7 MYTHS ABOUT PHIMOSIS IN CHILDREN


As you seek to inform yourself about your child's genital health, it is crucial not to be influenced by untruths with no solid medical-scientific support. Here are 7 of the most commonly propagated myths - some of them, sadly, even by health professionals.

1 - "your son has phimosis, because it's not possible to expose his glans; THIS HAS TO BE FIXED ASAP"​

FACT: the infant foreskin should not be retracted until the boy is able to do so on his own[1]. In a study carried out in Denmark, an average age of about 10 years old was found to be that of the first total retraction performed by the boy himself[2]. Children's foreskins are naturally non-retractable or only slightly retractable, and therefore physiological phimosis is a normal condition before puberty, just like the absence of body hair, a "soprano" voice, and so on.

2 - "UNCIRCUMCISED BOYS DO NOT CLEAN THE INTERIOR OF PENIS AND get INFECTIONS"​

FACT: while the foreskin of a boy who has not reached puberty is not yet retractable, the only hygiene the penis needs is external (it should be washed as if the mother, father or guardian was washing a child's finger) or limited to the part that can be exposed by exerting slight traction, without discomfort for the boy. As the foreskin becomes more and more retractable, the child himself can be taught to rinse his insides during the bath or shower: once he discovers this new capacity of his penis (the retractability, even if partial, of the foreskin), rest assured he will do this with the greatest interest.
But, ideally, soap should not to be used to wash the inside of the penis (at most, a neutral, delicate soap could be used[3]). Washing the glans with soap can remove protective body oils and cause unspecified contact dermatitis, which is often mistakenly used as a justification for performing surgery - when in reality it would suffice to stop using soap, apply some emollient cream and wait for the natural oiliness of the body to be restored[4].

3 - "A NON-RETRACTABLE FORESKIN CAUSES URINARY TRACT INFECTION (UTI)"​

FACT: girls have a higher incidence of UTI than boys[5]; and when a girl has UTI, she simply gets some antibiotic-based treatment. The same treatment works for boys.
It can't be said enough: as long as the child's foreskin can not be naturally retracted, the penis does not need to be washed inside. Forced retraction can introduce harmful bacteria and cause, rather than prevent, UTIs and several other infections[6]. And speaking of forced retraction of a boy's foreskin, it can generate lacerated and scar tissue in the preputial opening, narrowing its diameter even further. Or can even lead to a critical condition of paraphimosis, which is when the phimotic ring (the narrower circular band of the preputial opening) gets trapped behind the glans, causing it to be strangled.

4 - "YOUR SON'S FORESKIN IS INFLAMMED, OR HE FEELS PAIN WHILE URINATING? HE HAS PHIMOSIS, AND WILL HAVE TO BE CIRCUMCISED"​

FACT: inflammatory and/or infectious processes should not be confused with phimosis[7]. Anyway, most of these processes (including those which can actually cause pathological phimosis) are reversible through appropriate medication and do not require surgical intervention[8]. In many cases, simple attention to basic hygiene care (such as frequently changing diapers and rinsing the genital region between each exchange) is enough for the regression of certain inflammations, such as those due to ammoniacal dermatitis.
​
When a patient has an inflammation or infection in any other region of the body, no reasonable doctor will propose the amputation of organic tissue without first trying to reverse the status with the use of medicines.

The only cause of pathological phimosis normally (but not always) irreversible  is lichen sclerosus[9], which is even rarer in children than in adults.

5 - "CIRCUMCISION WILL MAKE YOUR SON MASTURBATE LESS"​

FACT: whether in childhood, associated with self-discovery, or in adolescence, due to high hormone levels, masturbation is a somewhat normal developmental behavior that may even help to stretch the phimotic ring and decrease the tightness of physiological phimosis[10].
The question is not whether your circumcised son will masturbate less, but whether he will have more work (some circumcised boys get into the habit of spitting in the hand so that it can slide up and down the glans) and less satisfaction.

