This is important care information for all intact children. It might seem silly that I am giving basic care about proper care of the genitals but I see parents getting improper information on a DAILY basis.
DEVELOPMENT OF THE GENITALS:
In both boys and girls the genitals are not fully developed at birth. Yes, all the parts are there, but those parts are not sexually developed. Both boys and girls are born with the prepuce (foreskin) that is fused to the underlying sex organ. On a girl it is fused to the clitoris and on boys it is fused to the glans (head) of the penis. The genitals are like a rose that will bloom will age and sexual maturity, there should NEVER be an attempt to try to pull at the foreskin of a girl or boy. In general we don't try to do this to girls but many people do not understand the importance of leaving a boy's foreskin alone. Trying to retract a foreskin causes tearing, scaring, bleeding, introduces infection, and other more serious complications. The foreskin is fused for a reason, to protect the underlying sex organ from urine, feces and other pathogens. With girls you never have to worry about a care provider or doctor trying to retract, but with boys it is a real danger. Stay with your newborn son at all times at the hospital. If they ask to take your son to the nursery, send a member of the family with him. Clearly address that your son's foreskin should NOT be manipulated in any way, shape, or form on your birth plan and consider buying a onsie that says "Please do not manipulate my foreskin". When you take your baby to your baby-well-checks always remind the doctor that he is NOT to manipulate your son's foreskin for any reason. Have this discussion BEFORE he removes your son's diaper. This might seem redundant but I find that doctors have a general curiosity to see what is "underneath". There is absolutely nothing for the doctor to see and there is no reason for him to try to manipulate your son's foreskin. Print off the following pamphlets and give them to your doctor if they ever try to challenge you. If the doctor continues to challenge you, take your son and leave. Do not put your son at risk to be forcibly retracted.
Answers to your questions about your intact son:
Dangers of Forcible Retraction:
Development of a Retractable Foreskin in a Child/Adolescent:
AAP Care for Intact Boy Guidelines:
Avoiding Circumcision after the Neonatal Period:
DIAPER CHANGES AND BATHS:
If poop gets on the penis you can wipe like a finger, from base to tip. Only clean what is seen. For both boys and girls wipe from front to back. For really messy diapers you should shower your child off. You DON'T need to wipe after urination this is totally unnecessary and could disturb the natural flora.
In the bath you just swish the genitals in the water. With both boys and girls you want to avoid bubble baths and soaking in soapy water. This can irritate genitals and cause flora imbalance (causing yeast). I always apply the baby wash to my children LAST after they have finished playing in the water and then rinse them immediately. Never apply soaps directly to your child's genitals.
Prolonged exposure to urine saturated diapers can cause redness or irritation/rash to the genitals of children.
When your child is learning how to wipe themselves remind them that they should not touch their bottoms then their privates. Teach them good hand washing.
For both boys and girls yeast infections can happen during the diaper wearing years or after a round of antibiotics. Yeast is easily treated with an anti-fungal ointment (prescription or otc). To avoid yeast infections you should always have give your child probiotics during and for one week after a round of antibiotics. You can get probiotic supplements from the pediatrician or from a health food store. They have some especially formulated for infants and babies. Probiotics are just healthy bacteria. Also, if you choose to cloth diaper you will want to strip your diapers with vinegar and hang them to dry in the sunlight if they have diaper yeast (thrush). Yeast can be quite hard to remove from cloth diapers. You will want to use disposables until the yeast on your baby is treated and all the diapers have been thoroughly stripped.
SPECIAL INFORMATION ABOUT THE DEVELOPMENT OF THE INTACT BOY:
During childhood/adolescence your son will go through a normal separation process as the foreskin separates from the glans. As I said before, the foreskin is fused during childhood to protect the developing penis from feces and other pathogens. Separation is different for each boy and happens at a different age for each boy. During this time he might experience some irritation, itching, stinging, minor redness, minor swelling, ballooning, spraying, smegma pearls, uneven retraction, etc. These are all totally NORMAL and resolve by themselves. I get get many concerned parents asking about their son's irritated, red, or slightly inflamed penis. 97% of the time it is just normal separation occurring. Some boys don't experience any of this but most boys have 1 of these symptoms at some point especially around ages 2-5 when boys really begin to explore their genitals with their hands. During self-discovery is a prime time for separation symptoms to appear. UNLESS it gets increasingly worse, extremely inflamed, he has fever, or you suspect yeast infection there is nothing to worry about. (Bacterial infections are VERY RARE and usually only occur only after forcible retraction or a wound to the penis.) Usually the symptoms of normal separation resolve themselves within 48 hours. Due to the fact that US doctors know very little about the development of the intact boy, it is wise to wait it out and let this resolve on its own. Since boys tend to be more "hands on" with their genitals and their genitals are not as internal as girls' genitals these symptoms appear more frequently than with girls. You may want to remind your son to be gentle with his privates as he begins to self-explore.
Print this article and keep it on hand:
Remember that just b/c the foreskin has separated from the glans does NOT mean that anyone should try to retract your son. The opening of the foreskin remains very narrow and widens with sexual maturity. A foreskin only becomes retractable after BOTH the foreskin has separated and the opening has widened. Hormones play a big role in the widening process. These hormones replace the fiberous tissue with a more elasticy tissue. Through self-discovery your son will learn when he is retractable. Only 50% of boys are retractable by age 10. It is normal for a boy to not become retractable until after puberty. The only person to retract a boy should be the boy himself. Once a boy/man is retractable he can retract his foreskin, rinse with water only, and replace the foreskin back over the glans during his showers. Easy as that!
***If your son becomes retractable at an early age you will notice that his glans and inner foreskin is very red and moist. This is NORMAL!!!! The intact boy's glans are an internal organ, unlike a circumcised boy. Circumcised boys develop extra layers of skin over their glans, this puts the blood flow further from the surface than with the intact boy. Because the foreskin is protecting the glans the intact boy's blood-flow is very close to the surface which gives it a red appearance. The foreskin is also very vascular (like the lips) so this also gives it a more red appearance. The normal appearance of the glans of the intact boy is red and moist. If your son becomes retractable at a young age, remind him that he should always replace his foreskin over the glans after retraction.***
KEEP THIS NOTE AND A PRINT OUT OF ALL THE LINKS PROVIDED TO PROTECT YOUR SON