Saturday, January 30, 2010

Basic Care of the Intact Child

By Jennifer Coias © 2009
See also: Intact Care Resource Page



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. For a girl wipe from front to back. For really messy diapers you should shower your child off or take a bath with clean, warm water. You DO NOT need to wipe after urination. This is totally unnecessary and could disturb the natural flora of the genitals. As children learn to wipe themselves teach them the importance of wiping from front to back and washing their hands after they finish.

In the bath, just swish genitals gently 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 son LAST after he has finished playing in the water and then rinse him immediately. Never apply soaps directly to your child's genitals or try to 'scrub' them. Warm water is enough.

Prolonged exposure to urine saturated diapers can cause redness or irritation/rash to the genitals of children.

YEAST 411:

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 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 you ever get 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 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 trauma 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 U.S. 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 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.

Important Article--- Protect Your Intact Son, Expert Medical Advice

Here is a helpful article about separation

Remember that just because 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 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 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.


Additional Resources on Intact Care and Forced Retraction can be found at How To Care for Your Intact Son.



Also by Jennifer Coias:

31 comments:

  1. Thank you for posting this. My pediatrician started to retract my son at our well baby check a week ago. I smacked her hand away before she could finish. Because she had never tried before I assumed that she wouldn't try this time. From now on I will make sure they know NOT to before his diaper is even off. I'm going to send some of those links to my pediatrician too! Thanks!

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  2. Our pediatrician has always pushed back our son's foreskin just a little at well-child visits--not like she's trying to scootch it back over the glans, but just up to the end...is this forcible retraction that I need to ask her not to do, or not?? Should she really not be touching it AT ALL? She has never said anything that seemed amiss about telling us to retract/clean, etc so I figured that she knew what she was doing, but since we are in MI and have one of the highest circ rates that still may not be the case...

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  3. Good points! I would like to add that for yeasty diaper rashes you can apply a probiotic directly on the rash. Mix the contents of a capsule with some water to make a paste or dump it dry on to the area. Try to keep diaper off as long as possible. Works wonders and no need for Rx anti fungal.

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  4. There should be a blanket rule: just don't let the pediatrician take off the diaper ever. What do they need to see anyway? Or how about not going to the pediatrician in the first place, they just wanna mess with your kid and make more money. Toxic vaccines, foreskin retraction, yikes. I recommend only taking your kid in if they have an earache or broke their arm. Healthy breastfed kids are perfect and doctors just mess with em, foreskin retraction being one prime example. My kids don't have any allergies, no doctor ever retracted their foreskin or shot them up with poisonous vaccines, they therefore don't have asthma, adhd, autism, they don't need glasses, they are perfect weight, they are perfect in every way and its because I kept them away from the goddamn doctors who would have wanted to cut their weiner off and shoot 'em up. There you have it, I said it. Take your kid in only if he has an earache, rash, broken arm, etc, but not if they are well!!!! Any "well child" visits are just a scam to make money off of your kid and create illnesses with vaccines that they will later make tons of money off treating.

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  5. I gather that the author of this article is the great Jennifer Coias, one of a number of American women who have become very eloquent advocates of intact this century.

    When I was 7, my pediatrician asked to be alone with ne, then forcibly retracted my foreskin. I really don't know why he did this. There was some discomfort, no sharp pain, certainly no damage. I suspect that my skin had already fully separated from the glans. He never did this again. I assumed that he believed that a boy should be retractable by age 6-7, and if this did not occur naturally, nature should be nudged.

    The only other time he said anything about my being intact was to ask me if my school mates were intact. This burned in my soul that the real reason Americans circumcised was the fear that if one didn't, one would be seen as hopelessly weird.

    But nothing was told to me in childhood, except frequent reminders to "wash where the doctor told you." I do not recall having been told anything, but I knew what my mother had in mind. I was never told why I looked different from my father, brother, and school mates. I was never told that while I was not at all the norm, I was fine. This is because when we baby boomers were young, there was not a single word in print saying that intact was OK. The USA intactivist conversation did not begin until Mothering magazine started in 1976.

    In 2009, my mother told me that this doctor supported her decision to leave me intact. I was quite surprised to learn this, because he very much left me with the impression that he thought I was aberrant.

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  6. Thank you for this post and the very first comment- I felt traumatized when our ignorant pediatrician retracted our son's foreskin without my permission at his well baby appointment. She just did it, as she was asking me if I ever do it, and telling me I need to do it- and I freaked out! I told her NO I don't do it because all the sources I have read say NOT to retract the foreskin! My poor baby!!! Getting a new pediatrician for sure!!

