For over a year now, we have been dealing w/a very small foreskin opening w/my 5 year old son. He doesn't have an adhered foreskin, and does balloon when urinating, he just has a very small opening. We have tried Silvadene cream off and on for this year - he responds while we are using it (the opening opens and we are able to fully retract his foreskin), but closes back down when we stop the cream. He is now complaining of pain on urination and I'm faced w/circumcision - which is absolutely something I want to avoid at all costs. Also, unfortunately, there seems to be only one Pediatric Urologist in the area I live in, and he wants to circumcise. Am I prolonging the inevitable and causing my son more pain than necessary? Are other there methods that I can try? Any help or advice, or even words of encouragement, would be greatly appreciated.

There is absolutely NO REASON anyone should attempt to retract the foreskin of a five year old. Retraction is never really a requirement of intact males, but ideally it is best if it occurs at puberty. Even then, it's no big deal if it doesn't happen yet, but having an expection of retraction at age five is just plain nonsense. Whoever instigated this needs to learn about male gential development and quit being so eager to earn some extra fees by lopping off a perfectly good part of another's body.

Are you washing the boy's penis with soap? If some of the soap gets inside the preputial cavity, it could cause irritation which might cause pain during urination. If so, quit getting soap inside. One cardinal rule is that the boy should never take bubble baths.

Who recommended the cream preparation and why? Was there a diagnosis? Was a possible cause cited?

I think it sounds like a problem with yeast brought on by over zealous attempts at hygiene. If that's the case, the yeast needs to be brought under control while simultaneously removing the cause, which could be washing too much. Antibiotics can also bring on problems with yeast.

For now, relax on the mere thought of circumcision. I really can't think of a valid reason for ever circumcising a five year old. The doctor suggesting it is just looking for a profitable way out at the expense of your son's future sex life.

Thank you for your passionate response!!!

Unfortunately, they don't teach people about intact males, and being female, I have no experience in the matter . Everyone I talked to a year ago, from the urgent care doctor, to the pediatrician, to the peds. urologist, told me he should be retractable by now. I'm sorry, I probably didn't provide you w/enough info., or I'm not making myself clear, but the opening is very, very small. No part of the penis head is visible through the opening, and his urine stream often goes shooting up, down, everywhere (totally fun when you get shot in the face w/it).

I so wish we could have left him alone, but unfortunately, we couldn't ignore the problem, as it started when he had pain & blood w/urination and it got to the point that he was refusing to go to the bathroom.

I had to take him to urgent care tonight, cause he was dripping blood from his penis (not just the light blood in his urine he had this morning). We're ruling out a UTI, but I can almost guarantee that the cause is that the foreskin is irritated inside from either a backup of urine (he's 5, so he doesn't always remember to squeeze out all the urine) or the simple friction of the urine having to pass through such a small opening.

We don't really clean him outside of wiping the urine off w/toilette paper - there's no way to clean inside, as he opening is much too small, and we don't use soap in the area. He does get baths w/soapy water - I will stop that. Again - no one has every said to me to stop giving him bubble baths or even suggested that could be part of the problem - how very frustrating... all any body seems to want to do is mutilate the end of his penis. Maybe I should be cleaning him???

Because of the blood, I can predict that doctors are going to recommend circumcision even more - something I don't want. The urgent care doctor today suggested I try some OTC hydrocortisone cream??? The silvadene cream is a prescription from the peds. urologist, as their first response was to circumcise - I told them no and what are my other options - I got the silvadene cream. Oh, BTW - I was given "looks" when we went to the urologist because I didn't circumcise him as a newborn...

My main goal right now is easing his pain so that he can go to the bathroom comfortably.

Secondarily, I want to stop this from happening again and get him into puberty/adult hood w/an intact penis.

THANK YOU for this board and the support!

I'll let Paul address this issue. Meanwhile, I would personally NOT consent to a circumcision or any other cutting on the penis.

OK, you are in a country where the expectation was that you would circumcise him as a newborn? And "Paediatric Urologists" who know nothing of care of the penis?

Well, that could clearly be Israel, but of course I know by now that you are in "Little Israel" - that is, the USA! New York? Or Arkansas?

(Just joking! )

{Supplementary information: If you take a urine specimen to detect or rule out a UTI, you must ensure that it is taken as a true "mid-stream" - that is, he starts peeing and only while he is continuously peeing do you put the container in the stream.

