Medical Professionals for Genital Autonomy
The majority of men worldwide are happily intact for a lifetime, and these numbers continue to rise each year with education and awareness raising among the United States' population. Today, not only do most parents keep their children intact regardless of their nationality, but also more Jews, Muslims, and Christians opt to protect their sons as they come into this world - perfectly intact.
Because most men have normal (intact) genitals across the globe, male development and intact care is also taken as a given - almost commonsense. Parents know not to retract until a child does so on his own, physicians are not engaged in premature or forced retraction of their patients, and the foreskin is left alone to do its job. There is no more meddling with a male child's foreskin than there is with a female child's foreskin (her clitoral hood). Neither is disturbed with retraction, soap, or "cleaning." The foreskin is regarded as useful - some say "the best part" of the genitals. And as a result, children grow into adults who are able to enjoy their full, functioning genitals for a lifetime. In most of the world today, when a man becomes an older adult it is common knowledge that care of his genitals does not change - a warm water bath or shower is sufficient for cleanliness. Should he enter assisted living care, his nursing staff is familiar with the foreskin, as it is something all humans have, and it is seen as just another normal body part.
In the United States, however, we tend to observe a different picture of nursing home care for our elderly, intact men, than the rest of the world sees. Here, nursing staff working in assisted care facilities are not routinely trained in the correct care of an intact man, and have often grown up in the midst of a cutting culture, where foreskin is yet to be well understood, known, or appreciated. As a result, this organ is seen problematic and U.S. based nursing personnel come up with a host of bizarre, mythological notions about its care.
After working for 14 years at a well respected nursing home facility outside Madison, Wisconsin, I've come to find that the vast majority of these rumors about intact adult men are quickly put to rest with some very simple, very basic, facts on the care of elderly men. I am writing here to share these with the hope that it will make things easier for nursing staff, and the men in our care.
How to clean the intact genitals of an elderly man in assisted living
1) Have the patient enter a warm water-only bath or shower in your facility.
2) Gently run warm water over the outside of his penis and scrotum. Using the hand cloths typically used for baths in your care facility, without soap, run your hand cloth along the groin, scrotum, and exterior of the penis to ensure it is fully washed with warm water only.
3) Gently retract the penis while it is either submerged in warm water, or while warm (not hot!) water is running over it. This keeps the tissues relaxed and does not cause a sudden change in temperature for an elderly gentleman who is sensitive to such things. While the foreskin is retracted, run warm water (no soap) over the interior parts of the penis for about 5-10 seconds, or gently 'swish' in warm water if this man is submerged in a bath, for the same 5-10 seconds.
4) Gently move the foreskin back down over the end of the penis, keeping it in warm, clean water (or under warm running water if in a shower and not a bath). Keeping the penis in warm water allows the tissues to remain relaxed and easily moved.
5) After this is complete, move on to using soap for the buttocks and scrotum, and other parts of the body where soap is justified. Soap does not need to come into direct contact with the intact penis, and the foreskin does best when it does not have soap applied to it. Soap interferes with pH and microflora of the penis and foreskin, and increases the likelihood of future issues, especially when it is placed inside the penis (i.e. when the foreskin is retracted). Ensure all soap used on other parts of the body is rinsed clean with warm running water at the end of the bath -- be diligent that a man is not left unrinsed, or sitting in soap suds.
That's it! Task complete.
If this warm, water-only rinse for 10 seconds is done once or twice each week, the foreskin will maintain its normal form and function, and all will be well. If you notice irritation or inflammation occur on the genitals, or other parts of the body, Calmoseptine is the best choice of ointment to quickly soothe and alleviate such things. Apply through gentle dabbing on any red, irritated, or inflamed areas of the genitals. If the sore area is on the penis itself, apply Calmoseptine to the outside only of the penis -- do not apply under the foreskin. It will work its own way inside.
One quick note should be added about the difference in care between an elderly man who has been retracting his entire life, versus a pediatric patient. If you switch your location of nursing care to working with children, instead of adult men, know that retraction should not take place in the normal care of a baby or child. For an infant or child, wash with warm water (or a wet wipe) only on the outside of the penis and foreskin. Never retract a baby or child. The foreskin is tightly adhered to the glans (head) and shaft of the penis through most of babyhood and childhood. Only later (average age 10.5 years) does retraction begin to naturally occur. If a child has his foreskin retracted by someone else it can cause tearing, bleeding, scarring, adhesions, and problems later in life. This is more often the case if retraction is a repeated occurrence. Retraction is a sexual function, and it is not something that need occur before puberty. Some young men do not retract until even later (or never fully retract at all) and this is also within a normal range of development. Find further intact care information of children from four of the major pediatric health organizations at the bottom of the Physicians' Do Not Retract page at Saving Our Sons.
Nursing Home Myths and Facts
Myth: Elderly intact men need to be circumcised at alarming numbers because it is so difficult to clean, and/or the foreskin becomes problematic in older age.
Fact: Only in the United States do we hear such nonsense. I have served with Mercy Ships overseas, as well as in elderly care settings as a volunteer aid worker in three other (primarily intact) nations, and not once did someone suggest that the intact man was difficult to clean, or that his foreskin would ever become problematic. In fact, when I brought this up on a couple occasions to see what my fellow care givers responses would be, they looked at me as though I had two heads. Across the rest of the globe, elderly care facilities (what we typically refer to as nursing homes) are present, but never are nursing staff heard complaining about the normal male body, its care, or its (mythological) demise.
It is true that nursing programs (and medical school programs) in the United States have a long way to go in teaching proper intact care and development. In fact, it was not once mentioned throughout the programs I attended, other than a brief "retract when you need to clean if a pediatric patient is not circumcised" (false information, by the way). However, a problem with care, and lack of training in nursing school, is not a problem with foreskin. Instead of demonizing the normal male body, we can simply take an easy step in teaching staff at nursing homes proper intact care --- and then all will be well, and these mythical problems will not arise.
In addition, it is very likely that my son will never even reside in a nursing home. According to the U.S. Department of Health and Human Services, just over 5% of the population in the United States age 65+ occupy nursing homes, congregate care, assisted living, and board-and-care homes; and about 4.2% of those age 65+ are in nursing homes at any given time. [Source: 65+ in the United States Census Report] This is not very many!
If, by some chance, my son is in the 4-5% of men who reside in a nursing home, it will likely be 65-95 years from now. Consider for a moment just how much the world has changed in the last ~75 years. Life is significantly different in 2010 than it was in 1935. Surely, we will continue to progress in our quality of care going forward, especially with the countless numbers of medical professionals for genital autonomy who are speaking up and taking steps to educate fellow colleagues, and medical and nursing school students who come after them. We will see new care facilities, new training, new technology, new standards, and protocols and ways of doing things.
Trust that your son's body knows how to function perfectly for a lifetime, and that elderly life in the U.S. will continue to improve (not decline) in the next 65-100 years. Trust that just as intact men enjoy their full genitals in 70+% of the world today, so will your son enjoy his for a lifetime.
Intact Care Resource Page
Adult Care of the Intact Penis
How to put a condom on an intact man
Registered Nurses on Circumcision (Resources)
Medical Professionals for Genital Autonomy
Intact: Healthy, Happy, Whole Community Group
Saving Our Sons Group