The good news is that most of the time one can avoid circumcision in children with tight foreskins. As I have explained here, almost all male newborns are born with tight foreskins. If the child does not have any problems, it is best to wait it out for natural separation to occur in almost 95% of all children by 5 years of age. They just require the usual care of the foreskin in uncircumcised boys.
If the child cries/strains while passing urine repeatedly and/or there is ballooning of the foreskin when he passes urine, one can try manipulation of the foreskin in conjunction with application of local steroid creams.
Manipulation is performed by first pulling the foreskin back as gently as possible till it will retract no further. Apply the steroid ointment to the narrowest portion and keep it retracted for a minute. Remember to reposition the foreskin back in place! This should be done twice a day till the foreskin retracts fully to the junction of the glans and the body of the penis or up to six weeks. This works in up to 90% of all children.
Downside: Like anything in life, there are potential downsides to manipulation too –
- If the retraction is anything but gentle then it might cause pain to the child, and tearing of the foreskin. Now these cracks may or may not be visible to the naked eye. All healing occurs by contraction, so in a circular area like the foreskin, we will get a smaller circle, ergo, tighter foreskin. This can happen even if the child suddenly moves in a direction opposite to our retraction.
- If one fails to reposition the foreskin then the foreskin will become swollen leading to paraphimosis This swelling and the associated pain and discomfort associated with it is progressive and must be dealt with at the earliest, to prevent complications.
- Manipulation does not work if the child has already suffered from local infections as a result of the phimosis.
Do ask your doctor to demonstrate the right technique and get a prescription for the local steroid ointment.
Have questions or comments?