At birth very few boys have a retractable foreskin.
Two natural processes allow the foreskin to slide backwards : growth, widening its tip and the gradual rupture of adhesions linking foreskin and glans. It is then possible to open the space between them in order to rinse it with water, an essential hygiene measure for the intact (uncircumcised) penis..
Normally these changes occur spontaneously. The male baby medical examination includes a gentle traction on the foreskin to appreciate its ability to slide towards the base of the penis. This procedure can be perfomed regularly by parents in order to help nature and support the natural widening of the foreskin ring.
Too much force may lead to a tear. Even small it can cause a retraction scar and a fibrous ring having lost its ability to grow. If despite all precautions, such a tear should occur - an event not always possible to avoid - it becomes necessary to maintain the foreskin ring dilation obtained, with daily stretching efforts for several weeks.
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Eventually a persisting tight foreskin impairs normal hygiene, with an increased risk of infection to the glans (balanitis) and / or the foreskin itself (posthitis).
In that case a passive approach becomes less defensible.
Foreskin care in a toddler involves gradual gentle stretching, ideally every day. The boy should become confident that it does not hurt, then progress will take place. There is no hurry, the skin is a flexible organ that responds to regular stretching. A few months may be necessary. Avoid paraphimosis (a medical emergency) which is the foreskin becoming trapped behind the glans. Pull to the widest part of the glans, not further.
If and when these efforts fail, they must be completed by a medical treatment :
2 years of age, it is most often possible to dilate a tight foreskin
ring by daily use of a steroid cream (clobetasol propionate, 0.05 % as
Diprosone cream, 30 g). The cream must be applied as a thin layer
on the anterior part of the foreskin, in front of the posterior
glans groove, once a day.
These efforts aim at widening the foreskin skin. Adhesions with the glans can be ignored. Their surgical rupture with a blunt probe is a painful, bloody, useless and abusive procedure. These adhesions rupture spontaneously and the last ones cannot resist the marked penis growth at adolescence.
Circumcision favoured by some traditions is a mutilating solution. It removes the glans natural protection and quite a few nerve endings, active in sexual arousal and pleasure. The health benefits of circumcision (less urinary infections, lower risk or AIDS) appear too marginal to offer a serious medical justification.
On this matter, it is interesting to read what the association "intact America" has to say.
And some studies suggest that the procedure itself has significant negative consequences : Milos and Macris (1992) argue that circumcision, often performed without anesthesia, and always painful thereafter, encodes the perinatal brain with violence and negatively affects infant-maternal bonding and trust.
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