Caring for Child's Uncircumcised Penis

Archived Q&A and Reviews

Am I supposed to be retracting my son's foreskin to clean it?

Oct 2012

There is an archive posting that exactly matches my situation, but the answers don't help me. Two different pediatricians have now retracted my son's foreskin - the first was when he was 4 months old and resulted in me changing doctors. The second was at his 15-month visit. Both times I was told that we need to retract it and wash under it. However, all the research I've done says this is not the case, it should not be retracted at this age, and it doesn't need to be cleaned under the foreskin at this age. I mistakenly assumed that, since the APA has a bulletin that describes uncircumcised penis care, all local peds would know not to retract his foreskin. So my questions are: Am I making too big a deal about this? Is the pediatrician supposed to be retracting my son's foreskin? Am I supposed to be cleaning under it? Should I change doctors again? And for parents of older boys, do doctors keep doing this even when they're older? My husband is circumcised and he is as confused as I am about what we are supposed to do. confused mom

Hi there, Absolutely no reason and a common error of American docs. I have two boys and live in China -- we are American -- and circumcision is uncommon here. Our US doc had said my son's foreskin should be retractable by age 10-11 or he should start manipulating it. Our doc in China laughed when I asked if he should start this year when he turned 11 and it still wasn't moving. He said as his testosterone levels increase naturally, the foreskin will become retractable and he will begin manipulating it like crazy around the same time, get my drift? Get another opinion.

My 9-year-old boy is uncircumcised, so is my husband. Neither one of them has ever had any foreskin problems. I never did anything to my son's foreskin. We never washed ''underneath'' it when he was a baby. It naturally started rolling back over the head all by itself--a little at a time. Was completely retracted at least 3 years ago. He now knows to pull it back and clean--never with soap, just with the water in the tub. Hubby says he never had any ''forced'' pulling back of skin when he was small. It just happens, miraculously, all by itself. my boys are happy

I am horrified that a pediatrician has done that. I would immediately switch pediatricians; if your healthcare provider doesn't know the basics of how an uncircumsiced penis works, I wouldn't trust him or her with being knowledgable and competent about your child's overall care. At this age the foreskin is still fused and self cleaning. My son is seen at a clinic where we often do not get our own pediatrician at visits. Since he was born he has been seen by a minimum of 5 or 6 doctors, NONE of whom have EVER tried to pull back his foreskin or tell me I need to pull back his foreskin to wash it.

I have never once pulled back his foreskin to wash it as it has never been neccessary. My son's foreskin does not pull back the way an adult man's does and does not work the same way or need the same kind of hygenic care. Occassionally the tip of his penis does get red. When he was in diapers, I would put extra attention into making sure his penis was clean and dry before putting on the next diaper. I put lavender essential oil in his next bath and let him lay/crawl/run around without a diaper for a day (or an evening if it's a work day). The redness has always cleared up quickly that way and he's never had additional problems.

I would interview your next pediatrician before switching. If the two pediatricians you have seen are in the same clinic or group, I would switch clinics. anon

Hello, Our almost-10-year-old is uncircumcised. We've never retracted or cleaned under the foreskin. We've never had a pediatrician do so eiher. My son has never had any health issues whatsoever as a result of not being circumcised.

If the doctor pulled forcibly to retract the foreskin, that was not in keeping with current medical best practices. If he/she pulled gently and the foreskin was already retracted, I guess there's no harm in it although there's also no reason to do it.

