A penis primer

Answers to your most pertinent questions

Janice Paskey 1

The penis really is a many splendoured thing, as your son will discover in the years to come. Whether your little guy grows up to be a boxers or briefs man, chances are his most treasured companion will be zipped, itched, scratched, kicked and, well, you know, in the intervening years. And since you may be new to caring for this part of the anatomy, here’s what you need to know about your son’s penis:

What is the doctor checking for?
In the early years, your son’s genital area will need to be examined by a physician at regular checkups. The physician will look to see that your baby’s genitals appear healthy and normal (that the urethra opening is at the tip, for instance), and that both testicles have descended into the scrotum by six months of age. Undescended testicles place a boy at risk of infertility because the scrotum keeps them about five degrees cooler, which is necessary for healthy sperm production, explains Bill Hyndman, a paediatric urologist with Alberta Children’s Hospital in Calgary. The problem is corrected with day surgery.

My son’s penis seems small compared with those of other babies I’ve seen. Should I be worried?
There is considerable variation in penis size, says Hyndman, who firmly insists that parents avoid any sort of outright comparison. “I don’t want parents to get into measuring,” he says, suggesting they concern themselves with how the penis is functioning overall.

However, there is a condition known as buried penis, in which the penis is partially enveloped by the baby’s body fat, explains Hyndman. “We need to reassure the parents that the penis is buried, but normal size. As the boy’s body slims down, the penis usually becomes more apparent by adolescence.” A physician can identify this condition in the newborn. A child with a buried penis should not be circumcised because of the difficulty of the procedure and increased risk of damage (see Circumcision Debate). If the condition persists, surgery can correct the problem well into adulthood.

How do I clean my baby’s penis? And when he gets older?
This is one of the most common questions raised by parents, says London, Ont., paediatrician Michelle Ponti, and not all doctors agree on the best approach. Ponti urges caution and very gentle handling. “Some people are too vigorous,” she says. Daily cleansing of the diaper area in babies and a bath every two to three days for older boys is sufficient. In uncircumcised boys, the foreskin should not be retracted for cleansing, she says; soapy water will get up there just fine on its own. “There are fine layers of skin between the foreskin and penis and, if you are too vigorous, you have little tears,” says Ponti. This creates scar tissue, preventing the foreskin from retracting when erect, a potentially painful condition known as phimosis.

By three years of age, the foreskin should be separating from the glans, and parents may notice that the foreskin begins to retract easily on its own. (In some boys, though, this separation can happen at a later age.) Ponti says force should never be applied to retract the foreskin.

Hyndman differs slightly on this topic. He says this approach might not teach boys the good habits they need for avoiding urinary tract infections. He suggests that by age three or four, a boy should be able to retract his foreskin on his own.

What should I know about urinary tract infections?
Urinary tract infections are one of the most common penis problems in boys two to 13: About one to two percent of boys will get them in the first six months. The infections occur when bacteria enter the urethra and travel to the bladder and, in serious cases, the kidneys. Symptoms include pain during urination and sometimes fever. (Babies may be unusually fussy or simply refuse to eat.) Parents will usually be able to tell that something is wrong, says Hyndman.

Some studies show that breastfeeding an infant reduces the risk of urinary tract infections, and frequent baths are thought to help avoid them too. Infections can be diagnosed with a urine culture and treated with antibiotics.

What are the most common childhood injuries to the penis? And how can I help protect my son?
The male genitals are certainly convenient for a quick pee at the side of the road, but they’re vulnerable to a hard curveball or a kick from a sibling.

Common causes of injury, say physicians, include a toilet seat falling on the penis (train your son to hold the seat or install a less wobbly one), or getting the penis caught in a zipper (teach him to zip slowly and pay attention!). As well, bike accidents produce some nasty genital injuries when boys go over the handlebars or come down too hard on a crossbar — these are known as “straddle injuries.” Some sports, such as hockey, require protective gear, but injuries can occur simply from normal roughhousing.

Cold weather can also affect the penis’s delicate tissue. With tiny blood vessels that extend right to the tip, the penis is at risk for damage in extreme temperatures if it’s not protected with enough clothing. So remember to put him in layers on cold days with underwear, long underwear and snowpants.

What do I do if my son says his penis hurts?
Take this complaint seriously, say physicians. Pain in the penis area is not common, says Ponti, and it can indicate a number of things, from trauma to a urinary tract infection. Ask your son about the pain: Is it the penis that hurts or the testicles? Is it constant or does it come and go? Did he get hit in the penis? Put anything into it?

