Give the new parents one more thing to worry about…. How do you care for your son’s hygiene if you’ve made the decision not to circumcise? The uninitiated (pun intended) have queasy thoughts about yanking back the foreskin and mining smegma with q-tips at every diaper change…..and years ago that was more or less the advice of the “experts” (many of them, circumcised men). So what’s the current recommendation and the reasoning for it?
Early in pregnancy there is no septation (line of separation) of the epithelial layers of the skin between the glans and the foreskin. Septation of the epithelial layers of the foreskin may be only partially completed by birth. The foreskin may not be fully retractable until several years after birth. In 90%, the foreskin is retractable by age 5.
Forget about forcible retraction of the foreskin at diaper changes. Forget about q-tips. Forget about solvents, cleansing solutions and the vile nature of smegma (the white, paste-y discharge of the glands of beneath the foreskin). Leave it alone. When your son understands your language, talk to him about keeping his body clean. Talk to him about washing his underarms and his bottom. Talk to him about his penis. Talk about his penis as though it’s just another part of his body. Do not discourage exploration. Do not tell him that it’s “nasty” or “dirty”. Ask him if he can retract his foreskin…..that is, ask him if he can pull his foreskin down over the head of his penis as though it’s a turtle-neck collar. If he can retract his foreskin, tell him that he needs to keep this area clean just like his underarms and bottom. That’s it…..no great mystery.
What about problem penises? Rarely, complications can occur with the uncircumsised penis. Phimosis is a condition in which the hole through the foreskin is abnormality tight and small. With phimosis, the foreskin will not retract. This is a problem that a physician can take care of…..sometimes, with circumcision. Urinary tract infection is more difficult to diagnose…. and very difficult with infants. An uncircumcised infant with a fever should be considered to have a urinary tract infection until examined by a physician and determined otherwise……although the MAJORITY of uncircumcised infants with a fever do NOT have a urinary infection.