6 - "TO BE CIRCUMCISED AIN'T MUCH DIFFERENT THAN cutting your nails or HAVING your hair cut"​

FACT: nails and hair are "designed" to grow continuously and be regularly pruned as a way to eliminate dead cells. The skin, on the other hand, is made up of very specific cellular tissues that are kept alive through bloodstream.

7 - "BUT THE FORESKIN IS JUST A FLAP OF SKIN, AND YOUR SON WILL NEVER MISS IT"​

​FACT: the foreskin is the only moving part of the human sexual anatomy, and acts as the border between the penis and the outer environment. It protects the glans from abrasions, keeps it lubricated and sensitive to tactile stimuli. When the foreskin is removed through circumcision, the glans undergoes a process called keratinization, and becomes dry and less sensitive[11]. In addition, the internal mucosa of the foreskin is intensively innervated and erogenous[12], and its removal will later deprive your child of a series of sensory stimuli.
But it is not only for your child that the foreskin may be sorely missed: due to dryness of the keratinized glans, when he grows up his penis will require more lubrication from his partner (or the use of some lubricant) so that she does not feel pain due to friction during sexual intercourse[13]. Several studies have concluded that male circumcision can negatively affect the sexual satisfaction of both men and women[14,15,16].
Of course, there are cases of pathological phimosis in which amputation of the foreskin ends up being inevitable. In the vast majority of cases, however, non-invasive treatments or minimally invasive and conservative surgical procedures (without tissue removal) such as preputioplasty are the preferred and recommended course of action[3]. Would you like to know more about this?

REFERENCES

  1. Wright JE (1994). Further to "the further fate of the foreskin". Medical J of Australia, 160:134-5.
  2. Thorvaldsen MA, Meyhoff H (2005). Phimosis: pathological or physiological? Ugeskr Læger, 167(17):1858-62.
  3. Shahid SK (2012). Phimosis in Children. ISRN Urology, 2012:707329.
  4. Birley HDL, Luzzi GA, Bell R (1993). Clinical features and management of recurrent balanitis: association with atopy and genital washing. Genitourinary Medicine, 69(5):400-3.
  5. Riccabona M (2003). Urinary tract infections in children. Current Opinion in Urology, 13(1):59-62.
  6. Babu R, Harrison SK, Hutton KA (2004). Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding? British J of Urology, 94(3):384-7.
  7. Rickwood AMK, Walker J (1989). Is phimosis overdiagnosed in boys and are too many circumcisions performed in consequence? Royal College of Surgery (Engl), 71(5):275-7.
  8. National Organization of Circumcision Information Resource Center (2000). Questions About Premature (Forcible) Retraction of Your Young Son's Foreskin. 
  9. Neill SM, Tatnall FM, Cox NH (2002). Guidelines for the management of lichen sclerosus. British J. of Dermatology, 147:640-9.
  10. Beaugé M (1990-1991). Conservative Treatment of Primary Phimosis in Adolescents. Saint-Antoine University, Paris VI.
  11. Sorrells ML, Snyder JL, Reiss MD, et al (2007). Fine-touch pressure thresholds in the adult penis. British J of Urology, 99:864-9.
  12. Taylor JR, Lockwood AP, Taylor AJ (1996). The prepuce: specialized mucosa of the penis and its loss to circumcision. British J of Urology, 77:291-5.​
  13. O’Hara K, O’Hara J (1999). The effect of male circumcision on the sexual enjoyment of the female partner. British J of Urology International, 83(1):79–84.
  14. Kim D, Pang M (2007). The effect of male circumcision on sexuality. BJU Int, 99(3):619-22.
  15. Bensley GA, Boyle GJ (2003). Effects of male circumcision on female arousal and orgasm. NZ Medical J, 116(1181):595-6.
  16. Frisch M., Lindholm M, Gronbaek M (2011). Male circumcision and sexual function in men and women: A survey-based, cross-sectional study in Denmark. International J of Epidemiology, 40(5):1367-1381.