The issue of the penis of babies and their foreskins is one of the great struggles of recent times, as many pediatricians, with the intention of saving an intervention to the child by phimosis, decide to solve it when it is still a baby, lowering the skin in a forced way or simply taking it to the limit of its elasticity to see how much it retracts.
Many children they cry, they bleed and suffer at that moment and others, although they endure the envy, they do not show the pain until the moment of going to pee, when the stinging is evident. And all for what? Well, for that, to make the child suffer, because It is a maneuver totally discouraged. So there goes the notice to all mothers and fathers: don't let the pediatrician, or the nurse, or anyone else, lower the skin of your baby's penis that way.
Do nothing with your child's penis
Babies have prepucial adhesions since they are born, this means that they have skin attached to the glans to avoid irritation from contact with urine, poop, etc. In addition, they have a fairly stiff skin ring that prevents retraction, which disappears over time.
As the skin is attached it is almost impossible to lower the skin, so what is advised is do nothing. Until a while ago I advised to lower the skin a little during the bath, always without forcing, because of hygiene, but it is not necessary to do anything in particular (that if it is done without forcing nothing happens, but it is likely that that moment of hygiene has no benefit and there is always a risk that some mother or father will lower more than the account).
Why do I say that nothing needs to be done? Because the National Library of Medicine of the United States says it, for example, when in the recommendations for the care of the uncircumcised penis (uncircumcised) it says:
An uncircumcised penis has the foreskin intact. A baby with an uncircumcised penis does not need special care and the normal bath is enough to keep it clean.Do not retract the foreskin back to clean babies and children. This can injure the foreskin and cause scarring, which could make retraction painful and difficult later in life.
Lighter, the water. The foreskin protects the glans and retraction is discouraged because if we separate them, the protection disappears and because the last thing to do if what is intended is for a skin to be elastic is to hurt it, because wounds cause scars and scars always have less elasticity That healthy and intact skin.
How the foreskin of children evolves
For not knowing what reason many pediatricians hope that the foreskin can go down at 2 or 3 years. Some wait until 4 or 5, in clear sign of having more patience, but it is still early.
According to the article "Conservative management of the foreskin" by JM Garat, the percentage of children whose foreskin can be retracted is 4%. At one year of life, 50% of children. At 2 years, 75%. At 3 years, 90%. At 4 years, 91% and at 5 years 92%.
It does not provide more data in older children, so we do not know how to follow the spontaneous resolution of physiological phimosis, but it seems that if nothing is done, it will also improve.
In fact, a study done in Japan, published in 1996, that analyzed the form and capacity of retraction of the foreskin of 603 Japanese children revealed that the incidence of the tight ring that made it impossible to retract the foreskin is as follows:
As you can see, phimosis is resolved from the moment the baby is born, gradually separating the skin from the glans and eliminating the skin ring that prevents the foreskin from retracting.
At one year, 40% of the children in the study still had the aforementioned ring, and from year to year the incidence was decreasing until reaching the stage of 11-15 years, where it remains at 8.6% of the children.
This It does not mean that at 12 months 60% of children can lose their penile skin, because in addition to the ring there are adhesions, which we have commented on the skin attached to the glans. These adhesions take much longer to disappear (at 6-7 years old, 63% of children have adhesions), but the adhesions are not phimosis.
To see it more graphically, I leave you with an image of the Peruvian Urology blog that represents it perfectly:
But what about infections?
True, in this study 9 children suffered from balanitis and all 9 had a foreskin that they could not fully retract. However, the total incidence was 1.5%, 7 children were between 1 and 5 years old and other studies show cases in 6-month-old children, so the cause seems to be more a hygiene deficit that the difficulty of lowering the skin of the foreskin (or a combination of both).
Another study, on this occasion from Denmark, published in 1968, shows that the incidence of phimosis at 6-7 years is 8%, at 8-9 at 6%, at 10-11% at 6%, a 12-13 of 3%, 14-15 of 1% and 16-17 of 1%.
That 1% is the one that most likely will need a phimosis intervention or not, because there are cortisone treatments that also work. But of course, we talk about the normal evolution of the foreskin without any medical intervention, with the only one of the children touching each other since childhood, often resolving phimosis themselves.
Children are the first "antipymosis agents"
Not everyone does it in the same way or with the same intensity, but many children touch their penis when you take off the diaper, so that it gives the feeling that they are going to hurt themselves: they throw out, to the side, to the other, they stretch and everything they can think of. They must be left to them (That there are mothers who should be afraid that they feel some kind of pleasure and avoid it). You have to leave them because stretching the skin outward is an appropriate method to separate skin and glans.
The application of corticosteroids is also effective.
Surgical intervention has always been considered as the only way to solve phimosis, also necessary at 3-4 years to avoid future problems. However, the tendency is to intervene every time later. Experts say that in order to avoid general anesthesia, it is better to operate later than 8 years, but seen the data may be even soon, because up to 12 years the percentage of children with phimosis is decreasing to 1%.
But this, intervene in the operating room, should be done only in case it has not been resolved before otherwise, because the application of a corticosteroid cream together with some slight retraction maneuvers are proving to be effective in many cases and not only is it much cheaper, is that you avoid having to go through an intervention, an anesthesia and the possible subsequent complications.
The resolution rate is very high, as it has a success rate of 85-95% when the cream administered is betamethasone. Such a high percentage in children over 10 years, for example, when the cases are few, leaves very few cases that have to be solved in an operating room.
Another indication to operate, of course, is if phimosis causes problems for the child. If you are doing infections such as balanitis or if you have pain when you have an erection, you should do corticosteroid treatment to try to solve it. If it is not effective, then it is recommended to operate, even if the child is small.
Concluding
Practically all children are born with the foreskin attached to the glans, without being able to retract. It is something normal that should not cause concern.
The skin of the penis should never be forced down, as it will be when it is ready for it, without having a specific age or limit from which it should happen in all children.
The recommendation for parents, pediatricians and nurses is the same: don't do anything with the child's penis. Yes you have to look at it, obviously, when they are babies, to assess that there is no malformation, but once this is ruled out, just ask a "Is everything ok with your penis?", because if there are no infections, pain or anything that worries parents, there is no need to touch it.
Later, when children already know how to retract the skin, they can be the ones who show the pediatrician how much it goes down, what adhesions he has and what intervention he may need, in case of phimosis (if he needs it, because as we have already said, if there are no symptoms there is nothing to do but wait).
So let's stop hurting babies without need, and not just harm: we will stop hurting their foreskins and add problems to a very delicate area, and more when the fact that they have phimosis is completely normal and physiological.
Photos | iStock
In Babies and more | Should we lower the skin of the foreskin so that they don't have phimosis? Care of the baby's penis, At the pediatrician: "I don't know, that's your mother's thing"
