How To Care For Your Child's Foreskin

Key points about caring for your child's foreskin

• the foreskin is the loose skin that covers and protects the end of the penis
• the foreskin and penis of a baby or child need no special care
• a child's foreskin should never be pulled back (retracted) by force
• there is no need to clean inside the foreskin in young boys - just wash their penis the same as any other part of their body and be careful to wash off any soap
• once the foreskin is easily pulled back, your son should learn to do this as part of normal washing
• make sure he rinses off any soap and pulls the foreskin back over the head of the penis afterwards

What is the foreskin?

The foreskin is the loose skin that covers and protects the end or head (glans) of the penis.

The inside fold of the foreskin is a mucus membrane that keeps the surface of the head of the penis soft, moist and sensitive.

What care of the foreskin and penis is needed in babies, children and teenagers?

The foreskin and penis of a baby or child do not need any special care. A child's foreskin should never be pulled back (retracted) by force.

Early years

During the first few years of life, the foreskin is stuck to the head of the penis by a membrane (called the synechia). This membrane or connective tissue dissolves naturally – a process that should never be hurried.

Childhood and puberty

The foreskin can be pulled back when its inside surface separates from the head of the penis, and the foreskin's opening widens. This process happens naturally in childhood or during puberty and has usually happened by the age of 18. Even if the head of the penis and the foreskin separate naturally in infancy, the foreskin may still not be able to be pulled back because the opening in a baby's foreskin may only be large enough for the passage of wee (urine).

When a young boy pulls at his foreskin, he usually pulls it outward. This is normal and natural, and no cause for concern; he won't hurt himself.

Once the foreskin is ready to be pulled back, your son will most probably discover this for himself. He should be the first person to pull back his foreskin.

Telling your son about pulling back his foreskin beforehand will keep him from becoming alarmed the first time it happens.

How do I teach my son to wash his penis?

There is no need to clean inside the foreskin in young boys. Just wash the penis the same as any other part of their body and be careful to wash off any soap. When a boy is old enough to bathe himself, he can wash his own penis.

Once your son can pull back his foreskin, you can talk to him about pulling back his foreskin and washing. A simple explanation of 'how to' may be helpful:

• gently slip your foreskin back
• rinse the head of your penis and the inside fold of your foreskin with warm water
• slip your foreskin back in place over the head of the penis

Tell him to make sure he rinses off any soap before pulling the foreskin back over the head of the penis.

What happens if the foreskin is pulled back too early?

Tearing

Forcing the foreskin back before the natural separation of the foreskin from the glans has happened can cause tearing of the connective tissue. This is painful and can lead to problems. 

Tearing the foreskin from the head of the penis leaves an open wound which can lead to infection. 

Scarring

Small tears in the opening of the foreskin can heal to form non-stretchable scar tissue, possibly causing acquired narrowing (phimosis).

The raw surfaces touching each other can heal together and form areas that stick together (adhesions) between the foreskin and the head of the penis. This can lead to permanent problems with pulling back (retraction). The foreskin can get 'stuck' behind the head of the penis (paraphimosis).

What is the white lump (smegma) under my son's foreskin?

The white lump (smegma) is made up of the cells that once attached the foreskin to the head of the penis. As new cells form on the head of the penis and the foreskin's inside fold, old cells form pockets that eventually work their way to the tip of the foreskin. They can eventually be wiped away. If you see a white lump (smegma) under the foreskin, you know that the separation from the head of the penis is occurring naturally.

Why does my son's foreskin 'balloon' when he wees?

This is another indication that the natural separation of the foreskin from the head of the penis is occurring, but the opening of the foreskin is still narrow.

Ballooning can be normal, but if it is severe, so the flow of wee is restricted, you should seek advice from your family doctor. Encouraging boys to gently try and pull back their foreskin as part of daily hygiene can help. Sometimes a course of steroid cream is needed. Your family doctor can advise you about this.

What if my son's foreskin can't be pulled back (phimosis)?

Phimosis refers to a foreskin that cannot be pulled back because its opening is too small to expand over the head of the penis. This is normal during infancy and childhood. In later childhood, if your child is still unable to retract the foreskin, a course of steroid cream can be prescribed, which thins the skin and helps it to stretch over the head of the penis. Your family doctor can discuss this with you.

What causes my son's foreskin to be red (balanitis)?

Sometimes the tip of the foreskin becomes reddened. This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive head of the penis and the opening in the penis where wee comes out (urinary meatus).

If children are still in nappies, it may be part of nappy rash. When bacteria in the poo react with wee, they produce ammonia, which burns the skin and causes nappy rash.

Some ways to prevent a reddened foreskin and nappy rash

• change nappies more often
• allow nappy-free times to allow air to circulate and help healing
• soak in warm baths
• avoid things that can irritate the skin (such as bubble baths, soap, highly chlorinated water, some laundry powders)
• encourage your child to drink more so their wee is not too concentrated

If the foreskin or penis is red, painful and swollen, there may be an infection. See your family doctor.

What about circumcision?

Circumcision is the operation to remove the foreskin. There is no medical reason for routine male circumcision.

Circumcision

There is an operation called a dorsal slit where the foreskin is cut to widen and loosen the foreskin, without removing any foreskin tissue.