Exactly the same instruction for girls, except that you hold the lips (labia) open in order to obtain the direct stream. For boys/ men, the foreskin should be retracted if it is able to.}

For the present problem, I think you have confessed that "bubble bath" is indeed the cause of the problem and will in future avoid all exposure to soap. Does he have any other signs of dermatitis elsewhere? In the meantime the hydrocortisone may well help it to settle although I do suggest simple Zinc and Castor Oil cream, worked into the tight opening as far as practical - just as you would for any other exhibition of nappy ("diaper") rash (irritant dermatitis) which is pretty much what you are dealing with here.

A diagnostic point - can he indicate just where the tenderness is in the foreskin - whether it is at the tip which extends beyond the glans (penile head) as I suspect it is, or the part which covers the glans (and then balloons)?

I trust you will keep us up-to-date with progress over the next few weeks.

Oh yes, as Jim implies, I'm quite sure the "Paediatric Urologist" wants to circumcise, but I am certainly anything but sure that this stems from a genuine interest in the boy's well-being.

Now your question involves a number of interconnected matters, and to sort it out requires a little more detail of the interconnections.

Jim is correct in wondering just why attention started being focused on your son's foreskin in the first place? If there was a perceived actual problem, such as pain on peeing, then certainly that problem needs to be addressed. On the other hand, "ballooning" is a perfectly normal phenomenon which indicates - as you say - that the foreskin has separated from the glans, and is of little other significance.

If you have used some treatment - whatever its merits - and this has resulted in the foreskin alternately being able to be retracted and not, then this clearly demonstrates that there is no restriction to peeing and by way of reference, if he can void completely within 30 seconds (bar the drips and a couple of "squeezes"), then that is pretty much all you need to know.

As to retractability - well, at age five, a boy - your son - might be able to retract his foreskin, or might not - the numbers would be not too far from 50-50 (and whatever reputable surveys have been done give various figures, but are just as likely to be either side of this). The only thing that concerns me is that if he can fully retract at this age, then it does seem to be important that steps are taken to ensure that it remains retractile as he grows up.

What steps? Well, generally, that he is given the habit of retracting each time he pees (with the possible exception of when he sits on the toilet).

Retracting for bathing is not so important. In fact, if he is taking baths, then it is actually important that he does not retract after any soap has been used in the bath, because soap is the usual cause of irritation under the foreskin in children. If, even worse, he has been using dish-washing detergent (sold as "bubble bath") in the bathwater, then its surfactant properties - the ability to penetrate into capillary spaces such as into the preputial (foreskin) space even without retraction - would certainly have been the direct cause for all his problems.

Showers on the other hand, minimise the risks of getting soap (or detergent) under the foreskin. Reactions to soap are in general, the primary cause of inflammation under the foreskin (just as they are for vulvitis in little girls and not a few adult women), and an actual infection whether from yeast or bacteria, is a secondary consequence.

SSD is probably not such a bad topical medication - we use it for burns and so it is presumably minimally harmful, but you should not need it in this situation because infection is as I say, not the real problem. That it appears to permit the foreskin to become more retractile, is a little confusing - one does not expect it to do anything directly to make the skin more pliable, so I can only surmise that using it is a combination of an emollient for the skin, and perhaps it is suppressing a degree of Candidal ("Thrush") superinfection.

(As you will see from many of my previous postings,) I suggest simple Zinc and Castor Oil "nappy" or "diaper" cream, unscented and without extraneous ingredients which (just as on a baby's bottom) you can use over the long term. But I really have to suspect that soap or detergent is the actual culprit and getting rid of that will cause the problem to disappear entirely such that you would no longer have a need for the Zinc and Castor Oil.

OK, there's the advice and the encouragement. The "Paediatric Urologist" you have already seen appears to me (as well as to Jim) to be a "loser" and to be frank, I cannot see why you would want to see another. I'm punting that the removal of soap is most likely to arrest the problem entirely, and the fact that the "Paediatric Urologist" hasn't explained this to you (or has he?) - well, you figure!

(Extra points you just might care to mention: From what country do you post, have you any other children including girls, and what vulval problems might they have had and what would you have done for them?)

I can't thank you both enough!

After reading these responses from you both - I did more research on the internet ('cause of course, I was given no other information that than from the peds. urologist's mouth). I do now see that the soapy water could have been the culprit of this whole problem. I could have, given that information a year ago, stopped all this much, much sooner. You two are the first to mention to me that soap is an irritant. In fact, the peds. urologist told me to retract him while in the bath and wash him while he was retracted. And if there was any smegma, to attack that w/soap too. I will let you know if his pain eases w/time and no more soapy water.

I'm in California, USA. I have 2 girls, 7 & 3 - have never had vulva problems w/them.

