By Janice PaskeyUpdated Aug 09, 2017
Sure, Jacob’s* penis looked a bit inflamed, but for Maura*, that didn’t set off any red flags. The Toronto mom figured it was probably a diaper-related irritation. The next day, though, things looked much worse. “It was very red and swollen,” Maura says. “It almost looked as though something was tied around it.” Now concerned, she reached out to friends on a local parenting message board for advice. Her toddler was uncircumcised—perhaps his foreskin was just starting to retract? Maybe he’d been a little too rigorous while exploring his body?
The next day, Maura took Jacob to see his paediatrician, who diagnosed the toddler with an infection. He prescribed a topical cream and some antibiotics. “And then he said, ‘But if this doesn’t work, we may need to do an emergency circumcision,’” Maura recalls. “That felt really weird, and it totally freaked me out.”
Happily, the raw, red bits cleared up, but Maura is still worried. She and her husband were secure in their decision not to circumcise, and the prospect of subjecting their toddler to a sudden surgical intervention was unnerving. That anxiety is common, says Karen Psooy, a paediatric urologist based in Winnipeg. “Parents are often unclear as to what justifies a circumcision,” she explains. The most common medical reasons are foreskin issues (one that’s too tight, one that’s unusually scarred or causes problems with urination) and a series of ongoing infections. “In the majority of these cases, a trial of topical steroids, prior to considering surgery, is worthwhile,” says Psooy.
If your son is uncircumcised In most instances, though—especially with boys who are uncircumcised—the best approach to care is to be proactive, says Aubie Diamond, a Toronto-area doctor who specializes in circumcisions. For your son’s first year, take care to wash his penis gently with mild soap and water, and dry it thoroughly. Keeping the area clean will help ward off fungal infections, which can be nasty and lead to the kind of swelling Jacob experienced. But “never, ever try to forcibly push back the foreskin on a baby,” Diamond says. “If it hasn’t naturally separated, it’s very sensitive. It could tear or scar, and that’s going to lead to complications.”
Eventually, the foreskin will retract on its own. According to the Canadian Paediatric Society, by age six, about half of boys can retract their foreskins, though the separation may not be complete until puberty, and 95 percent of boys have retractile foreskin by age 17. Once the foreskin has retracted on its own, Diamond recommends rolling it back every time you give your son a bath. Using a soft washcloth, gently wash away any residue, then thoroughly dry the area before bringing the foreskin back into place.
“It’s a moist, dark, warm region,” says Diamond, “and if you don’t dry it properly, that can lead to yeast infections. You need to keep this up until your child develops the maturity and level of independence to do it himself.”
Typically, says Diamond, a mild infection can simply be a signal to a parent that a child’s penis requires a little extra care—additional baths, more methodical drying—but recurrent or severe irritations, especially those that cause clear discomfort, may require a trip to a urologist.
If your son is circumcised Similar to their intact counterparts, circumcised penises should be gently washed with mild soap during bath time. Post-procedure complications might include bleeding and can be controlled in most cases. “In experienced hands, complications are uncommon and, in most cases, are easy to deal with,” Diamond says. “More serious complications are extremely rare.” One of these rare complications is called urethral meatal stenosis. “Basically, it’s when the pee-hole narrows,” Psooy says. “This can occur in up to 10 percent of cases.” One sign might be a urine stream that seems to veer skyward. “If you have a kid who always wins the peeing-over-the-fence contest, Dad may be proud, but it can be a sign that you should consult a urologist,” she says.
Psooy says she often encounters parents who are overly concerned about adhesions—or foreskin areas that attach to the glans in both circumcised and uncircumcised boys. In cases thought to be causing symptoms, revision can be necessary to separate the skin from the glans manually. But these cases are the outliers, says Psooy. “People worry that the adhesions need to be dealt with now to prevent complications later in life, but they’re almost never a problem.”
* Names have been changed