You’ll need to look (if he’ll allow it) and see if there are any cuts or bruises, and monitor him for fever. Take your son to his doctor to check for injury, infection or possible hernia.

My three-year-old constantly has his hand down the front of his pants. What should I do?
Welcome to the world of self-gratification, a healthy human exercise, but one that’s a little embarrassing when displayed to the world.

“Don’t shame your son about this. We want our children to have positive self-esteem,” says Calgary sex educator Valerie Barr. “So say you’re in a parents’ group, and your child is grabbing his penis, you can tell him, ‘That is something that’s private, that you do on your own.’”

It’s common to see this behaviour a lot around age three or four. This is a good time, says Barr, to be sure to use the anatomically correct terms with your child. “It’s really important because it gives the message to the child that this is not a weird part of the body. It’s best to normalize sexual health as part of a child’s whole health.”

At what age do boys start to experience erections? And how do I explain this to my son?
Erections occur in utero, so you’ll see them in even the youngest babies. Between three and six years of age, when you’ll probably be getting your first pointed questions about erections, a frank discussion of intercourse might be more than your child bargained for. You can simply say: “If you touch the penis, it will get hard. If you stop touching it, it will go down again.” The key, says Barr, is to convey that erections are normal and healthy.

But by the time a child is about eight to 10, says Barr, it’s time to explain how the sperm and egg come together. “Otherwise, your child will be learning this from other children.”

Circumcision Debate
Circumcision involves the removal of the foreskin, the sheath of skin that covers the end of the penis. It’s a touchy subject because the decision to circumcise a boy is intensely personal and, in some cases, cultural. In its last review of the topic, the Canadian Paediatric Society (CPS) evaluated hundreds of articles on the topic and concluded the benefits did not outweigh the risks. The slight increased frequency of urinary tract infections in uncircumcised boys (about two percent more than in circumcised boys) wasn’t enough to recommend circumcision. Instead, the CPS called for more studies to see if better hygiene could reduce infections in uncircumcised boys.

“Our position is quite clear — there is no medical evidence that supports circumcision,” says Robin Walker, an Ottawa neonatologist and president of the CPS. “I’ve seen some serious effects of circumcision from mutilation to very serious infections.”

Yet at the end of the position paper, the authors note their advice will likely be ignored: “There is evidence that parents’ decision making is based mainly on social, rather than medical, concerns.” The CPS also stresses that it did not consider religious motivations in its paper. In the Jewish and Muslim faiths, circumcision is an important religious ceremony.

Some parents choose circumcision so a boy will look like dad. Paediatric urologist Bill Hyndman advises against circumcising a child for this reason. “I tell the dad, ‘The ears aren’t exactly the same either.’ Kids could care less that they look like their dads.”

He cautions that boys with a condition called hypospadia shouldn’t be circumcised. This condition occurs when the urinary opening is not at the end of the penis; it’s usually on the underside instead, and the penis is sometimes bent as well. In these cases, the foreskin will be needed for reconstructive surgery — the most common penis surgery Hyndman performs on boys.

Though there are no reliable national statistics available, physicians from the CPS say that, anecdotally, the Canadian circumcision rate is down, says Walker. The procedure is no longer covered by medicare in all provinces and territories except Manitoba, meaning you have to pay to have it done.

However, there are medical reasons that make circumcision a good idea, such as when the boy’s foreskin is too tight and urine collects in it, causing it to balloon, or when a foreskin won’t retract. If your son runs into problems like these, then the procedure may be covered.

One comment on “A penis primer

  1. Ballooning of the foreskin is natural and not a cause for alarm. It merely indicates that the natural adhesions of the foreskin are breaking down, as they should. Ballooning does NOT suggest any problems unless also accompanied by urinary tract infections. Parents of intact boys will recognize that this is just a transitory phase. At this point there is still no reason to expect the foreskin to retract, but his is one of the first indications that it may be starting.

    Do NOT, I repeat DO NOT subject your child to painful, unnecessary genital surgery because your child is experiencing ballooning during urination. If your child is not in pain, and is not having infections then just leave it be. It is a natural phase that will pass naturally. It in no way is an indication that anything is wrong with your child’s penis. Full foreskin retraction will happen sometime before or during puberty. There is no cause for alarm until the boy is 14 to 17 years of age.

    Ballooning is NOT and indicator that circumcision must be performed. If your doctor is telling you that, then it is time you find a new doctor.

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