The tight foreskin became an "issue" when, a year ago, the blood was determined not to be from a UTI - the drs. then told me he was too tight (wrong, he's not actually tight, just has a very, very small opening) and that I need to work to get him retracted. Referral to a peds. urologist and Rx for the cream w/the instruction to stretch him as far back as possible w/the application of the cream 2x/day. I was then told to retract him and stretch him 2 times a day after we completed the round of cream treatment to keep him retractable. He just started to close back down and we stopped the stretching/retracting because it became to painful for him. We treated him 2 more times w/the cream, but did no stretching/retracting. The reason we treated him w/cream 2 more times is that he would start to complain of pain upon urination... we'd call the peds. urologist... and they'd tell me to start the silvadene cream all over again - this time for 8 weeks instead of for 6.

Here I was steeling myself to bring my son into, yes, see another urologist (mind you, not the first one we saw), and you both have reaffirmed my instinct that, as I do enough digging, I can find a better remedy. I was very scared yesterday when he starting dripping blood from his penis. His pain is the same as yesterday - from what he tells me I would say it's a 5-7 on a scale of 1-10. He does vocally cry out when peeing - saying "ow ow". He is not dripping blood so far today - just a light tingeing in his urine.

He is not retractable at all - he can pull the foreskin back, but can not get any of the penis through the opening (you can't even see the penis). Should I be pulling him back when he pees, should I have him do it, should I leave him alone until we get the pain to go away?

Again - my many thanks!

He should be able to pee on his own without any help from either mom or dad. The stream might not hit its target each and every time, but he's only five. By the time he gets a wife, he'll have it figured out. Show him how to mop. There is no need to retract to pee, ever. It just that as males get older, things might be a little more tidy if urine doesn't collect inside the foreskin.

It sounds as if the bleeding may have come from the irritation from washing. While it sounds like a pretty extreme reaction, if it's now clearing up, the possibility becomes greater, especially since a UTI was ruled out. Little boys in general good health shouldn't be getting UTIs.

Yes, these arrogant professionals have lots of misinformation, primarily because you are out of step with the main stream. Your decision to leave little Johnny intact goes against everything they've been taught, and everything they've encountered. All the while, the rest of the world leaves their little boys just as they were born, and when left alone, the boys grow for the most part without major problems.

California is an area of the country where more boys are being left intact, so your doctors should be seeing lots of them. Nevertheless, doctors tend to be a stubborn lot, and they have their own ideas on how things should be. I'm curious about your general location within the state. I'm in the central San Joaquin Valley.

FYI, my male descendants had very tight foreskin opening, and they peed through them just fine. One actually peed on the doctor right after delivery! At age five, none was retractile.

I daresay I give more hints here by what I do not say, and I will say no more about that particular "doctor".

For the moment, let him heal, use the Zinc and Castor Oil soothing cream, or Hydrocortisone if you have obtained that, by wiping a little on the end of the penis (that is, foreskin) and in it it possible. As Jim says, he can do this for himself, the stuff is cheap and no harm if it gets everywhere else.

Retraction is not an issue at the age of five. Many, perhaps not Jim's, but probably about 50% of boys at this age will be able to retract. If they can, they can do this to pee - it's not essential, but a bit of "airing" is probably favourable to clean out anything that might be under there. The general principle remains that insofar as the foreskin keeps the glans covered, there is nothing that comes from inside that will cause trouble, the problem is that of things from the outside getting in that should not, and soap is one of those. The situation is directly comparable to that of a girl's genitals.

Retraction implies that the foreskin can be puled back to expose the glans, and full retraction will expose the whole of it. If this was in fact possible at one stage, then it must be concluded that something has gone badly wrong if it becomes tight again. This is not a natural or physiological progression, and it is not the normal, healthy behaviour of the foreskin, it indicates an externally caused problem - such as irritant dermatitis. In this circumstance, I do feel that the long-term expectation actually should be to (first) heal the condition such that (eventually) the foreskin again becomes retractile - if and because it previously was.

So, if at five, it did not retract, that is not a problem. If it could retract and then became so it would not, that is a problem.

I'm very horrified by all these helpless boys. After suffering, things end up with circ. It's a chance that you found this forum, but one mother for how many other ones? Politics are guilty by not teaching things at school, and other places.
Moreover, I think a mother shouldn't care about her son's sex where there is no health problem! Personaly, I'm pretty sure that I wouldn't have let my mum touch it at 4/5 years.
I don't fully agree that retraction is a good thing while peeing, if there isn't any need.