Here's the quote from AAP guidelines: ''Caring for your son's uncircumcised penis requires no special action. Remember, foreskin retraction will occur naturally and should never be forced. Once boys begin to bathe themselves, they will need to wash their penis just as they do any other body part. '' anon

I have three boys, 14 yo, 2.5 yo and 9 mo, all uncircumsized. Their pediatrician, Mary Jones at East Bay Pediatrics has never retracted(forcibly or otherwise) their foreskins. They have three baths a week, and my oldest retracts his foreskin himself to clean under it. He has always done this himself, starting when he was around three yo. The foreskin itself, as you know from your research, is still partially attached to the penis when children are young. The only person who can know how to retract it, and how it feels, is the owner. East Bay Mom

My advice would be to find a new pediatrician. Ours is Dr Cuthbertson at Berkeley Pediatrics. Dr C has never ever attempted to retract my son's foreskin and has never given us the impression that we should attempt to do so. Love Dr C

Our son is uncircumcised and 9 years old. I've never had a pediatrician try to force his foreskin back. Like you, I would object if one tried. My son still has a foreskin that does not fully retract tho it is no longer attached to the glans (ballooned when he peed while the opening was still small. Now he MD says he has a large foreskin relative to the size of his penis with a small opening that prevents it from retracting we have finally started with some steroid cream to loosen the skin. We didn't even think about doing anything until after age 5. If he had been uncomfortable infections. Any other issues we would have been more aggressive but at your sons age it should really be left alone anon

Sorry to hear about your experience. My son is 4 and just started to retract the foreskin on his penis. but his older brother did not do this until he was 6. I think it natural process and should not be forced until ready. I would be upset if the doctor tried to do it sooner. Luckily my husband helps with the process because he is not circumcised. karuna

My son is also not circumcised and is 14.5 months old. He has had 2 different pediatricians because we moved when he was 9 months old. Neither one has retracted his foreskin. It sounds weird to me that they would be retracting it. another mom

Am I making too big a deal about this? - No, your son's penis is an extremely sensitive organ and should be treated properly!

Is the pediatrician supposed to be retracting my son's foreskin? - No, unless there is a specific need to examine the head of the penis (I mean like inserting a catheter or examining an injury), the pediatrician should not need to retract the foreskin.

Am I supposed to be cleaning under it? - No, allowing your son to manipulate his penis in a normal bath will keep it clean enough. (You wouldn't scrub the inside of your daughter's vagina, would you?)

Should I change doctors again? - If the doctor insists on retracting your son's penis at every visit, I would definitely change doctors.

Unfortunately there is a lot of ignorance regarding uncircumcised penises in this country, especially when it comes to babies and toddlers, as the foreskin often doesn't separate and move freely around the head of the penis for several years. When my first son was very young and required a catheter in the ER he had his foreskin retracted for the first time by an ignorant male nurse who informed me that his foreskin was too tight and needed to be ''fixed''. He was completely wrong - he didn't know that the difficulty was because it was the first time it had ever been done. My four year old is finally starting to show some, ahem, *interest* in retracting his foreskin. My understanding is that four years old is a typical age at which foreskin retraction starts to become easy and comfortable for them. http://www.nocirc.org/publish/pamphlet6.html mother of two boys

What do you mean by 'retraction?' I remember the pediatrician testing the retraction of my son's foreskin. That was a gentle slipping motion, with no pulling or pain. I wouldn't worry about that, or even consider changing pediatricians. Nor would I worry about retracting and washing. Your son will play with his own penis in the bathtub, and that pretty much takes care of it. em

Wow, yes, you are making way to big a deal about this. If your son's foreskin retracts, you should be gently retracting it and cleaning with plain water. Most babies this age still have the foreskin stuck to the glans and it won't retract. If it's stuck, it shouldn't be forced down. But if it retracts it can accumulate bits of dead skin, leftover drops of pee, etc in the space. It just needs to be retracted as far as it easily goes down when he's in the bath, before there's soap in the water. Swish it around a bit, cover it back up, and you're done. It's probably variable from pedi to pedi how often they check. I like to check at least once around 9 years old to make sure it's not still stuck and don't usually bother earlier. But that means I'm missing opportunities to notice lumps and bumps or poor hygeine earlier than that, so there's no one right way. another pedi who's never (to my knowledge) been fired over this

You ask: Am I making too big a deal about this? Is the pediatrician supposed to be retracting my son's foreskin? Am I supposed to be cleaning under it? Should I change doctors again? And for parents of older boys, do doctors keep doing this even when they're older?

