The Normal Foreskin
In the new born baby and for the first several years of life it is normal to not be able to retract the foreskin. In fact, if the glans (head) of the penis can be seen this is abnormal and may be a pointer to other conditions such as hypospadias. There is no reason to retract the foreskin for the purposes of cleaning, in fact, this is only recommended after puberty. Some degree of ballooning in the foreskin while the child is passing urine in the first 5 years of life is also normal. As long as it drains out after the child is finished and there is a good stream, in itself it is not something to worry about. After 5 years of age, the ballooning usually settles down.
Circumcision
Circumcision may be performed by choice (elective) or there may be a medical indication for circumcision. Elective circumcisions are best performed under a general anaesthetic after the age of 6 months. Circumcisions may also be performed for medical reasons. Urinary tract infections, recurrent episodes of balanitis and phimosis are the commonest reasons for circumcision.
Phimosis
Phimosis is a narrowing of the foreskin usually caused by some degree of scar tissue. This may present as the inability to retract the foreskin after the age of 5 years, with pain or spraying on passing urine, or with small tears in the skin and sometimes even some drops of blood. Sometimes, in the younger child, the application of steroid cream can be helpful here. A phimosis before the age of 5 may be physiological and as long as the child is well and with no symptoms then nothing, in particular, needs to be done. After the age of 5 it is much more likely that a phimosis is pathological. Unfortunately, in the pathological phimosis after the age of 5 the application of steroid cream is seldom successful and in these situations a circumcision may be indicated.
Balantitis
Sometimes there can be recurrent infections of the foreskin which is called balanitis. Recurrent episodes of balanitis may be an indication for circumcision. Episodes of balanitis can usually be successfully treated with a course of antibiotics however, if a boy has multiple episodes of balanitis then it is likely that he will continue to get more.
Urinary Tract Infections
Urinary tract infections are rare in boys. Boys, however, who have proven urinary tract infections, can gain a significant benefit in reducing any subsequent infections by having a circumcision. This benefit is the most marked in the first year of life.
Circumcision - Post operative care
The stitches used are dissolving and do not need to be removed. The wound is then often sealed with a tissue glue. The only dressing required after a circumcision is to completely lather the end of the penis with either VaselineR or Papaw cream. We recommend no baths or showers for 2 days and then normal baths or showers. After your boy comes out of the bath or shower just gently pat the area dry and then lather again with either VaselineR or Papaw cream. You will need to do this for about 7 – 10 days. It is normal for a crust to form around the end of the penis. As the skin heals below, the crust and the flaking tissue glue will then fall off. It is quite normal for there to be significant swelling after a circumcision. Again, this may take up to 7 – 10 days to settle down.