Of course I concur with your concern as to how glibly boys are subjected to mindless mutilation in our purportedly "civilised" societies. Inappropriately offering surgery that is clearly not only painful and traumatic in its execution (which is to say that even where it is performed under general anaesthesia, the pain in the recovery period must by definition exceed that of a few instances of an inflamed foreskin; and that's if all goes well - I do remember being called "out of hours" to deal with an infected circumcision - the sort of thing trivialised in the pro-circumcision promotions), but permanently hobbles penile function, is indeed criminal. And it's not that men can't discern such impairment (http://www.cirp.org/library/sex_function/masood1), but that they are deceived into believing "it had to be done".

Unfortunately, children (both sexes) are barely adequately educated at school regarding matters that will have the most severe impact on their life, such as pregnancy and disease. Asking that education might include understanding as to how sexual relations (of any sort) might be optimised for the pleasure of the participants would be scandalous in the extreme, presumably because of the implication that young people be permitted to find any such thing pleasurable!

Sadly, your comments are themselves exemplary₍₃₎ (http://dictionary.reference.com/browse/exemplary) - albeit innocently - of just such an attitude. "A mother shouldn't care about her son's sex where there is no health problem!" Well, actually, she should care, and take all steps necessary to protect his sexual function, including ail the matters I have mentioned.

The suggestion that you are "pretty sure that I wouldn't have let my mum touch it at 4/5 years" unfortunately demonstrates that you had subliminally learned your parents' attitude to your genitals, they had taught you their own sense of deep shame. This is precisely the attitude that induces parents to circumcise on the expectation that they will not need any involvement or (further) with the boy's genitals (no need to care for something when you've cut it all off!).

I have seen it suggested that "when boys (children) reach the age of ten or thereabouts, hey develop a natural sense of modesty". This is the most absurd nonsense - they are doing no more nor less than adopting the expectation of others - parents, peers, society - that they adopt this common shame.

And the reason I care about such things is quite simply that I see first hand albeit perhaps not every day, the consequences of ignorance enforced by shame. I am naturally pleased to observe that my own children were not inculcated with such a deep impediment, but I have deep sympathy for the majority.

As to retraction when peeing, I agree there is in most cases no absolute need. If there were no other factors operating, such as discouragement to the boy manipulating his foreskin in play, then it most likely would not matter at all. I feel the advice is however necessary insofar as it gives the parents permission ("officially") for the boy to manipulate his penis, so that they in turn will actually give him this permission.

(Jim, apparently Network54 will no longer permit any proper links or images in posts. This is really going to cruel the forum! )

Yes, you can still drop URLs in and they are rendered, but it no longer allows the writer to specify the mark-up, so you just get stuff loosely splotched around the page.

Very messy and not good, it's definitely a grossly poorer service.

(I can only presume they have had problems with "phishing" exploits in pages.)

Well.. I am happy to report that the bleeding has stopped (of course, there was no UTI) and he no longer complains of pain. He is unafraid to go to the bathroom by himself again (he was afraid it was going to hurt and wanted someone there with him). The plain water baths seems to have done the trick (I still can't believe it was that simple, and that no one ever mentioned it to me) and I'm keeping my fingers crossed that this problem doesn't resurface. He's not stretching himself when he pees and he actually, now that it no longer hurts, seems to have better aim (LOL).

I love Jim's advice to tile the bathroom floor - we've invested in some nice, washable, carpets.

Again - I can't thank you enough, for both myself and my son. What you and this forum have done for us, for my son, there are just not enough words to express our gratitude.

By the time he's thirteen, this problem may go away all by itself. That's how it's supposed to work, and it does for most boys. If it hasn't by then, the boy can start working on stretching at that time.

Thank you for your kind words. This is what you can do. Tell your friends who are still actively producing babies about this situation. They need to know that foreskins are natural, and that they are owned by their sons, and that they have a right to keep them. There is no special care necessary to keep them healthy, other than keeping soap away from the opening. If more mothers actually knew this, doctors would be forced to learn too. Until that time, little boys will suffer needlessly, and they'll continue to grow into men who can't understand why an valuable part of their bodies was removed for no apparent reason.

In case you don't know, the foreskin restoration movement has been alive and well in the USA since 1985 when an organization known as BUFF was formed. It morphed into NORM, a group which has expanded worldwide and includes men numbering in the tens of thousands. There are perhaps close to a dozen various commmercial devices designed to facilitate skin expansion in order to replicate what was robbed from these men. The process takes a minimum of two years to complete and requires attention several times per day in order to be successful. There is a lot to be said for that kind of dedication, isn't there? Some might think these men are nuts for doing something that tedious, but those involved in the process know they lost something very important to them. It's just a way of recapturing what they have been missing. You can learn more at www.norm.org.

Well, as Jim says, you have thanked us enough - well almost - by returning to tell us of success. Naturally, you won't be totally sure for a year or so. Should you have any further problems, please do report back (you might need to start a new thread, that would be no problem; hopefully the "linking" problem will have been repaired by then!).

