Cleaning the Penis with Intact Foreskin

Cleaning the Penis with Intact Foreskin
Q:
Cleaning the Penis with Intact Foreskin

My 19 month-old son was not circumcised at birth at my husband’s request. I am the one that gives him his bath, and mostly change his diapers every day but I never do anything specific to clean his penis. I’ve heard that I’m supposed to but have no idea what to do, and my husband tells me not to do anything specific. I just want to make sure I’m doing the right thing. Do you have any recommendations?
Texas

A:

Dr. Greene`s Answer:

Today in the office, a great mom asked me about her son’s newly acquired habit of licking garden snails. Little boys often have a very different sense of hygiene than their mothers. They delight to splash in muddy water, and think nothing of the trail of mucus running down the nose that prompts many mothers to action. Most little boys will not spontaneously wash their hands or clean their penises.

If this conflict weren’t enough, sources of childcare information have very different recommendations for care of uncircumcised penises. Some advocate aggressive wiping using cotton swabs and alcohol to clean under the foreskin. At the other extreme, some authorities suggest doing nothing at all until puberty, saying that the collection of cheesy material under the foreskin is natural and desirable. One popular childcare book even differs from itself, saying in a caption, “The uncircumcised penis requires meticulous hygiene; the circumcised penis … requires no special care,” while the accompanying text says, “Contrary to what was once believed, no special care is needed for the uncircumcised penis.”

I recommend a more moderate approach.

Structurally, the penis consists of two main parts, the shaft and the head (which is called the glans). Urine and semen exit the body through a tiny opening at the tip of the glans. At birth, the shaft and the glans are covered by a single continuous layer of skin. If circumcision is performed, the part of this skin that covers the glans is cut off. Immediately after circumcision the glans appears swollen, tender, and vivid red, since the foreskin was firmly attached to the glans before it was forcibly separated and then cut off.

In uncircumcised boys, the foreskin at first remains firmly attached to the glans, but gradually over time the attachments are broken (mostly by the stretching resulting from repeated normal erections). In 90% of boys the foreskin is loose and mobile by age 2, but the process can sometimes take five or more years. When the foreskin has separated from the glans, the foreskin can easily be retracted, or pulled back, to leave the glans exposed. Throughout life, a cheesy white material called smegma, consisting primarily of dead skin cells and secretions from sebaceous glands, will accumulate under the foreskin.

In uncircumcised boys, forcibly ripping the foreskin from the glans in the name of hygiene can lead to pain, scarring and adhesions. Do not try to forcibly retract the foreskin or to clean under an adherent foreskin with swabs, antiseptics, or even water. On the other hand, even though doing nothing at all may be considered natural, similar reasoning would lead to not cutting the hair, trimming the nails, washing the hands, or cleaning the bottom after a poop. Gentle hygiene enhances health.

Only the outside of the foreskin needs to be cleaned during the first year. It should be cleaned and bathed with soap and water just like the rest of the diaper area. After his first birthday, you might want to very gently pull back on the skin of the shaft to see if the foreskin retracts. If it doesn’t at all, don’t worry — and don’t force it! There is certainly no rush. If urine can flow freely, the hole in the foreskin is big enough. As long as the foreskin doesn’t easily retract (even in a ten year old), only the outside needs to be washed. If the foreskin retracts a little, it would be okay to gently clean the exposed part of the glans with water (but don’t use soap while the foreskin is still partially attached to the glans, since this can irritate this tender area). After cleaning, always pull the foreskin forward to its usual position. This is very important — otherwise it can get stuck and lead to serious damage.

Once the foreskin has completely separated and retracts freely, begin to teach your son to retract his own foreskin and clean underneath it when he bathes, or at least once a week. For most little boys this personal cleaning will not become a habit unless you encourage it. Mentioning it positively and frequently throughout the years can instill an important sense of responsibility, prevention, and health that will benefit him for years to come.

Your bathtimes together are precious now, but the habits you help your son develop might also reduce sexually transmitted diseases and cancer of the penis (and cervix in his partner) when your little boy becomes a man.