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  7. This makes me so thankful for our pediatrician who has intact sons herself. She told me she was so glad that I made the decision I did. I really don't see a reason for taking the diaper off at well baby visits. The only time that it might be necessary is in the case of severe diaper rash or suspected UTI.

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  8. thank you for this. i'm also very reassured to see you should not wipe after urination. something always told me not to and his dad reprimanded me for it. i asked him if he wiped after peeing and the argument was over.

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  9. Jen - regarding the pediatrician taking the diaper off - there IS one reason to do so that I know about, and that is hernias. We have a child in our family who was obviously distressed, screaming and crying constantly for several days after having been a happy and content baby with no evidence of problems up to that point. He was around a year old at that time. A doctor's exam after taking the diaper off revealed that he had developed a hernia that was very bad, and required surgery to repair. The child is now 9 (if I remember correctly, I always have trouble remembering ages) and has had multiple surgeries to repair multiple hernias, all in different places. I know I remember 4 surgeries, and one of the surgeries repaired two hernias. Even a well-respected specialist at a children's hospital cannot figure out why this keeps happening. They have seen so many doctors in their search for answers that I do not know how his mom keeps it straight.

    This is an extreme case, yes, but if it was my son I would definitely want it caught before it got to that point that it was so painful. Before that visit, he had never had an exam with his diaper off. The pediatrician said that it might have been caught before it got to that point, but there was no way of knowing for sure if it would have been obvious.

    Our pediatrician asks me to unfasten and open the diaper during the exam, quickly looks and says "transmission looks good" (he has car names for some of the body parts... we use the proper names for body parts, but my sons LOVE his names and get a good laugh out of it) and covers him back up and moves for me to redo the diaper. He has touched only once when the tip of his intact penis was a bit red from a particularly bad diaper rash (poor baby has my sensitive skin) and I asked him if neosporin was the best treatment. He lifted my son's penis to look underneath to examine how much of the penis was affected before answering.

    ANY doctor who attempts to retract needs proper training, and I would suggest that you provide them documented medical information on the subject. Blogs are great for us to get information, but most doctors are not going to look at it, much less follow the guidelines listed. As for finding documented medical information on it, I'm at a loss for sources. Maybe try sources from other countries with lower male genital mutilation (aka circumcision) rates.

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  10. A note on (normal) redness from "diaper rash" or friction (rubbing on diapers) or heat rash: One of the best items to use (that does not irritate the genitals, aids in soothing and healing, and allows the genitals to maintain their proper pH levels) is Calmoseptine. You can pick it up on the shelf at most Walgreens or request it at any pharmacy (a lot may need to order it overnight if they do not have it in stock). One tube costs about $5-6. This is an exceptional product and better than any other 'diaper cream' out there. It is also likely the best over-the-counter product for other skin sores and ailments. Highly recommended for all homes with babies or kids (or elderly persons with skin irritation). Their website:

    http://www.calmoseptineointment.com/

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  11. The genitals only need warm water - no soap required. Can't get EASIER than that!

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  12. Right - you're actually NOT supposed to wash the inside with soap! Girls OR boys.

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  13. A baby penis does not need to be washed inside - just WIPE LIKE A FINGER! Outside only. Premature retraction to 'clean underneath' is what causes all the problems in the first place!

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  14. Actually we don't *need* to use soap at all, water alone can and does get a body clean...soap is really not good for us in general. Just sayin'.

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  15. Hi,
    So glad someone sent me to your site. I have had a ton of questions and concerns and you give very straight forward and easy to understand information. Our son is not circumcised but my husband, unfortunately, is so he's no more familiar with the foreskin than I am. So I'm trying to make sure I'm doing the right things. And all the info you have is really great. I also wanted to mention, someone wrote on here about don't even let a dr. see your boys genitals, though for the most part I agree, if my dr. hadn't looked at my son we wouldn't have realized he had an undesended testicle, which if it doesn't come down, it sounds like it can cause alot of damage later in life. So for that I'm glad to have had my dr. take a look down there. But I'm also glad I know to talk to my dr. and watch out for any forcible retraction "attempts", etc. I feel much more prepared. Thanks again!!

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  16. As far as I'm aware, one of the reasons doctors routinely check an infant or child's gential area is to check for signs of abuse. A good doctor with good practice will tell a child that noone should touch them "there" other than parents or doctor with parents present. If you refuse to remove a diaper, you could be alerting suspicion. That's not to say you can't insist that the doctor leave your child's foreskin alone. I found the comment that a healthy, breastfed baby should not be seen for well-visits naive and misleading. Breastfeeding does not give a child immunity to all health issues. It boosts and increases immunity. I've known many a breastfed baby who suffer from ear infections, digestive issues, frequently colds and 'flus and of course there are many other "red flags" and milestones that doctors are checking for.

