Parents who are unfamiliar with intact boys are often told that it is more difficult to care for and clean uncircumcised penises. In the case of children, this could not be further from the truth. Circumcision results in a wound which must be cared for, and even with proper care can reopen, become infected, or form adhesions with the glans penis. In contrast, the intact infant penis requires no specialized care at all.
Myth #1: The foreskin must be retracted to properly clean infants
This myth is the result of the foreskin being excised (circumcised?) from the medical literature in the US. Most medical providers—even urologists—do not understand the anatomy and physiology of the male foreskin, particularly in infants.
The foreskin of infants is fused to the glans penis by way of the balanopreputial lamina. To better understand this, gently pull back upwards on one of your fingernails: the bond between the nail and your finger is similar to the bond that is between the foreskin of infants and their glans. It is for this reason that a tool called a circumcision probe is forced between the foreskin and the glans to tear the lamina and then drawn around the entire glans penis so that the foreskin can be surgically removed without severing the glans.
To care for you child, it is sufficient to wash the exterior of the penis just as you would any other skin. Infectious material can’t get under the foreskin unless the foreskin has been forcibly retracted, tearing the lamina.
WARNING: as most healthcare practitioners are unaware of the existence balanopreputial lamina (the foreskin and associated anatomy and physiology is not described in most US medical texts), it is common practice that the first thing a pediatrician or nurse will do when examining a child’s penis is to forcibly retract the foreskin. As a parent, you must be extremely vigilant in protecting your child, as this dramatically increases the child’s risk for phimosis, paraphimosis, and infection both of the penis and urinary tract. As this has been common practice for decades, many scientists have theorized that forcible retraction is the reason that intact boys suffer more UTIs and infections that circumcised boys.
Myth #2: It is difficult to teach an intact boy self care
Between the ages of 5 and 15 the balanopreputial lamina will gradually dissolve, allowing retraction of the foreskin (median age of 10.6 years). Just as parents need to instruct their daughters in proper feminine hygiene, the same goes for their sons and penile care.
The general rules for penile care in an intact male:
- When washing, the foreskin should be gently retracted (do not force it if there is pain) and the exposed area should be gently washed and rinsed.
- When washing and rinsing is complete, the foreskin should be returned to its unretracted position. If the foreskin gets trapped behind the glans and is unable to be returned, this is called a paraphimosis and can be a medical emergency. If the precaution against forcing the foreskin is followed, this is an extremely rare event.
As is apparent, self care for intact boys involves very little additional effort in comparison to circumcised boys. Boys should be taught that if they don’t properly clean their penises, it could result in buildup of endothelial tissue and oils under their foreskin (smegma), similar to what occurs when girls don’t properly clean their vulvas.
Myth #3: My pediatrician says my son has a phimosis and requires circumcision
If you have read the refutation of the previous two myths, both the cause and the solution are apparent. Actual phimosis (the opening of the foreskin is too small for foreskin retraction) is astonishingly rare. If by the age of 18 a boy is still unable to retract his foreskin (the lamina has dissolved but the tissue won’t retract), physicians can prescribe steroid creams and “stretching exercises” that typically relieve the problem within a couple of months. If this fails, a small dorsal slit in the ridged band at the tip of the foreskin can be made to allow for retraction. Circumcision is never necessary for this condition.