Often, once parents make the decision to not circumcise their baby, they’re unaware of what to do with their child’s uncircumcised penis. They may have heard confusing, conflicting, or just plain wrong information about how to care for an uncircumcised penis. Let’s set the record straight on what’s normal, what’s a problem, and what’s an emergency.
What Is an Uncircumcised Penis?
At birth, a baby’s penis still has a layer of skin over the head (glans). This layer is called the “foreskin” or “prepuce,” and it is attached to the head of the penis. This is completely normal and does not mean there’s something wrong. As the child grows, the foreskin begins to separate naturally, or “retract,” from the head of the penis. As the foreskin starts to retract, sometimes a white, cheesy material builds up under it. The material, called “smegma,” is made up of the skin cells that slough off during the separation process. Sometimes smegma may develop into white pearl-like lumps. Though these lumps can look like an infection or a cyst, they’re completely normal.
Foreskin Separation
Parents are often concerned that the foreskin isn’t separating fast enough, and they will make the mistake of pulling on it to loosen it from the head. In addition to pain and bleeding, the trauma of pulling on the foreskin can cause a kind of scar tissue to form between the foreskin and the head of the penis. This scar tissue can interfere with normal and natural separation. Basically, forcing the foreskin back instead of letting nature take its course creates a permanent problem. The foreskin usually doesn’t completely separate from the head of the penis until the time puberty hits, although it sometimes happens in kids as young as five years old.
Uncircumcised Penis Care
The best advice for parents is to keep the outside of the penis clean when your child is a baby, and encourage them to do this themselves as they get older. When it comes to cleaning the foreskin, the American Academy of Pediatrics says that an occasional retraction with cleansing beneath will do for kids who haven’t reached puberty. There’s no need to do any special cleansing. Simply pull the foreskin back away from the end of the penis as far as is comfortable, wash the head of the penis and the inside fold of the foreskin and rinse well with water (soap can irritate the sensitive skin on the head of the penis). Then pull the foreskin back over the penis. Once they start puberty, teens should clean beneath their foreskin as part of their daily routine.
When to Call the Doctor
If your child reaches puberty and the foreskin is still stuck to the head of the penis, it may be time to call a pediatrician or family healthcare provider. They can prescribe a steroid cream that can speed up the process of separation. It’s a simple treatment that has good results. If the foreskin won’t retract at all, the foreskin may still be attached to the head of the penis, which can be normal depending on the child’s age. Additionally, the end of the foreskin can become too tight for it to come back over the head of the penis. These issues, called phimosis, can also be treated by your provider with a steroid cream or, if necessary, by circumcision depending upon the situation. Paraphimosis is another problem that is an emergency. With paraphimosis, the foreskin has been pushed back over the head of the penis, but it becomes stuck behind the head so that it can’t be pulled back down over the glans. This can be quite painful, and the tight skin can begin to cut off normal blood flow to the head of the penis. If your child has this problem, it’s important to see a doctor right away. If your doctor isn’t immediately available, a trip to the emergency room will be necessary. With some lubrication, a provider can help get the foreskin back over the head of the penis. Sometimes, an emergency circumcision is necessary.
