Wednesday, November 12, 2008

Those of you, who will have the pleasure to care for my son one day...


At birth the penis is anatomically immature. The foreskin is connected to the head of the penis. This membrane protects the developing penis from irritation by feces, the ammonia in urine, and invading pathogens. (SAME REASON CIRCUMCISION SHOULD NOT BE PERFORMED AT ALL) By the end of puberty, the foreskin will have detached from the glans because hormones that are produced in great quantities at puberty help with the process. The tightness of the foreskin is a safety mechanism that protects the glans and urethra from direct exposure to contaminants and germs. The tight foreskin also keeps the boy's glans warm, clean, and moist. The prepuce contains muscle fibers that work to keep the tip closed when the child is not urinating.

Proper Hygiene:

Throughout childhood, there is no need to wash underneath the foreskin. The first person to retract the child’s foreskin is the child himself. Simply wash the penis like a finger, from base to tip; never in the other direction. Only warm water, gently applied to the outer, visible portions of the genitalia is wise. No manipulation is necessary, and as you will see below is quite harmful. Cleaning cannot be easier!


Skin cells from the glans of the penis and the inner foreskin are shed throughout life. Natural skin shedding creates smegma, which acts as a barrier to keep the inner foreskin and glans apart and keep a permanent adhesion from forming should there be any irritation. Smegma moisturizes the glans and its antibacterial and antiviral properties keep the penis clean and healthy.

What is retraction?

Retraction is not just “pulling back on the foreskin toward the body to expose the head of the penis.” It also encompasses “pulling back any on the foreskin toward the body." Even just a tiny bit it still falls under the heading of the word. It also means manipulating the opening of the foreskin by stretching it out or moving it around to see the opening.

Why is retraction bad?

The foreskin is bonded to the glans just like the fingernails are bonded to the nail beds. Retraction is exactly the same thing as peeling the fingernails back and is uniquely painful because the foreskin is among the most densely nerve-supplied structures of the male body. Even if the retraction doesn’t rip the child’s foreskin from his glans, it can create micro-tears, or even tears in the opening of his foreskin. Inside the foreskin will be adhesions between the foreskin and glans in most babies and toddlers. The adhesions may be almost a complete bonding of the two or they may only be spots. If the adhesions are just spots, they are easy to miss until you've gone too far. Even manipulation of the tip of the foreskin that opens it or moves the opening can cause these tears and resulting infections.

Retraction and any wounds that result, whether or not they are visible can cause infection. This can lead to UTI’s, or even complete blockage of the urethra. The raw, bleeding surfaces, formerly separated by a natural membrane, might now grow together, causing unnatural adhesions. Scar tissue will form and render the foreskin inelastic, and cause extreme tightness of the foreskin opening, which might not fade with time and may require medical intervention. The now inelastic foreskin may now periodically become trapped behind the glans when retracted resulting in a painful condition. The child may now endure painful nocturnal erections because of his compromised foreskin (four or five involuntary nightly erections are normal at all ages). This may interfere with necessary REM sleep and might even create sexual dysfunction in adulthood.

"Unfortunately, while more and more parents are coming to understand that circumcision isn't a necessary medical procedure, many are unaware of what to do with their child's uncircumcised penis. And it does seem that one of the biggest problems that leads to children needing a circumcision later in life is improper care of their uncircumcised penis, with this improper care usually involves a parent being told to retract their child's foreskin before it is ready to be retracted. The best advice that a parent can follow is to simply 'leave it alone' and let a child retract and wash his penis once he discovers that it is retractable."

Vincent Iannelli, M.D.
Board certified Pediatrician
Rockwall, TX

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