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Daily Dose

Circumcision Care

How to care for a baby's circumcisionThe questions continue about little boys and circumcision.  Recently, a reader asked if her 7 month old son’s circumcision could “grow back”.

I am often asked this question when examining little boys especially infants who have a large “fat pad” above the base of their penis which pushes down on the penile shaft. Once a boy has been circumcised (see old post on this issue) and the circumcision has healed, I show parents how the “head or glans” of the penis should look and how to continue to push back the foreskin when they are bathing their son. There are definitely two schools of thought on this and some doctors prefer to just “leave the skin alone.”  Pediatric urologists seem to differ on their thoughts on this issue too.  At any rate, if you push on the base of the penis with your fingers around the shaft  the skin will spontaneously pull back and the glans of the penis may be washed. If you do not do this then debris will gather in the area around the glans and the skin will get “stuck” with the “gunk”  there and the penis will not only look different, but at times it will appear as if the “circumcision has grown back”. When this occurs, the result is termed penile adhesions.  But, bottom line, by beginning to clean the penis thoroughly and retracting the foreskin wit diaper changes and bathing the problem usually does not get started. When a circumcised male infant is in my office for their routine check up and found to have penile adhesions I point out the issue to the parents. This is typically at the 2, 4 or 6 month visit.  They may even note during their questions as I start my exam that their sons penis looks “funny” and would I make sure that I “ check it out”.  The adhesions are typically very thin at this point and it is easy to manually reduce the adhesions with very little pain to the infant. In my experience this is preferable to waiting until the adhesions are worse or sending the patient to the urologist. It is easy for the parent’s to then get a visual of what their child’s penis looks like with and without adhesions as they often forget what the glans or head of the circumcised penis looks like.  I tell them it should look like a mushroom cap with the stalk beneath.  When the fat pad has pushed the skin over the penis it is important to review cleaning as the penis often gets hidden (like a turtle in the shell) and hygiene may not be as easy. I tell parents to continue cleaning the penis just like other areas of their child until they are bathing or showering alone. It is really easy (I have 3 sons). If boys do continue to  develop penile adhesions they will typically resolve on their own once the child reaches about 5 years of age. So for worried parents with preschoolers I reassure them that “this too shall pass”.  Occasionally severe cases of adhesions where an actual band of tissue occurs may require surgical intervention. I do think that there are many pediatricians with differing views on penile adhesions, just as with many other no life threatening issues in pediatrics. That's your daily dose.  We'll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

Caring For An Uncircumcised Penis

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.

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