Managing Foreskin Care in Young Boys: Addressing Pain and Concerns

Issues related to foreskin cleaning?

My son is now over 3 years old and has a condition of urinary reflux.
He is regularly followed up by a pediatric nephrologist.
I have seen two doctors who both advised that the foreskin must be pushed back daily to expose the glans for cleaning.
When he was about one year old, a doctor forcefully retracted the foreskin, which caused severe lacerations, and insisted that I clean it this way every day.
Since then, I have been doing this daily, but I have noticed that occasionally there are lacerations on the foreskin.
In the past month, the occurrence of these lacerations has increased.
I consulted a doctor about this, and the doctor said that the tightness of the foreskin is not an issue (the doctor also retracted the foreskin during the visit), but as soon as we left the office, my son kept saying that his penis hurt.
I immediately noticed a new laceration on the foreskin.
Now, my son is very anxious about urinating and is afraid of anyone touching his genital area, including himself.
I would like to know if, given the continuous lacerations of the foreskin, which have already caused significant psychological distress for my child, should I still continue to retract the foreskin for cleaning every day?

EVA, 30~39 year old female. Ask Date: 2015/10/24

Dr. Xiao Kaiwen reply Pediatrics

When cleaning the glans and foreskin of young children, it is important to gently retract the foreskin to expose the glans for cleaning, adhering to the principle of avoiding injury.
There is no need to forcefully retract it, as this could cause harm.

Reply Date: 2015/10/24

More Info

Managing foreskin care in young boys, particularly in the context of your son's experiences, is a sensitive issue that requires a careful balance between hygiene and comfort. It is understandable that you are concerned about the recurring injuries to your son's foreskin and the psychological impact this may have on him.
First, it is important to recognize that the foreskin is designed to protect the glans (the head of the penis) and that many boys are not fully retractable until they reach puberty. Forcing retraction can lead to pain, bleeding, and even scarring, which may explain the recurrent injuries your son is experiencing. The American Academy of Pediatrics (AAP) suggests that parents should not forcibly retract the foreskin in young boys, as this can lead to complications. Instead, gentle cleaning of the external area with mild soap and water during bath time is usually sufficient.

Given your son's history of painful experiences with forced retraction, it may be beneficial to reconsider the approach to his foreskin care. Here are some recommendations:
1. Gentle Cleaning: Instead of pushing back the foreskin daily, focus on cleaning the external area gently. You can wash the penis with warm water and mild soap, ensuring that you clean around the foreskin without forcing it back. This method can help reduce the risk of further injuries.

2. Monitor for Symptoms: Keep an eye on any signs of infection, such as redness, swelling, or discharge. If your son experiences any of these symptoms, it is essential to consult a pediatrician or a urologist specializing in children's health.

3. Pain Management: If your son is in pain, over-the-counter pain relief medications, such as acetaminophen or ibuprofen, can be used as directed for children. However, it is crucial to consult with your child's doctor before administering any medication.

4. Psychological Support: Given that your son is developing anxiety around his genital area, it may be helpful to address these feelings. Reassure him that it is normal to feel discomfort and that he can talk to you about his feelings. If his anxiety persists or worsens, consider seeking support from a child psychologist who can help him process his fears and develop coping strategies.

5. Consult a Specialist: If the problem continues, it may be worthwhile to consult a pediatric urologist. They can provide a more thorough evaluation and discuss potential options, including whether any medical intervention is necessary.
6. Education: Educate your son about his body in an age-appropriate way. Help him understand that it is normal for boys to have different experiences with their bodies and that he can always come to you with questions or concerns.

In conclusion, while maintaining hygiene is important, it should not come at the cost of your child's comfort and mental well-being. A gentle approach to foreskin care, combined with open communication and professional guidance, can help alleviate both the physical and emotional challenges your son is facing. If you have ongoing concerns, do not hesitate to seek further medical advice to ensure your son receives the best care possible.

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