I'm writing this article because this is probably one of the most
frequent misconceptions that I encounter. It seems that everyone knows
of a child or man who 'had' to be circumcised due to a tight foreskin,
also known as phimosis. When people hear these stories, most of them do
not question the validity of the diagnosis and treatment and simply
accept it as, "What had to be done". Could it really be that so many men
were designed with such a flaw or is this really just an epidemic of
misdiagnosis courtesy of widely foreskin-ignorant medical professionals?

In this article, I will give an overview of the development of the intact
male and explain why the diagnosis of phimosis in children and teens is
entirely phony. Additionally, I will outline what is true phimosis, its
proper treatment, and why our doctors are so confused.

Development of the Prepuce ('foreskin' in males/'hood' in females):

{parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_P07uaGtMQn4/S0f-GcDa7eI/AAAAAAAAClk/OiHmOpg2_3Y/s1600-h/IMG_5449.JPG"">During infancy the prepuce is tightly fused to the glans (head) of the penis.
The tissue itself is fibrous and dense at this age, as it is composed of
a whorl of muscle fibers. The opening of the prepuce acts like a
sphincter and only releases to allow urine to pass. This design serves
very important functions:

-It protects the developing penis from feces, bacteria and other harmful pathogens. This is especially
important during the diaper-wearing years when a baby is continually
exposed to his/her own feces (e-coli and other harmful
bacteria/viruses).

-It protects the developing glans and keeps them from becoming desensitized and keratinized.

-It protects against urinary tract infections.

As a child grows, the foreskin will separate from the glans. This can take many years for
some boys and for other boys, it seems to happen all at once. During or
after the separation process, there may be some shedding of dead skin
cells in the form of smegma (please note that women and girls also have
smegma). This shedding of dead cells aids in separation since it helps
the foreskin differentiate itself from the glans. There is no need to
try to clean smegma from underneath a child's foreskin. It will slowly
work itself out via the narrow opening. Once a child's foreskin is
completely differentiated from the glans this is not an indication that
retraction is possible.

Retraction is a separate function that is designed specifically for intercourse and masturbation. Retraction
enables the foreskin to glide smoothly over the glans of the penis. This
gliding stimulates nerve endings in both the foreskin and the glans. In
order for retraction to occur, the foreskin must have separated from
the glans and the opening of the foreskin must have widened to allow it
to slip back over the glans. How does the foreskin opening widen?
Throughout childhood and adolescence, there is a release of hormones. As
hormone levels rise, the fiber-dense tissue of the prepuce is replaced
with a more elastic tissue. A boy will begin to explore his genitals as
he grows and as time passes, the elastic tissue will allow the opening
of the foreskin to widen. This can happen at any age but it is not
common in young boys. In fact, only
50% of boys are retractable by age ten
. The other 50% usually
become retractable between age ten and the completion of puberty.

So why all the fuss about retraction? Well, many parents fear that if a
boy can not retract, he will get infections. This fear probably stems
primarily from misinformation given to them by their doctors and their
own fears about lack of hygiene. First, parents must know that there is
absolutely no need to clean under a boy's foreskin. As mentioned above,
the smegma produced by a boy is merely a shedding of dead skin cells. It
is not harmful will not harbor bacteria. Trying to clean under a
prepubescent boy's foreskin is the equivalent to trying to wash out a
girl's vagina. It is entirely unnecessary and, in fact, harmful.
Premature retraction introduces harmful pathogens, disturbs the natural
flora, creates scar tissue, damages the intricate structures and can
lead to long-term complications. Second, parents must know that
retraction of the foreskin is not a necessary function in boyhood.
Retraction is specifically designed for sexual relations. The only
function a boy's penis needs to perform during childhood is urination.
In other words, if a boy can urinate, then his penis is doing exactly
what it needs to do.

