I just received an e-mail from a listener asking about the care of her infant son’s uncircumcised penis. Her baby is four-months-old and she wondered how to wash the penis and if she should pull back the foreskin. In an uncircumcised infant the foreskin (the skin that covers the head or the glans of the penis) will not really retract, and you do not want to “force” it. You should just clean the tip of the penis with soap and water while bathing the baby and over time, typically by the time a little boy is 5 years old, the foreskin will become fully retractable. Once the foreskin is retractable (as adhesions have broken down on their own) you can retract the foreskin and clean the glans (head) of the penis and teach your son to do the same thing.

Seeing that we are already discussing the uncircumcised penis it is a good time to discuss the pros and cons of circumcision. The American Academy of Pediatrics (AAP) does not routinely recommend circumcision of male infants. They state that it is a matter of choice for families to make. Circumcision rates in this country are around 55 to 65 percent and are variable in different geographic areas. Circumcision may also be routinely performed due to cultural or religious preferences, or for the social reason of wanting sons and fathers to “look the same”.

There has been some recent literature showing that there is an increased frequency for uncircumcised males to develop a urinary tract infection (up to 10 times more likely).  The incidence for male urinary tract infections is still low, but further studies are being done to determine if circumcision should again be routinely recommended. There is also an increased incidence for irritation, inflammation and infection in uncircumcised males, as the uncircumcised penis may be more difficult to clean. There has also been data to suggest that circumcised males have a lower risk of contracting sexually transmitted infections, including HIV. Lastly, the incidence of penile cancer (although rare) may be higher in uncircumcised males.

All of these issues continued to be studied, so ask your pediatrician about ongoing data if you are trying to decide whether to circumcise a newborn boy. Like so many things in medicine, continued studies may bear new recommendations.

That’s your daily dose, we’ll chat again tomorrow.