Phimosis / Tight Foreskin / Circumcision

[ksmama]

Hi worried mummy, you can observe first if your kid and yourself are not mentally prepared for the op yet. Some kids get the first infection and is ok after that for a long time. My 2 kids took it very well. 1 had it at 6, 1 at 7. Younger child was manja the first day and after that ok. However, if he does get frequent infections, will be good to have it done because sometimes the pain from infection can cause a lot of stress for the kid and parent. After the op, let the kid run round half naked at home and they will be quite happy.

[worried mummy]

thanks! I hv already booked a date for the surgery, just hoping for a miracle…

[worried mummy]

Hi, does anyone know whether is it medically necessary to circumcise a boy before puberty if he has phimosis but never has any infection?

[ZacK]

worried mummy:

Hi, does anyone know whether is it medically necessary to circumcise a boy before puberty if he has phimosis but never has any infection?

Hi worried mummy... My personal opinion is even if there is infection, it may not be medically necessary to circumcise the boy... The risk of getting infection is much higher in a child with phimosis, however, it is not a life threatening situation probably more pain and discomfort than anything else.

Based on the extract below... It seems that the non-retractability of the foreskin is natures way of protecting the organ... And the non-retractability of the foreskin may be considered normal up to adolescence.

I'm not considering circumcision for DS1, will just wait and see the degree and frequency of his infection, if any, before making further decisions on this. So far, he is coming to 6 and has not experienced any infection.

Extracted from Wikipedia
Natural development of the foreskin

At birth, the inner layer of the foreskin is sealed to the glans of the penis. This attachment forms \"early in fetal development and provide[s] a protective cocoon for the delicate developing glans.\"[11] The foreskin is usually non-retractable in infancy and early childhood, when the developing glans needs complete protection from the mechanical trauma of the nappy and clothing, and the chemical trauma of ammoniacal urine.[11]
Until recently, knowledge of the development of the foreskin has been a neglected subject. Physicians often saw the natural unretractability of the foreskin in infancy as pathological and recommended circumcision. Often it was used as justification for routine infant circumcision.[11]
During the 20th century studies were released which furthered our understanding of the normal development of the foreskin.[12][13][14]
The American Academy of Pediatrics and the Canadian Pediatric Society state that no attempt should be made to retract the foreskin.[15][16] Age is reportedly a factor in non-retractability: according to Huntley et al. the foreskin is reportedly retractable in approximately 50% of cases at 1 year of age, 90% by 3 years of age, and 99% by age 17. These authors argue that, unless scarring or other abnormality is present, non-retractibility may \"be considered normal for males up to and including adolescence.\"[1] Hill states that full retractability of the foreskin may not be achieved until late childhood or early adulthood.[17] Cantu states that acquired phimosis may be caused by forceful retraction, due to the formation of scar tissue.[18]
Although the rate of surgical treatment of phimosis (usually circumcision) is falling, some pediatric urologists have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis, and that phimosis is overdiagnosed.[2][19][20]
Phimosis is sometimes used as a justification for circumcision,[21][20] so that it will be covered by a national health system or insurance plan. The definition may be stretched by a physician for an older child; particularly where (as in North America), post-neonatal circumcision is usually outpatient surgery by a pediatric urologist, more expensive than the neonatal procedure.[20] Most pediatricians[who?] do not consider it a compelling argument for routine neonatal circumcision.[22] While circumcision prevents phimosis, at least 10 to 20 healthy infants must be circumcised for each prevented case of potential phimosis according to some incidence statistics[citation needed].

[worried mummy]

Thanks, ZacK.


I have my reservations to send my son for circumcision because it is a irreversible surgery. So far, he only has a minor infection which was cured in a few days with oral medicine. That’s why I really hesitate whether it is really medically necessary to send him for circumcision. I also did a research on the NET and understand that some boys cannot pull back the foreskin till more than 10 years old and my boy is not even fully 6 years old.

I wonder where can I can a second medical opinion. On the other hand, if it is really necessary to be circumcised for phimosis in future, it would definitely be better and less embarassing to do it now while he is young.

[ZacK]

worried mummy:

Thanks, ZacK.


I have my reservations to send my son for circumcision because it is a irreversible surgery. So far, he only has a minor infection which was cured in a few days with oral medicine. That's why I really hesitate whether it is really medically necessary to send him for circumcision. I also did a research on the NET and understand that some boys cannot pull back the foreskin till more than 10 years old and my boy is not even fully 6 years old.

I wonder where can I can a second medical opinion. On the other hand, if it is really necessary to be circumcised for phimosis in future, it would definitely be better and less embarassing to do it now while he is young.

I can only comment as if I were in your position... Was the first incident of infection traumatising for both you and your boy? Or was it manageable? If it's manageable and the discomfort bearable for your boy, then I would hold back until much later and see if the condition would go away before doing anything that drastic.

Even if you get a second opinion, most docs will tell you prevention is better than cure, so would probably tell you to consider circumcision. The problem is boys' foreskin in general are not retractable till a bit later, so it may still be too early to tell if our boys have phimosis or not.

[worried mummy]

He only had one incident of slight infection with no other complains. In fact he didn’t even complain to me about the pain till the GP asked him. We sent him to see a GP because of his frequent urination. The GP subsequently referred him to a paediatric urologist who thinks that there is very low chance of him being able to pull back the foreskin and suggested circumcision.

[Christine_T]

worried mummy:

He only had one incident of slight infection with no other complains. In fact he didn't even complain to me about the pain till the GP asked him. We sent him to see a GP because of his frequent urination. The GP subsequently referred him to a paediatric urologist who thinks that there is very low chance of him being able to pull back the foreskin and suggested circumcision.

It is normal for the foreskin not to retract.
http://www.cirp.org/library/normal/

Unfortunately some doctors are not aware of this. Especially in the USA where the rate of circumcision is higher.

You must not try to retract the foreskin or clean under it. This can damage the foreskin and create scar tissue. Scar tissue is inelastic and may cause true phimosis (rather than normal infant unretractability)

The penis doesn't require any care. So the advice is to just leave it alone. Most boys worldwide are intact (75%) and do fine. IN Britain , France, Germany and most of Europe they do not circumcise. They know there is no care required and their kids grow up great.
http://www.cirp.org/pages/parents/care/

[ZacK]

Christine_T:

worried mummy:

He only had one incident of slight infection with no other complains. In fact he didn't even complain to me about the pain till the GP asked him. We sent him to see a GP because of his frequent urination. The GP subsequently referred him to a paediatric urologist who thinks that there is very low chance of him being able to pull back the foreskin and suggested circumcision.

It is normal for the foreskin not to retract.
http://www.cirp.org/library/normal/

Unfortunately some doctors are not aware of this. Especially in the USA where the rate of circumcision is higher.

You must not try to retract the foreskin or clean under it. This can damage the foreskin and create scar tissue. Scar tissue is inelastic and may cause true phimosis (rather than normal infant unretractability)

The penis doesn't require any care. So the advice is to just leave it alone. Most boys worldwide are intact (75%) and do fine. IN Britain , France, Germany and most of Europe they do not circumcise. They know there is no care required and their kids grow up great.
http://www.cirp.org/pages/parents/care/

Thanks for the note. My sentiments exactly

[worried mummy]

Thanks to all of you. You have helped me to decide not to send my boy for circumcision. This thing has been bugging me for the last few days…