The answers are: No. NO! No (normal exterior wiping/bathing is enough). Maybe (more below). And doctors should not do this at all as part of routine/preventative care, to boys or men of any age, so it's really a moot question.

It's not unusual for doctors, particularly older ones, to be unaware of the currently-advised best practices for care of intact penises, given that it's only in the last decade or two that infant circumcision has ceased to be a near-universal practice in this country. So if you really like your son's doctor otherwise, it may be worth a bit of effort to educate him, rather than simply switching. But NOBODY should ever retract your son's foreskin except your son himself. Mom of 11yo

No, you certainly are not supposed to retract the foreskin when they are little. I don't know why your first pediatrician did that, did he tell you? What was his justification for doing so? I would think that that could injure the child. My son was intact, and the only time there was a problem was when he got a little red and sore on his penis, and the pediatrician showed me how to GENTLY pull it back, only as far as it would go, but never more, and clean there. Also, my son's penis looked like a little beehive, with the end of the penis being smaller than the middle, so it was tricky. He grew up just fine and is now healthy, and so my advice to you would be to make sure that whatever pediatrician you go to is completely aware and comfortable with the notion that you do not pull back the foreskin. The child himself will do this as he grows, and he will not hurt himself. Most European men are not circumcised, unless Jewish or Muslim, so maybe you should find a nice European doctor. Good luck with all this, and good for you for leaving your boy intact. keep asking good questions, mama

My (2.5 year old) son is also uncircumcised, and it is my understanding that unless there is a medical need to do so, you NEVER forcibly retract the foreskin of a child's penis. It will separate and retract on its own in anywhere from 2-6 years. I would be pretty unhappy (read: pissed) if my child's doctor took it upon themself to do this without prior discussion - none of the doctors that my son has seen have ever done this, or mentioned the need for it.

I will also say that before having my son, I would have thought it would be standard procedure to retract the foreskin to clean his penis. It wasn't until after reading baby books while pregnant that I learned otherwise (my husband, who is also uncircumcised, had no idea either). Go figure. don't force it!

I am a pediatrician with an uncircumcised son. I will say this is unusual as all my colleagues who are willing to say have circumcised their children. However I personally think this is a cultural and personal choice and elective surgery and have seen a couple disastrous cases. The foreskin does not need to be retracted. It will loosen by itself but often not until puberty. Noninterventional MD

Pediatrician retracted son's foreskin during exam

Feb 2004

During a routine 6 month exam yesterday, my son's pediatrition retracted his foreskin all the way. She did it quickly and without warning, or I wouldn't have allowed it! As soon as she did that I said-''hey, I thought you were not supposed to do that!''. She responded that it is fine, does not hurt the membrane and I should pull it back to clean it. Now, according to every baby book, all of my friends, this website and my gut instinct this is all totally wrong. So my questions are these-first, how do I proceed with the pediatrition? Do I dump her or compile some evidence and send her a letter and then dump her or try to talk it out with her? I am so upset and angry about what she did, but I do like her in all other regards so its hard to sort out my feelings on this one. Second, now that she has retracted the foreskin-do I need to do anything special when caring for it? Did she damage the membrane or if I leave it alone will it be OK? Is it more prone to infection now? The end of it looks red and irritated today, by the way. I am furious, feel terrible and guilty and am just a mess over this. I appreciate any advice about where to go from here. Rebecca

My five-year-old is also uncircumcised, and I was also a bit freaked out the first time my pediatrician yanked that puppy back to check things out down there. I just was sure it was hurting him! But she said, ''Just wait til he gets to be a toddler and can play with it all the time. You'll be amazed at the tugging, pulling, stretching he'll do himself with absolute calm. Meanwhile, you need to occasionally do this when he's in the bath, and just swish the water around it. And you'll need to teach him to do it.'' Man, I was not ready to hear that!

