Care of the Uncircumcised Penis

Guidelines for Parents

American Academy of Pediatrics

At birth, the penis consists of a cylindrical shaft with a rounded end called the glans. The shaft and glans are separated by a groove called the sulcus. The entire penis – shaft and glans – is covered by a continuous layer of skin. The section of the penile skin that covers the glans is called the foreskin or prepuce. The foreskin consists of two layers, the outer foreskin and an inner lining similar to a mucous membrane.

Before birth, the foreskin and glans develop as one tissue. The foreskin is firmly attached – really fused – to the glans. Over time, this fusion of the inner surface of the prepuce with the glans skin begins to separate by shedding the cells from the surface of each layer. Epithelial layers of the glans and the inner foreskin lining are regularly replaced, not only in infancy but throughout life. The discarded cells accumulate as whitish, cheesy “pearls” which gradually work their way out via the tip of the foreskin.

Eventually, sometimes as long as 5, 10, or more years after birth, full separation occurs and the foreskin may then be pushed back away from the glans toward the abdomen. This is called foreskin retraction. The foreskin may retract spontaneously with erections which occur normally from birth on and even occur in fetal life. Also, all children “discover” their genitals as they become more aware of their bodies and may retract the foreskin themselves. If the foreskin does not seem to retract easily early in life, it is important to realize that this is not abnormal and that it should eventually do so.

Drawing reprinted with permission of Edward Wallerstein, author of Circumcision: An American Health Fallacy. [ACWF note: The drawing is presented only in the older (1984) edition of the pamphlet.]

The Function of the Foreskin: The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.] [ACWF Note: This important paragraph, and the drawing, were printed in the 1984 edition of this pamphlet; but were removed in the 1990 version!]

Infant Smegma: Skin cells from the glans of the penis and the inner foreskin are shed throughout life. This is especially true in childhood; natural skin shedding serves to separate the foreskin from the glans. Since this shedding takes place in a relatively closed space – with the foreskin covering the glans – the shed skin cells cannot escape in the usual manner. They escape by working their way to the tip of the foreskin. These escaping discarded skin cells constitute infant smegma, which may appear as white “pearls” under the skin.

Adult Smegma: Specialized sebaceous glands – Tyson’s Glands – which are located on the glans under the foreskin, are largely inactive in childhood. At puberty, Tyson’s Glands produce an oily substance, which, when mixed with shed skin cells, constitute adult smegma. Adult smegma serves a protective, lubricating function for the glans.

Foreskin Hygiene: The foreskin is easy to care for. The infant should be bathed or sponged frequently, and all parts should be washed including the genitals. The uncircumcised penis is easy to keep clean. No special care is required! No attempt should be made to forcibly retract the foreskin. No manipulation is necessary. There is no need for special cleansing with Q-tips, irrigation, or antiseptics; soap and water externally will suffice.

Foreskin Retraction: As noted, the foreskin and glans develop as one tissue. Separation will evolve over time. It should not be forced. When will separation occur? Each child is different. Separation may occur before birth; this is rare. It may take a few days, weeks, months, or even years. This is normal. Although many foreskins will retract by age 5, there is no need for concern even after a longer period. [1984 version only: No harm will come in leaving the foreskin alone.] Some boys do not attain full retractability of the foreskin until adolescence.

Hygiene of the Fully Retracted Foreskin: For the first few years, an occasional retraction with cleansing beneath is sufficient.

Penile hygiene will later become a part of a child’s total body hygiene, including hair shampooing, cleansing the folds of the ear, and brushing teeth. At puberty, the male should be taught the importance of retracting the foreskin and cleaning beneath during his daily bath.

Summary: Care of the uncircumcised boy is quite easy. “Leave it alone” is good advice. External washing and rinsing on a daily basis is all that is required. Do not retract the foreskin in an infant, as it is almost always attached to the glans. Forcing the foreskin back may harm the penis, causing pain, bleeding, and possibly adhesions. The natural separation of the foreskin from the glans may take many years. After puberty, the adult male learns to retract the foreskin and cleanse under it on a daily basis.

• Questions And Answers About Infant Circumcision
• Care of the Uncircumcised Penis

WHAT IS CIRCUMCISION?
Circumcision is the cutting off of the fold of skin that normally covers and protects the glans (head) of the penis. This double layer of skin, the prepuce, is commonly known as the foreskin.

WHY IS THE FORESKIN THERE?

The foreskin comprises as much as half, or more, of the penile skin system and has three known functions: protective, sensory, and sexual. During infancy, the foreskin is attached to the glans and protects it from urine, feces, and abrasions from diapers. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury. Without this protection, the glans becomes dry, calloused, and desensitized from exposure and chafing. Specialized nerve endings in the foreskin enhance sexual pleasure.
“The foreskin protects the glans throughout life.” American Academy of Pediatrics (AAP)

WHEN AND WHY DID DOCTORS IN THE U.S. START CIRCUMCISING BABIES?

