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As a parent, the decision to circumcise or not circumcise your newborn’s penis may be based on multiple reasons- cultural, religious, health benefits, personal or other family reasons. Whatever it is, it’s your choice.

The rates of circumcison varies widely by location (country) from over 90% in Israel about 86.3% in South Korea, to 50–80% in the United States, to 58% in Australia, to 45% in South Africa, to 20.7% in the United Kingdom, to under 1% in Japan and Honduras.   

Over the years, the population of parents who have decided to circumcise their child’s penis has actually declined. According to the  Centers for Disease Control and Prevention (CDC)—58.3 percent of boys were circumcised in 2010, 10 percent decrease from circumcision rates in 1979. These numbers have further declined by now.

Here is the challenge. with rates declining, not a lot of parents and/or healthcare professionals know (or teach) how to care for an uncircumcised penis in kids. Most parents who have thir children circumcised are taught how to care for the penis after circumcision.

What happens if uncircumcised penis is not cared for correctly?

Circumcision involves involves surgically removing the foreskin to expose the head of the penis. For the uncircumcised penis, this foreskin is intact and not removed. 

Unfortunately, some families attempt to pull back this foreskin while cleaning and that ‘SHOULD NOT’ be done.

Forcefully pulling back the foreskin could cause:

• Pain to the child
• Bleeding around the penis (think about tearing off skin)
• An emergency condition called Paraphimosis (where the foreskin gets stuck under the penis)- causing swelling and more pain.

So, how do you clean the uncircumcised penis in babies?

Remember these steps:

• Clean only what you see like you would other parts of the body (less is better)
• Wash with mild soap and water Or clean with water wipes  during diaper changes
• DO NOT FORCEFULLY PULL BACK (RETRACT) THE FORESKIN.

As your child gets older, the foreskin will self-retract (seperate) and can be easily pulled back on its own. This may occur before 5 but in most kids it may occur between 5 and 7 years and in some others, the foreskin may not fully seperate till puberty.

How do you clean it after the foreskin retracts (seperates)?

Since this happens when children are a little older, you should teach your child how to do this themselves:

• Gently pull the foreskin back from the head of the penis
• Rinse the inside of the foreskin and the head of the penis with mild soap & warm water, 
• Then allow the foreskin to return to its position on its own or they can gently pull it back. This step must be done or it may get stuck as described above (paraphimosis).

What about the white bumps my child is noticing during seperation? 

Your child may notice the small white bumps underneath as the foreskin starts to seperate. These are normal and are essentially cells that were attached to the foreskin that are shedding off. It is called Smegma and usually nothing to worry about.

What if my son needs to be catheterized to obtain urine, how can it be done safely?

As an ER physician, it’s not uncommon for me to request to obtain urine from a baby if I am concered about a urine infection. In that case, the best way to get a clean sample of urine is through catheterization.

This process entails using a sterile, rubber or plastic small tube to insert into the urethra (tip or hole of the penis that leads to the bladder. This may be uncomfortable but typically not painful.

It’s more easily done in circumcised but for the uncircumcised penis, accurate technique is required to avoid pain.

Here are some tips (for both parents and healthcare professionals)

• Never forcefully pull back the foreskin beyond what it has naturally separated. 
• Manipulate the penis gently to see if you can see the urethral meatus (hole)
• With the thumb, stabilize the penis and with the index and middle fingers occlude the space and guide the catheter through the preputial opening into the urethral meatus. (see image below)

Remember to advocate for your child to ensure it’s done properly.

If you are looking for tips for diaper rash for your little one be sure to check out this post: Diaper rash tips

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