It took awhile to be sure that I was not hurting my son (and to top it off, he has a fairly tight foreskin that's not so easy to pull back!), but I managed, and I worked really hard to calm down, so that I wasn't communicating squeamishness or nervousness when I helped him in the bathtub. Now he does it all himself with complete aplomb, and refers to pulling his foreskin back in the tub as ''squeezing out the purple toothpaste''! earned my penis care badge

I hear your concern; perhpaps my family's experience with this will be of help. My 2 boys, ages 9 and 7 are uncircumsized. At first we did not do anything special in terms of care, until the youngest got an infection under his forskin at age 3. At that time the physicians encouraged us to have the boys retract their foreskins while they were in the bath tub to prevent future infections. They did so, without problem, and have had no further infections. Donna

''Uncircumcized penis care'' is a myth, unless there is a problem. There is absolutely nothing a parent has to do under normal circumstances. Eventually, the skin will stretch on it's own (or by it's owner). We have an 8 year old and the skin hasn't been pulled back - no problem! The above is from various doctors' advice. I remember how my mother took me to a doctor back in the 50's and I'll never forget the excuciating pain I went through. This has proved to have been totally unnecessary. Let it happen naturally. anon

Maybe someone already said this and I missed it, but foreskin does not need to be retracted by force by anyone. This will happen naturally sometime before puberty because all little boys play with their penis', until then there is no cleaning necessary. I have just recently noticed that my 3 year old's foreskin is now retractable. As another parent already pointed out, little boys will play with their penis in the bathtub and this is care enough. Susan

As a pediatrician, I feel compelled to add a comment to the discussion about how to manage the foreskin of an uncircumcised penis. The American Academy of Pediatrics actually publishes a brochure about this somewhat contentious issue, entitled ''Care of the Uncircumcised Penis'' which should be available thru most pediatricians or perhaps at their website www.aap.org. The bottom line is that it is entirely normal for foreskins to adhere to the penis for several months (and often years-- again, entirely normal) after birth. They should NEVER be forcibly retracted, although gradual retraction as the child gets older and the foreskin gradually detaches itself is fine. Once detached, the boy can be taught to push it back to wash underneath.

Forcibly retracting still-attached foreskins in young infants was in vogue earlier this century,and still occurs among some less informed doctors, but is unnecessary, potentially harmful, and undoubtedly painful for the child. PBrinkley

September 2002

Can anyone recommend a good reference or offer an informed opinion on hygiene for a one year old uncircumsized boy? A respectable- seeming article in Mothering magazine (written, I think by a physician) basically says that a healthy penis will take care of itself which is my own instinct). The last few times we have seen our pediatrician though, she retracts his foreskin and advises washing this way about once a week, ''so he gets used it, and eventually does it himself''. I don't feel really persuaded that this is necessary, but don't want to be negligent.

My son is almost seven and I have never pulled back the foreskin to wash his penis. Our doctor always told me to leave it alone as not to cause trauma by pulling it back and forth. He does play with it in the bathtub which is the natural way of taking care of it. My brother is also uncircumsized and I doubt if my mother ever did anything to clean it either. He is now 30 and turned out just fine. mom of boy

I was really surprised by your doctor's advice. My pediatrician (Myles Abbott- one of the best-respected peds in the East Bay) routinely chanted to me during appointments ''The care of an uncircumcised penis is no care at all.'' he was adamant that nothing needed to be done, which was advice I was happy to follow. Fran

Your pediatrician is overly concerned. My son is four now and has had no problems with his uncircumsized self. No special care has been needed. anonymous

I'm uncircumsized myself and I stil remember, back in the 50's when my doctor forced the skin back because ''you were supposed to do that''. The pain was excruciating. It turns out now that this is totally unnecessary. My uncircumsized 7 yr old has no problems and the doctor adviced us not to do anything with it. Let nature take it's course. The body will take care of the cleaning, stretching etc. anonymous

Tell your physician to get her hands off your son's penis! She could cause tearing and adhesions by prematurely separating the foreskin from the glans, which could cause scaring and other problems down the road. Let your son be owner of his body. Intact penises are no more in need of such manipulation and cleaning than girls are in need of douching. anon