Reviewed by: Khanh-Van Le-Bucklin, Rebecca Hicks
Last reviewed: June 20, 2008
Dr. Alan Greene

Article written by

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

 

Comments

  • Amanda

    I HAVE A QUESTION… My son is 4 years and 5 months old and I did not have him circumcised. I don’t remember exactly but when he was between ages 2-4 I remember he pulled back his own foreskin to the point that I had to try to gently pull it forward but I don’t remember him crying. Now at his current age when I try to pull it back just a little to clean the tip when he has a bowl movement in his pull up he whines and tells me it hurts a little and the tip of the skin is a little red. My question is, how could he have pulled it back that far years ago without crying but now it bothers him just to pull it back to clean the tip?

    • Alan Greene

      Amanda – that’s a very important question. When the foreskin is pulled back forcibly all at once, sometime adhesions or even scarring can form, making it harder to retract for awhile. Often this will soften back up on its own over time – but not always.

      The redness at the tip could be a little irritation – or a little infection. Repeated infections, pain, urine problems, the tip feeling hard, or having a white ring scar at the tip are all good reasons to get his difficulty retracting the foreskin checked out.

      When the tip is red, sometimes Sitz baths 2-3 times a day will help, and/or gently cleaning with a cotton swab. Sometimes an antibiotic ointment is needed. Once the redness is cleared up, it’s wise to avoid irritants and to avoid forcibly retracting the foreskin (which you are already doing well, from what you say).

  • Nicole

    I to am having the same problem with my 4 old boy as Amanda has written below so am very curious to hear the answer.

    • Alan Greene

      Does that make sense to you, Nicole?

  • David Chambers

    I have a 9 month old little boy. He is uncircumcised (as am I). My well-meaning sister retracted the foreskin from the glans as early as a few months ago (age 6 months). I was not aware of this until a few days ago. Now that the seal between the glans and the foreskin is broken, would it be better to occasional retract the foreskin and wash with warm soapy water? Or should we continue to only clean the outside for now, as we have been.

    Thanks,
    David

    • Brother K

      WHAT IS THE MOST DANGEROUS EVENT FACING AN ‘INTACT’ (NOT CIRCUMCISED) BOY?

      Aside from circumcision? … a well-baby visit. Our physicians’ international non-profit intervenes in over 100 cases each year of intact boys who
      were injured by a primary care provider. The injury is called ‘PFFR,’ or Premature Forcible Foreskin Retraction. We conservatively estimate the
      annual incidence in the U.S. at more than 100,000 cases. Ironically, many occur when a parent takes the child to a well-baby visit, at 6, 12, or 24 months; but this injury might occur at any age. The children we have helped range in age from one week to 12 years.

    • Nora Martinez

      Hi David, saw your question and I am having the same worry about my 20mo old son I did it forcibly listening to some advise and I was terrified when I did and now I don’t know what to do or if I caused him some damage??? did you ever get an answer or did you ever find out about this??? pliz let me know, thanks!!

  • Nik

    My DS has an infection. His foreskin isn’t discolored, but his penis is red and swollen and has been for over 24 hours. He went to the emergency room and they retracted his foreskin! His father took him so I had no control and could not protect my son. The doctors there informed my husband that the foreskin needs to be retracted and cleaned. So far, we had been cleaning it on the outside only, almost as you would a finger. They did nothing for him, and simply said to take him to a urologist. Possibly to discuss circumcision.

    I am 110% against that. Seriously. Last night I gave him a salt bath and it seemed to ease the issue a little, enough where it doesn’t cause as much pain. I noticed that pus (not smegma) started to practically leak from his foreskin following. The more it leaked though, the less his penis was swollen. But the issue still remains.

    Please advise.

  • maggie

    Thank you this helped alot I have 2 boys and the oldest is 3 his skin retracts easily because I would retract it every now and then since my mother in law told me it was important. But now my 1 yr old I have totally neglected his penis since I assumed it wasnt nessecary but lately I remembered because the tip was a bit red amd when I tried retracting it, it became painful and I was afraid that this was abnormal. My mother in law had told me her nephew had to get circumcised at the age of 5 or 6 because his skin would not retract so I have been paranoid.

  • elodi

    Hi my son is 20 months old. His penis foreskin is still not retracted. It has a small opening on the tip,he can urinate. What must i do? Must i retract it now and then or must i just leave it?

    • Conuly

      LEAVE IT. When he is older, he will be able to retract his foreskin.