Doctors in the English-speaking countries started circumcising babies in the mid-1800s “to prevent masturbation,” which was blamed for causing many diseases, including epilepsy, tuberculosis, and insanity. Other reasons have been given since then, but all of them, including the claim that circumcision prevents cancer of the penis, cancer of the cervix, and venereal diseases, have been disproven.

We now know that the foreskin is a normal, sensitive, functional part of the body.

IS CIRCUMCISION PAINFUL?

Yes. Circumcision is extremely painful – and traumatic – for a baby. Just being strapped down is frightening for a baby. The often repeated statement that babies can’t feel pain is not true. Babies are as sensitive to pain as anyone else. Most babies scream frantically when their foreskin is cut off. Some defecate. Some lapse into a coma. The reason some babies don’t cry when they are circumcised, is that they can’t cry because they are in a state of shock. Most babies are circumcised without anesthesia. Anesthetics injected into the penis don’t always work.

DOES CIRCUMCISION HAVE RISKS?

Yes. Like any other surgery, circumcision has risks. They include: excessive bleeding, infection, complications from anesthesia, surgical mistakes, including loss of glans and loss of entire penis, and in rare cases – death.
Many circumcised males suffer from: extensive scarring, skin tags and skin bridges, tearing and bleeding at the scar site, curvature of the penis, tight, painful erections, difficulty ejaculating, impotence, feelings of having been violated, feelings of having been mutilated.
All circumcised males lose some or most of the sensitivity in their glans and all of the sensitivity in their foreskin.

IS CIRCUMCISION HARMFUL?

Circumcision amputates approximately 50% of the heavily innervated tissue of the penis that is a specific erogenous zone. Circumcision creates an abnormal physical appearance with disfiguring scar encircling the shaft and the glans penis permanently exposed to drying, abrasion, and mechanical injury.

PARENTS HAVE NEW CONCERNS

More and more parents – including Jewish & Muslim parents – are questioning the wisdom of subjecting their baby to the pain and risks of circumcision and its life-long consequences. Today parents are wondering if they have the right to consent to the irreversible amputation of a healthy, normal, sensitive, functional part of their baby’s penis – an amputation that experts regard not just as unnecessary, but as contraindicated. More and more parents are becoming truly informed and, as a result, more and more parents are deciding against circumcision and are keeping their baby boys intact.

HOW DO I CARE FOR MY YOUNG SON’S INTACT PENIS?

“Care of the uncircumcised boy is quite easy “˜leave it alone”™ is good advice” (AAP). External washing and rinsing with warm water is all that is required. Minor irritations may occur due to highly chlorinated water (swimming pools, hot tubs), too many bubble baths, harsh soaps and detergents, antibiotics, and concentrated urine from dehydration. Drinking water, soaking in soap-free warm baths, and running around with bare bottoms help healing. “Do not retract the foreskin in an infant, as it is almost always attached to the glans. Forcing the foreskin back may harm the penis, causing pain, bleeding, and possibly adhesions. The natural separation of the foreskin from the glans may take many years” (AAP). The first person to retract a child’s foreskin should be the child himself.

“My own preference, if I had the good fortune to have another son, would be to leave his little penis alone.” Dr. Benjamin Spock, Pediatrician

“Many parents today realize that if they had been given accurate information about circumcision, they would never have let anyone circumcise their baby.” Marilyn Milos, R.N.

“Circumcision is irreversible; I call for parents to be more considerate and responsible in their decisions.” Dr. Vigen Zargarian, Pediatrician

“Routine circumcision is not a medical issue or a social issue. It is a sexual issue and a human rights issue.” Frederick Hodges, Medical Historian

“The best reason to let a baby keep his foreskin intact is that it’s almost a certainty that he will be glad you did.” John A. Erickson, Intactivist

“Of all the horrors that have been visited upon Armenians in the last century, I hope circumcision was/is not one of them.” Gary Harryman, Intactivist

“From the perspective of Christian theology, it is essential to acknowledge that there is an inherent fundamental conflict in Christening and, at the same time, circumcising infant boys. Christianity proposes the concept of “circumcision of the heart” and not the “˜flesh”™ and one negates the other.”

Dr. Benjamin Spock, Pediatrician
“Many parents today realize that if they had been given accurate information about circumcision, they would never have let anyone circumcise their baby.” Marilyn Milos, R.N.
“Circumcision is irreversible; I call for parents to be more considerate and responsible in their decisions.” Dr. Vigen Zargarian, Pediatrician
“Routine circumcision is not a medical issue or a social issue. It is a sexual issue and a human rights issue.” Frederick Hodges, Medical Historian
“The best reason to let a baby keep his foreskin intact is that it’s almost a certainty that he will be glad you did.” John A. Erickson, Intactivist
“Of all the horrors that have been visited upon Armenians in the last century, I hope circumcision was/is not one of them.” Gary Harryman, Intactivist
“From the perspective of Christian theology, it is essential to acknowledge that there is an inherent fundamental conflict in Christening and, at the same time, circumcising infant boys. Christianity proposes the concept of “circumcision of the heart” and not the “˜flesh”™ and one negates the other.”

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