OPINION: What’s the Biggest Risk for Uncircumcised Boys?

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Last year, Kaylee Alvarado, a young mother in Bismarck, North Dakota, brought her three-year-old boy to the emergency room with bad stomach pain. Hours later, she left in tears, clutching the hand of her traumatized toddler. The nurses had needed a urine sample, so they had forcibly retracted the boy’s foreskin to insert a catheter.

Kaylee says it happened so quickly she couldn’t stop them.

“I was holding my boy’s hands and comforting him so they could get the urine sample. Then he let out a scream like I never heard before,” Kaylee says. “I looked at what the nurses were doing, and there was blood everywhere.”

Parents like Kaylee, who keep their sons intact (uncircumcised), are learning that their children’s foreskins are still at risk.

“A penis-care information gap exists in North America where most physicians and parents do not know how to care for an intact boy’s penis, especially his foreskin,” says Dan Bollinger, author of the Thymos Journal of Boyhood Studies journal article, The Penis-Care Information Gap: Preventing Improper Care of Intact Boys.

“For decades, nearly every male baby was circumcised, and North American medical professionals lost their knowledge of how to care for the natural penis. Simply said, doctors and parents who’ve experienced circumcision as the norm have neither the medical training nor the personal experience of caring for an intact boy’s penis.”

The Canadian Medical Association, the Canadian Urological Association and the American Academy of Pediatrics all agree that a boy’s foreskin should never be forcibly retracted. Yet many doctors and nurses are not aware of how the foreskin naturally and gradually detaches from the head of the penis (known as the glans).

When baby boys are born, a membrane fuses their foreskins to the glans. The membrane is similar to the membrane that binds the fingernail to a nailbed. Gradually, the membrane dissolves and the foreskin naturally loosens, often aided by the boy playing with his penis.

The average age of retraction is 10.4 years old when the hormones of puberty emerge, but the age varies. Some boys’ foreskins retract when they are toddlers—some young men can’t retract their foreskins until their late teens or early twenties. Both scenarios, and every age in between, are normal.

The consequences can be dire if a boy’s foreskin is prematurely retracted. The boy feels excruciating pain, akin to what’s felt if a nail were ripped from the nailbed. Forcible retraction can tear the ultra-sensitive foreskin tissue, making the penis prone to scarring and infection.

In some cases, the scarring can lead to “iatrogenic pathologic phimosis,” or an abnormally tight foreskin caused by the retraction. If that’s the case, the boy—or the man he will become—will require further medical intervention.

Kaylee says her son was traumatized by what the nurses did. “He was in pain when he urinated,” she says. “When I took him to the pediatrician for a well-child check-up, he screamed and cried and tried to run away.”

Tora Spigner, a labor and delivery nurse and adjunct nursing professor at San Francisco State University and Los Medanos College, says, “It is sad that mothers who resist pressure and coercion to cut the genitals of their sons and keep them whole still have to be wary at doctor visits. Sometimes, when parents bring their intact boys to the doctor for a well-child visit or an unrelated medical issue, the doctor or nurse will force the foreskin back because they don’t know better.

It is painful and harmful and it goes against established medical teachings. The main thing that parents and medical professionals need to know is to only clean what is seen and never manipulate the foreskin.”

There are no data on how common forcible foreskin retraction (FFR) is in Canada. But the data from the United States are alarming. A study by Intact America found that 43.4% of intact boys have had their foreskins forcibly retracted by the time they are seven years old. Of those retractions, 50% were done by doctors. Nine percent were done by nurses and 25 percent were done by parents at the encouragement of doctors.

Another study, published in the Journal of Specialists in Pediatric Nursing, reported that 53% of pediatric nurses thought foreskin retraction is necessary for genital hygiene and 42% thought it is necessary to place a catheter.

But there’s no need to force back the foreskin during catheterization, according to Marilyn Fayre Milos, RN, co-author of the paper, “Catheterization without foreskin retraction.”

She explains, “The catheter can be lubricated and gently inserted through the foreskin opening and guided into the meatus [the opening through which urine passes], much like an intravenous catheter is guided into a vein by feel.” She emphasizes that “The owner of the foreskin—the boy—should be the first and only person to retract his foreskin.”

If your son experienced forcible foreskin retraction, give him baking soda baths (no soap or bubble bath) to help soothe the area, says Spigner. “You can also give him pain medication, such as children’s ibuprofen to decrease inflammation.”

Also, do not repeat the retraction; let nature do its job of healing the wound.

You can also provide your child’s medical professionals with proper intact care, such as Intact America’s Intact Care Guide. Sometimes, the doctor doesn’t know best. But mothers often do.