  • ThatNewMommy

    My child is 1yr old. He was diagnosed with hypospadias at birth and his pediatrician told me I should retract his foreskin softly. I didn’t because it didn’t seem right. At 4months old, a urologist said he possibly didn’t have hypospadias. That he had a thin strip of skin covering his urethra making it look like he had hypodpadias. His next followup was at 12months. THAT urologist told us he didn’t have it. He retracted the foreskin back a little and told me I had to do that weekly so that the smegma could be cleaned out that it will take years for the forrskin to fully retract and that the strip of skin is the one penises have underneath the urethra (vertically). That it looks like it’s horizontal across the urethra because the foreskin is still attached. This is my first child and I am so lost between what I read and the different things the doctors have told me.

  • Julian

    Hi, my son is 12 month now and definitely uncircumcised ( as I am). Today I found that discharge on the tip of his penis, I removed it and one hour later I’m searching to see what it is?? ( or if it is what I think it is). I don’t remember how it was when I was one year, but I definitely remember how I retracted the foreskin when I was 10 or 11 years old. For at least one year I told myself to do it but the pain or the fact that I’m doing something wrong stopped me. I never asked my father about it. So one day I did it without much pain, found the smegma ( dead cells) and ever since not worrying about that. I never had any infections ( before or after that day). I think to do nothing about that is an option, I’ll definitely wait a long time until doing something on my son. I would try to keep him as clean as possible at the tip of his penis without retracting the foreskin ( pull gently just the extra skin and clean…..the foreskin is bigger then the top of the penis at young age and you are able to pull back a little bit, but just a little bit, 0.5 cm about 0.2 inch). I wrote this because I was shocked by Maggie’s post about the boy circumcised at 5-6 years old. I’ m not saying to wait until 10-11 years old like me, but don’t worry if the child tells you is painful to retract all the way ( is always a point that he doesn’t want you to pass). Eventually one day will retract all the way, doesn’t matter if is 1, 2, 5, 10…it will happen.

  • Amber Faires

    I believe less is “more”, in regards to the care of the intact penis, and doing “nothing” is far more saer than using SOAP on genitals and pulling on genitals that dont belong to you.
    You know baby girls also have foreskin and we dont pull them back to clean them with soap.
    Soap and repeatingly pulling the foreskin can actually introduce bacteria and encourage a PH imbalance and inadvertently cause an infection.
    My son is 11 years old, I have never attempted to pull back his foreskin, nor have I encouraged him to do so himself.
    When he was a baby/toddler his penis was treated like the rest of diaper area, wiped w/a wet cloth. His foeskin/penis were cleaned like a finger and only what could be seen.
    He’s never had any issues.
    I just cant imagine that a body part would “hang around” for thousands of years if it were truly that much trouble to take care of.
    This is not rocket science people.
    Most little boys have no problems discovering their penises in the bathtub. That is enough to keep it clean.
    If the INTACT penis does not belong to YOU do not attempt to retract it period!
    Leave the foreskin alone.

  • lily ray

    I have a question, my son is 1yr 2 months and he was recently in foster care. he is uncirc and i had told the foster care ppl how to properly clean him and they assured me his foster mom would know how to clean him. I just got him back a few days ago and I went to clean him and his foreskin is able to be pulled all the way down….i called his foster care worker to ask her about this and she said that the foster mom said he was having issues peeing when she got him (which is not true) bc the hole was too tight. they ended up having to put creme on him bc he would scream at every diaper change. well to get to the point when i went to give him a bath last night he started crying and grabbed himself and shook his head no to me…is there a chance that his foster mom had forced his foreskin back the first night she had him and that would be the reason he had so many issues when he was in her care, and why he is not fond of bath time like he used to be? and also is there a chance he can get an infection now and end up having to be circ?

    • olivierpascal

      Yes, there’s a chance that a forced retraction happened and that it could create problems. If I were you, I’d contact Doctors Opposing Circumcision (M. Geisheker in particular) and perhaps Attorneys for the Rights of the Child.

  • DKen0

    Should a 15 yr old (uncircumcised) have retractable foreskin? If not, do I need to take him to a physician/urologist? What advice should I offer to him as parent? Is there a good hyperlink I can send him that explains what he should try/do?