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  17. I have four intact sons and live in an area this is not even an issue (Sweden). We've never had a physician remove our sons' diaper during a check up, and I asked around, but no one has heard of such a thing. What is with checking the penis of a child? If there is a problem, would the parents not know and seek help?

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  18. I am so lucky that our pediatrician was very STRICT that we do not retract the penis. I was the uninformed one, but thankfully hadn't done anything yet. My mother-in-law is a surgical nurse and does circumcisions often. She's the one who brainwashed me into thinking I was supposed to start retracting it to clean it and I believed her because I trusted she was more educated in the field than I was. So thankful for that doctor!

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  19. In response to the last Anon and so many others I've read elsewhere - what is up with all the "you have to retract it!" comments coming from those who are PRO-cutting? I don't get it... It is as though ignorance about the normal, healthy, intact body goes hand-in-hand with being fearful of this beautiful organ and wanting to destroy or remove it.

    It also is rather ironic that the very things you are not supposed to do to an intact child are those things pro-cutting people push... and then USE to say, "Oh, see, he has a problem now - so you should cut it off." The issues would have never risen in the first place if the terrible advice had not been given.

    How is this 2011 and we still are so blind as a nation. Wake up people!!! It takes about 30 minutes of research - that's it. And you will know how to properly care for an intact child, and not damage him in the process.

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  20. Our 3 year old son ended up in the ER w/ a coin stuck in his throat. They wouldn't so surgery for 4 hours after he last nursed so I decided to leave he & dad at the hospital to be home with our other children. When I came back to the hospital after the surgery my husband told me that the doctor commended us on not circumcising, which was nice because my husband had wanted to. The next thing my husband said was that the doctor had pulled the skin back and took a look. I'm still shocked and confused by this. Think I'll print this out and send it in with the next bill payment.

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  21. I am so totally confused now about wether or not i want this done to my son. I did not know until now that it came with so many possible complications, thanx for the info!

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  22. I printed off the AAP Guidelines article and handed to the PA at my son's exam yesterday. I told her I didn't want him even touched. Apparently she belived me. She didn't even look at him!! So, thank you!!

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  23. Thank you so much for all of this wonderful information. Yesterday, my husband and I were dead set on circumcising our son. (who is due in 4 weeks) I had actually googled "when" to have it done, and luckily I found this website!! After doing some reading, I made my husband watch a video with me of how a circumcision is performed on a newborn. 2 minutes into the screaming video, we quickly made the decision to NOT circumcise our son! Thank you so much for saving us the guilt and regret that we would have blindly entered into. We will let our son make his own decision once he is a man, whether or not he wants to be circumcised.

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  24. I did all sorts of research before our son was born a year ago on proper care of intact boys. We also found an amazing doctor who knew even more than we did - and NEVER tried to retract his foreskin. Then we moved across the country. I took my son in for a 12 month well-child check at our new doctor today, and was taken by surprise and shocked when she proceeded to retract his foreskin! I grabbed her hand and said "stop! please don't do that!" but she continued to, all the while saying we needed to do retract his foreskin to clean under it because if we don't it can fuse and develop adhesions, etc. I'm so upset over it! I feel like a horrible parent and like I've let somebody violate my son. :( I'll be finding a new doctor soon, and next time I will be on my toes. sigh. :(

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  25. As far as the last comment goes, don't beat yourself up over it! My son's first doctor pulled on the foreskin when he was about 1 year and caused some bleeding, crustiness following and irritation. Luckily it healed (I'm assuming there is not permanent damage, but I'm not an expert), but I was upset and annoyed because it happened so fast; it was like he was peeling an unripe banana! The dr. didn't say anything, he just did it! He didn't even say why he did afterward and I had assumed it was what was required, but because it appeared like it may have hurt my son, I did more research and realized I should have jumped up and stopped him! I still feel terrible and my son is now 3. I am going to buy one of those onesies for my second son that says intact, don't touch - this experience taught me to speak up. Since this dr. also thought I was ridiculous for wanting to space my son's vaccines out further than the typical schedule, questioning my "sources," and when I mentioned I had read Dr. Sears, he simply said that dr. didn't base his practice on any facts, just emotion, I decided to change drs. He insulted my intelligence, obviously has not read anything on Dr. Sears who is a pediatric dr. with maybe 9 of his own children (?), and was very arrogant. With some reservations, I did stay with the group, just not that dr. (I am fairly new to the area where we live so I'm uncertain about where to go now, but we may change as I learn more). In any event, I still feel very guilty about the dr. "peeling" my son's skin...but it appears all is well now and the new dr. does not touch him at all. Now I just have to worry about the new baby in July and make sure no one bothers my son in the hospital at birth...I will be extra vigilant this time but wanted to share so other moms felt better about someone else going through a similar experience; you're not alone!

