The facts on foreskins
Want to confuse a bunch of otherwise intelligent, well-informed parents? Just mention foreskins.
While the debate about circumcision snips on, there is little discussion around what to do with the extra flap of skin that, as per medical advice, 80 per cent of boy babies now carry; the foreskin.
Adding to the confusion is that most women of parenting age are from a generation where the statistics pushed the other way, with fathers, brothers, lovers and husbands all circumcised.
“I didn't know anything about normal foreskin development before having a boy,” says Nichola, mum to two boys.
“I expected the foreskin would pull back fully and was surprised that it was attached. When my son was two or three I asked my GP about his foreskin as it was still attached and I was concerned that this was not normal. He assured me it was and that the foreskin would detach over time with "use".
“I was confused because at no time did I hear about this information - not from the midwife, the paediatrician or the child health nurse. No-one discussed it with me.”
Paediatric Urologist at Brisbane’s Mater Children’s Dr David Winkle says there “is absolutely confusion”, with what constitutes normal foreskin development obfuscated by the ongoing circumcision dispute.
“It’s a minefield,” he says.
“Advocates of circumcision have created a perception that if a boy doesn't have a prepuce, or foreskin, which is fully retractile, then that is abnormal and justifies circumcision.
“The water is muddied and well meaning parents hear a variety of views, often passionately held.
“The medical profession is also divided in this issue with some outspoken doctors offering views for and against resulting in differing "expert" advice as to what is normal. It really is little wonder that there is confusion in this circumstance.”
For the uninitiated, the foreskin is a flap of skin that covers the head, or glans of the penis, protecting it when it’s not erect.
When baby boys are born, it is typically non-retractable, actually fused to the penis head with a thin piece of skin.
As nature takes its course, that piece of skin will separate. However there is no date-stamp as to when. It can happen anytime from birth to adolescence, which means there is a lot of scope for normal development.
“The foreskin is adherent to the end of the penis in most boys at birth,” says Winkle.
“The majority of boys can retract their foreskins by age five but many boys will have some adhesions between the foreskin and the glans until the age of nine or 10.
“Provided there are no infections, then the presence of adhesions is not a problem."
Puberty usually sorts out the last of the lingerers, with the surge in adolescent hormones causing cells in the lining of the skin to replicate rapidly, which helps it separate.
“Studies confirm that at least 98% of boys can retract their foreskin by puberty,” says Winkle.
However, just to confuse things, detachment doesn’t mean instant retraction.
Some foreskins are also kept in place by a condition known as phimosis, a word that comes from the Greek meaning muzzled. In Australian parlance, it means the tip is tight; the penis looks pointy towards the end. Again, this is quite normal and over time, the skin will stretch, allowing the foreskin to retract.
Sometimes, with phimosis, urine gets caught in the foreskin, causing it to balloon. As alarming as it sounds, it can actually be a good thing as the ballooning helps the skin to stretch and separate the penis. It usually does not require medical attention.
There are two instances in which you should seek medical attention, says Winkle;
If the end of the penis gets red and sore, see a doctor to check for balanitis, an infection that is easily treated with antibiotics.
Or if your child is straining to wee, either to get it out or get it out in a straight line, then also see a doctor. A tight foreskin might be hampering his ability to wee. Again the treatment is quite benign; usually a corticosteroid cream which helps the skin to stretch.
Medically required circumcision is “uncommon” says Winkle.
“Generally issues will be sorted out in childhood. If a circumcision is needed in adult life, the problem is generally something new rather than something that has existed since childhood.”
Other than that, just leave it alone.
“Normal gentle washing and cleaning of the area is appropriate.”
“Forced early retraction of the foreskin can cause tearing and scarring of the skin, so overzealous attempts to retract the foreskin in an attempt to clean the area is not good practice.”
However the owners, says Winkle, can do what they like.
“Boys playing with their penises and foreskins is normal and not harmful,” says Winkle. “They’re not going to cause themselves pain by forced retraction.”