroid cream is needed.

Your family doctor can advise you about this.

What if my son's foreskin can't be pulled back (phimosis)?

Phimosis refers to a foreskin that cannot be pulled back because its opening is too small to expand over the head of the penis.

This is normal during infancy and childhood.

In later childhood, if your child is still unable to retract the foreskin, a course of steroid cream can be prescribed which thins the skin and helps it to stretch over the head of the penis.

Your family doctor can discuss this with you.

What causes my son's foreskin to be red (balanitis)?

Sometimes the tip of the foreskin becomes reddened.

This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive head of the penis and the opening in the penis where wee comes out (urinary meatus).

If children are still in nappies, it may be part of nappy rash.

When bacteria in the poo react with wee, they produce ammonia, which burns the skin and causes nappy rash.

Ways to prevent a reddened foreskin and nappy rash can include the following:

  • changing nappies more frequently
  • allowing nappy-free times to allow air to circulate and help healing
  • soaking in warm baths
  • avoiding things that can irritate the skin (such as bubble baths, soap, highly chlorinated water, some laundry powders)
  • encouraging your child to drink more so the wee is dilute (not too concentrated)
  • If the foreskin or penis is red, painful and swollen, there may be an infection and you should see your family doctor.

What about circumcision?

Circumcision is the operation to remove the foreskin.

There is no medical reason for routine male circumcision.

For more information, see the fact sheet on circumcision on this website.

There is an operation called a dorsal split where the foreskin is cut to widen and loosen the foreskin, without removing any foreskin tissue.

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ismael

ismael

2 thoughts on “How to Care for the Foreskin of the Baby.”

  1. You could definitely see your expertise in the work you write. The world hopes for even more passionate writers like you who aren’t afraid to say how they believe. Always follow your heart.

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