Foreskin care

Basic Facts

1. The foreskin is normally attached to the head of the penis in small boys. These attachments are called ‘preputial adhesions’.
2. The foreskin can be fully retracted in most boys by 4 or 5 years of age, but in 10% of normal boys there may still be some preputial adhesions after that age. Sometimes it is reasonable to treat adhesions that persist into later childhood.
3. The foreskin does not need to be retracted and cleaned in small boys. Just leave the foreskin alone.
4. Forcible retraction of the foreskin is to be discouraged. A small split in the foreskin can result. This may cause bleeding and pain and possibly heal with a scar.
5. If the foreskin is retracted back, it is important that it is subsequently returned to its normal position over the head of the penis. If the foreskin is left back it can progressively swell and become ‘stuck’ back. This condition is called ‘paraphimosis’.
6. It is reasonable to perform foreskin hygiene after the child can easily retract his own foreskin.

Common foreskin conditions not requiring surgery

1. Foreskin adhesions (see above).
2. Smegma. This is sometimes visible under the foreskin of small boys. It appears as a semisoft lump, yellowish in colour.

Indications to do a circumcision

1. A tight narrowing at the end of the foreskin (called a phimosis) that has not responded to treatment with a steroid cream or ointment or is very scarred.
2. Recurrent foreskin infections.

Applying ointment to the foreskin

An topical steroid may be prescribed to help relieve a narrowing at the end of the foreskin.

Apply the ointment or cream twice a day for one month, or as directed by your doctor.

1. Gently stretch the foreskin over the head of the penis
2. Apply a small amount of the ointment to the narrow part at the end of the foreskin.

After one month, stop using the steroid. If there has not been a complete response, wait 4 weeks then apply the steroid for another month.

If there is not a complete response from the topical steroid then a surgical solution is indicated, either circumcision or a preputoplasty to increase the size of the foreskin opening.

Disclaimer

This information sheet is a guide only. For specific advice regarding your child, please see your doctor.