The Phony Diagnosis:

When a doctor diagnoses a boy with phimosis it is because he/she does not understand the normal development of the
prepuce. First, in order to diagnose this condition, the doctor would
have had to either try to retract the foreskin or encourage the boy to
try to retract his foreskin. This is a huge "no, no" for the reasons
described above. Second, there is no expiration date on developing a
retractable foreskin. Each boy is individual as to when the separation
and widening processes have completed. Just as each girl will begin
menstruation in her own time, each boy will experience retraction in his
own time. Since hormones play an important role in changing the
composition of the tissue of the prepuce, it is not abnormal if the
process isn't complete until the finish of puberty. Once an adolescent's
foreskin is retractable he can easily retract his foreskin in the
shower, rinse with water, and replace his foreskin over the glans. Most
men do this naturally during normal manipulation of their genitals while
showering. In the case that a boy becomes retractable before puberty, there is no need for
him to rinse under his foreskin, unless he so chooses. In the case that
an adolescent is not retractable, there is still no need to worry about
cleaning under the foreskin. Remember, it is not abnormal for retraction
to take until the end of puberty.

True Phimosis:

True phimosis is when a post-pubescent man is unable to retract his foreskin or becomes unable to retract his foreskin and he
feels discomfort during sexual activity. A small percentage of men (and
women) have prepuces that never retract. This can be a normal variation,
so long as it does not impede sexual activity. If it does impede sexual
activity then a man should seek conservative treatment. 90% of men with
this rare condition can correct the problem with the application of a
steroidal cream and stretching exercises. The steroidal cream mimics the
effects of puberty hormones and allows the skin to become more elastic.
A man usually applies the cream several times a day and uses manual
stretching exercises while he showers. Men should be wary of any doctor
who recommends circumcision prior to trying a more conservative
treatment.

Confused/Ignorant Doctors:

So why are most our nations doctors confused or ignorant as to the normal development of the prepuce? This question has a
few answers. First, if we look at the AAP (American Academy of
Pediatrics) recommendations, it wasn't until the 1990s that the AAP
finally warned against the harms of forcible retraction and outlined the
development of the foreskin in the intact boy. Prior to this AAP's
warning, it was widely believed that parents needed to retract their
intact sons for 'cleaning'. As you can imagine, this lead to many
complications for intact boys and resulted in many otherwise unnecessary
circumcisions. Second, there was a preliminary study of about 300 boys
to determine the average age of the development of a retractable
foreskin. This study concluded that most boys will become retractable by
age three. This out-dated study set an expiration date in the minds of
the medical professionals. A follow up study of thousands of boys
concluded that, in fact, only 50% of boys are retractable by age ten.
Many doctors, unaware of the most recent study, still operate under the
misinformation of the preliminary study. Third, the development of the
prepuce is not taught in medical schools. There is no discussion of how
the prepuce is structured, how it changes throughout childhood and its
protective and sensory functions. Essentially, the only thing medical
students learn is how to amputate the foreskin. Some medical students
may learn about the condition of phimosis but they are not informed that
this only applies to adult men, as children's foreskins are designed to
be tight. Fact is, the US medical profession has cut off so many
foreskins over the past century that the doctors rarely if ever saw an
intact boy and have lost the base of knowledge of diagnosis and
treatment. Now, professionals are operating in a vacuum of information
or even worse, in an environment of false information. As the nation's
circumcision rates have fallen dramatically, intact boys everywhere are
suffering the consequences of a widely foreskin-ignorant medical
profession. Each year thousands of intact boys between ages two and up
are circumcised unnecessarily at the hands of misinformed care
providers. Educating parents, doctors and future doctors is an essential
step to correcting this problem.

To see full article go to: http://www.drmomma.org/2010/01/phony-phimosis-diagnosis.html

Views: 210

Replies to This Discussion

Thank you for sharing this information! I've shared a lot of similar info to my sister in laws who have intact boys only because they didn't want to pay for circumcision. They were surprised at the information and very thankful. We need to keep the cycle of education going!
Thank you for posting this!!
I'm definitely not going to circ any of my future sons and I do read about a lot of people who claim their male children were diagnosed with phimosis. Or use it as an excuse as to why they got their sons circumcised as newborns.
I've had several family members circumcised in the 80s and 90s for this phony diagnosis and I continue to hear of boys who are falsely diagnosed. I feel that it is one of the greatest misunderstandings concerning intact boys. Feel free to pass this along and spread the facts! Here is another great link: http://www.kindredcommunity.com/articles/only-clean-what-is-seen-re...

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