tight foreskin

Introduction 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.  *   *   * 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  :  After 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. This treatment is completed by gentle tractions, starting at the base of the penis shaft, in order to make the foreskin  slide backwards and stretch it gradually. These efforts must remain limited (less than one minute) and  painless. Pain is evidence that it is useless and potentially harmful to pursue the traction and will of course elicit increasing resistance from the child.  The expected duration of treatment goes from 1 to 3 months. Failures are usually the result of a retraction scarring, and require surgery, preferably a foreskin plasty or a dorsal foreskin slit to enlarge the foreskin ring.  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. http://en.wikipedia.org/wiki/Circumcision http://en.wikipedia.org/wiki/Marilyn_Milos