Baby Foreskin Care

It is usual that a baby's foreskin will not retract (pull back) when he is a baby. Don't be concerned - the baby foreskin is still attached to underlying tissues of the penis.

Over the next few years your little boy's foreskin will start to separate from the tissues underneath so that he will be able to retract it fully eventually. It is important that you do not force the foreskin back.

So leave the baby foreskin alone.

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What do I need to do to clean my baby's foreskin?

• Firstly, never force the foreskin back. Forcing may cause a tear on the lining of the baby foreskin. Not only will this hurt your baby, but when the tear heals, the healed tissue will be tighter. If this keeps happening, your baby will end up with a tight foreskin which will not retract (pull back).


• When you are bathing your baby, gently wash the penis like you do the rest of the body - wash away any soap. There is no need to clean inside the foreskin. There may be secretions (smegma) at the end of the foreskin - gently wash them away. Smegma is debris from cells that were once holding the foreskin to underlying tissues. It is important to clear away any smegma you see but you do not need to force the baby foreskin back to do so - just remove any that is obvious.


• As a young boy, your son should just wash his penis gently like the rest of his body - wash the soap away. He should not force the foreskin back


• Once the foreskin can retract, which may not be until your son is near puberty or older, teach your son to pull the foreskin back gently during bathing (letting out any debris that may have gathered underneath) but never to force the foreskin back.

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What causes a tight foreskin (phimosis)?

Phimosis can occur if there is forceful retraction of the toddler or baby foreskin. This is because the foreskin can be torn and when it heals the tissue is tight.

A tight forekin (phimosis) can also occur if there is recurrent infection, called balanitis. Keeping the penis clean and clearing away any smegma that is present is important - but the foreskin should not be forcefully retracted for this.

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What is the treatment of a tight foreskin (phimosis)?

If your child is 5 years and has a very tight foreskin that will not retract at all (which is called phimosis), the traditional surgical treatment is circumcision. Circumcision involves the foreskin being cut off. However, there are now non-surgical treatments that can prevent the need for circumcision.

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What is the non-surgical treatment of a tight foreskin?

Before circumcision is considered, some doctors will try to stretch the foreskin with a steroid cream - this will work in the majority of cases and means circumcision can be avoided.

How to use the steroid cream to avoid circumcision for a tight foreskin:

• use a strong steroid cream, like Betnovate 0.1%
• apply the cream at least 3 times a day (4 times a day if you can)
• the cream needs to be applied for a minimum of 1 month - you might not see any improvement for at least 2 weeks so don't stop before that, and even if you do see improvement, keep applying for at least a month
• if you miss a day of applying the cream, you need to start again - so at least a month from that day
• to apply the cream, gently retract the foreskin as much as you can and apply the cream to the tip of the penis and then let the foreskin come forward over the cream so the cream sits on the inside of the foreskin

Good care of the baby foreskin will usually prevent a tight foreskin (phimosis) later in life.

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What are the reasons for circumcision?

Most boys are circumcised for religious reasons.

The main medical reason is a tight foreskin, which is called phimosis. This occurs in about 10% of boys. Circumcision can sometimes be avoided by using steroid cream - see above.

There is evidence that circumcised boys get less urinary tract infections than uncircumcised boys, but the risk of urinary tract infection is so low in most boys, that being uncircumcised doesn't matter.

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Should I have my baby circumcised to prevent him having a urinary tract infection?

No. The risk of the operation for circumcision cancels out any benefit from a urinary tract infection in most boys. Urinary Tract infection (UTI) is not common in baby boys.

Follow the Baby Foreskin Care steps outlined above.

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My toddler has a white lump on the shaft of his penis - what is this?

Young boys can get collections of smegma - smegma is made of the cells that were once attaching the foreskin to underlying tissues. You may see smegma coming up to the tip of the foreskin. Sometimes you also get collections on the shaft of the penis - these are called smegma pearls. These will eventually disappear by themselves and are of no concern.

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When should I see my doctor?

See your doctor if:

• your baby has a very red inflamed foreskin that is painful - he may have an infection
• your baby's foreskin balloons out as he passes urine and this is interfering with urine flow
• your little boy is 5 years old and has a very tight foreskin that will not retract at all

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References

• Ganiats TG, Humphrey JB, Taras HL, Kaplan RM.Routine neonatal circumcision: a cost-utility analysis. Med Decis Making. 1991 Oct-Dec;11(4):282-93.
• Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005 Aug;90(8):853-8. Epub 2005 May 12.

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Last reviewed 10 May 2011

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