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  26. What do you do if poop gets under the forskin from a messy diaper? I am due in four weeks with our first boy and we have made the decision to keep our son intact. I just don't know what I'm suppose to do if he gets dirty under his foreskin from a messy diaper ect...

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    1. One of the primary reasons the foreskin is TIGHTLY adhered to the glans of your baby at birth is to keep things out of the urethra. One of its purposes in infancy is to protect the body from invaders (viruses and bacteria) - especially during the diaper days. Rarely does poop actually enter the foreskin - unless someone is trying to mess with, retract, pull back, or 'clean' inside the foreskin. THIS causes tears, introduction of bacteria, and problems down the road.

      So the best guidelines are to wipe down the outside only - do not shift, move, or pull back the foreskin or let anyone else do so. And if there is a really messy diaper, take baby into a warm water bath (no soap) to 'swim' around a bit with your help - swish water all around and get things nice and clean that way. All that is needed in this early time are warm water baths, gentle wipes for the outside of baby's bum, and, possibly some Calmoseptine that you can get at your local pharmacy for any redness/irritation/rashes that come up. Calmoseptine is the best ointment you will find, and it will not interfere with your baby's healthy pH and microflora of the genitals. It can be used on the *outside* of the penis/foreskin/scrotum and bum. You do not need a prescription, but will need to request a tube from the pharmacist. If they do not have some, they can order it overnight.

      If you haven't read through other items on this page, you may wish to do so as well: http://www.drmomma.org/2009/06/how-to-care-for-intact-penis-protect.html

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  27. Hi, my name is hannah and I recently came across a debate about circumsision and all the negatives about it. Being a first time mother and listening to everyone say it should be done, I got my son circumsised. After reading all the comments in the debate, I never once came across a positive reason why it should be done. I am so glad I was sent to this sight because even though my son was circumsised I notice he still has skin that covers a lil over 3/4 of the glan. I feel it was only partially done. Is that possible and if so what is the proper care for it?

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    Replies
    1. Hi Hannah --

      It is very common today to have a child with a 'loose circumcision' - and this is actually better for your son than being cut too tight/too high because it will give him more slack skin to work with as he grows and his penis becomes larger. Many physicians today who do not really wish to perform circumcision, but still do for whatever reason they have, cut loosely so that a child will not have pain as he grows, and so that men (as adults) will not suffer from painful erections, sex, etc. Unfortunately this happens all too often when there is not enough left over to allow the penis to grow normally.

      At this point the best thing to do is to follow other standards for intact care. You can find many of them here: http://www.drmomma.org/2009/06/how-to-care-for-intact-penis-protect.html

      If you have specific questions, please feel free to email DrMomma.org@gmail.com and we will have one of the clinicians who volunteers for PP respond.

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  28. Hi, our son is adopted, and came to us several months ago, at 4 months old, intact. We didn't retract his foreskin and left it alone. A couple of weeks after he came home, he had a few bouts of diarrhea, one of which resulted in stool appearing to enter the opening of his foreskin. I gently retracted it to wipe it, and it slid right back. Completely retracted, no apparent discomfort, moist, purplish-red glans. I mentioned this at his next Dr. visit, and she gently pulled back on it and actually gasped when it slid back. Her advice was to retract in the tub for a water rinse once a day, and other than that, leave it alone. My question: Is it possible our son's foreskin naturally separated before 4 months old, or it is more likely that he experienced forced retraction/separation? If it was forcibly retracted/separated, could a one time occurrence resulted in a completely retractable foreskin, or would it have required repeated attempts. (Our son came to us with a history of neglect and abuse, and in trying to put the pieces together, I wonder if this is one more piece of his puzzle). Also, going forward, is our physician's advice reasonable or should we completely stop retracting his foreskin?

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    Replies
    1. Anon -- while it is rare, it is possible for the foreskin to retract in early babyhood. It is more likely (especially given his history) that he was forcibly retracted by someone who did not know how to properly care for him. However, at this point - no matter if he were retracting or not - the care is the same. As a baby he does not need anyone retracting and 'cleaning' under his prepuce. Soaking in a warm bath is great! But there is no need to retract or rinse until after puberty. You likely have these resources, but if not I will include them: http://www.drmomma.org/2009/06/how-to-care-for-intact-penis-protect.html

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