I am (as you have seen,) a little more "aggressive" in my viewpoint on stretching the foreskin than Jim, but only in this situation, because you have described that at certain stages your son could retract (and even comfortably - is that the case?). I am a trifle anxious that as a result of the irritation, he may have suffered a slight degree of fibrosis (i.e., scarring) and consequent tightness, so that he (or rather, his foreskin) is no longer quite "normal", but actually tighter than it would have been had the problem not arisen.

Now, the treatment for scarring is clearly not to cut something off (and with extreme absurdity, cause ever more scarring), but to stretch the scarred area. This is exactly what is done in standard medical practice, with the use of "pressure dressings" such as burn suits and "scar gels". As it relates to the foreskin, and as it relates to his age, what I suggest is nothing more than encouraging him to retract - as far as he can with comfort - from time to time, and show you whatever progress he makes.

Of course I do not suggest he does this just yet. I will leave it to you to determine just how long he goes without further irritation, to absolutely "prove" what the problem was. Once you are confident however, you may feel it safe enough (and he can feel it safe enough) for him to show you how far he can retract. Two things in particular we do not want; we do not want his foreskin not to be stretched at all, because if there is some scarring, this will make it difficult (albeit not impossible) to stretch later.

The second, is that we do not want him to retain a memory that this painful experience was associated with trying to retract his foreskin as that could seriously impair his subsequent development. This is why I feel he will need quite positive "permission" to "play" with retraction. Whilst others have said, quite rightly, that this is not strictly necessary, in this situation I suggest that a good association would be to encourage retraction when he pees.

When I said "almost thanked us enough", I mean the same as Jim. Sure, we like to feel good about a successful outcome. What we really value however, is people like yourself "spreading the gospel" for us. Of course, you could refer anyone you encountered with a problem, here to discuss it with us, but you are now empowered with considerable (and personal) experience which you need to share.

Hey Guys... he's been doing so well too recently... but he just went to the bathroom and started bleeding again. It's dilute, not dripping like before - but it's there and he's complaining that it hurts to pee again (I guess the discomfort started this morning, but it wasn't enough to tell me about it until just now). I've left him alone for the past couple of days... but I could swear the opening in his foreskin looks smaller - is that possible??? Can the foreskin close down on itself? I don't know what to do... I just don't know what to do...

Regarding the size of the foreskin opening and as I said before, irritations and particularly recurrent irritations do tend to cause a bit of fibrosis in the foreskin which will tighten it and that is why I suggest that when you have the current problem fully under control, it would be appropriate to get him interested in stretching it again.

Now as to the current problem, I refer back to my suggestion of simple Zinc and Castor Oil

I'm sorry... and we're better now . I started applying the zinc last night and it's helping, he's still in a bit of discomfort while going to the bathroom, w/just a touch of blood... but it's helping. I will do my best NOT to panic anymore - thanks for the grounding!

Oops! Something got missed there; let's try again (we are having major problems with the forum system here, but I do understand they are trying to repair it, so let's just keep our fingers - and anything else relevant - crossed):

Regarding the size of the foreskin opening and as I said before, irritations and particularly recurrent irritations do tend to cause a bit of fibrosis in the foreskin which will tighten it and that is why I suggest that when you have the current problem fully under control, it would be appropriate to get him interested in stretching it again.

Now as to the current problem, I refer back to my suggestion of simple Zinc and Castor Oil "nappy" or "diaper" cream, worked into the opening as far as practical while he pulls his foreskin back as far as possible. You do not have to consider this problem to be an "infection" each time it happens, it is mostly more a matter of an irritation and some inflammation, of the nature of dermatitis. If there should happen to be an element of Candida present, or indeed any other bacteria, the drying (astringent) effect of the Zinc will tend to suppress it anyway.

Revisiting the matter of "ballooning", when the present episode settles, it might be a good idea to get him to demonstrate for you (in the shower,) a full "balloon" with the foreskin opening gently held shut as he pees. There is a possibility that the bleeding is caused by the progressive separation of the foreskin from the glans; that it has not yet completely separated and it simply bleeds every time a little more separates.

If he really could retract fully at one stage, so that the "corona" - the hind part of the glans - and the "sulcus" - the "groove" behind it - were visible all the way around, then there should be no adhesions remaining, but it is possible to presume the foreskin is retracting fully when it has not separated from the corona, or when it is still stuck in places.

If you fully balloon the foreskin, the balloon should completely conceal the glans; the corona should not be visible at the edge of the balloon.

Just a thought ...