FOr Healthcare providers

Forced Retraction

modern medicine should not include forced retraction

American Academy of Pediatrics: Care for an Uncircumcised Penis
"Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin."

Canadian Urological Association: Foreskin Care for Boys
"At birth, the inner foreskin is usually fused to the glans. This prevents it from being pulled back or retracted to uncover to the glans... It is important not to retract the foreskin forcefully for any reason. Some parents feel the need to pull the foreskin back to 'clean under it.' Since the young boy's inner foreskin and the glans are initially fused, there is no space to clean... Forceful retraction also may lead to cracking and bleeding of the foreskin tip. Over time, this may cause scarring of the tip making retraction impossible."

Dr. Adrienne Carmack, Board Certified Urological Surgeon: Premature Foreskin Retraction
"As a urologist, I have had to do circumcisions on young boys because of scarring and infections that developed as a result of either doctors forcibly retracting their foreskins or parents doing it on doctor's advice... Parent's are routinely taught that this important. It's not.... it is of utmost importance that no one but the child messes with his foreskin... Their foreskin will separate with their own tugging and manipulation..."

The Children's Hospital at Westmead, Sydney Children's Hospital, Randwick and Kaleidoscope Children, Young People and Families: Male Infant Circumcision
"When a boy is born, the inner layer of the foreskin is normally stuck to the glans and the foreskin cannot be pulled back (retracted). As the boy grows, the inner skin separates and the opening becomes more elastic so that by the time he is fully grown he should be able to retract it without discomfort. Some boys can do this by the time they are three to four years of age. Others may not be able to do this until puberty."

Psychology Today: What is the Greatest Danger for an Uncircumcised Boy?
"The foreskin is fused to the glans (head) by a normal connective membrane... The two are functionally an undifferentiated single structure. It takes many years from this membrane to naturally dissipate, a few cells at a time. The average age for full foreskin retraction without trauma is ten years, with half of all boys at age ten fully retractable, and half not yet so... Typically [forced retraction] occurs when a poorly-trained physician or nurse tells the parent that the child has 'adhesions'... which must be separated 'for hygiene.' He or she will then tear the foreskin from the glans by forcing it towards the abdomen, exposing the entire glans and destroying the boy's protective membrane... The trauma of tearing the glans and foreskin apart before they separate naturally will cause intense pain, bleeding, swelling, and expose what was formerly a sterile, internal site to infection.

Doctors Opposing Circumcision: Forced Retraction
“… [a boy or girl] needs only warm water gently applied to the outer, visible portions of his or her genitalia, and only the very mildest soap if any. No intrusive or interior cleaning of the genitalia of either gender is ever needed or desirable, and aggressive hygiene is destructive of developing tissue and natural flora, and is harmful as well as painful.” 

Wrongful Foreskin Retraction
"As an international physicians’ organization, we deeply apologize for the conduct of our fellow professional, and for the unnecessary injury done to your son. American health care professionals are often not well trained or familiar with the normal, intact penis, which can lead to inappropriate and even harmful care or advice."


Urine Samples/Catheters

Catheterization without foreskin retraction (Carmack A., MD, Milos M., RN, Canadian Family Physician)
“"In boys with intact prepuces and physiologic phimosis, catheterization without retraction minimizes potential long-term problems and is an effective technique. Understanding how to catheterize without direct vision of the meatus and discarding the initial urine if culture is desired allow this procedure to be performed with high validity and minimal risk of iatrogenic problems for the child.”

Catheterization of the Urethra in Male Children (University Hospitals of Geneva, University of Geneva, Switzerland)
“A physiological phimosis is frequently present during childhood and the foreskin should never be forced to retract.” 

What is the right way to catheterize an intact boy? (Doctors Opposing Circumcision)
“Fortunately, forced retraction of the foreskin or complete exposure of the glans are not necessary for catheterizing a boy or for cleaning the area in preparation for the catheter. The foreskin can safely be gently manipulated to allow cleaning and exposure of the meatus, but this should never be done beyond the level of natural separation. Using a gentle touch and stopping at the earliest sign of resistance will avoid any harm. For a boy who does have a loose foreskin, retraction helps assure a sterile area for the catheterization. Otherwise, if the foreskin is tight or adhered, only easily visible surfaces need be cleaned.”


Ballooning, Yeast, Urate Crystals, and Smegma

Ballooning
"We saw Dr. Van Howe on January 10th and he was so kind and patient. I explained Andrew's whole history and my concerns. He said that even the extreme amount of ballooning is normal- in fact, it was good because it showed that everything is still nice and elastic as it should be."

Yeast & Irritation
"Swelling and redness, sometimes accompanied by discharge and/or pain/discomfort, in the absence of fever, are signs of yeast." Tips and tricks for identifying and treating yeast.

Urate Crystals
New parents are sometimes concerned to find dark pinkish-orange spots in their intact baby’s diaper during the first few days of life, and worry it might be blood the baby’s urine. In almost all of these cases, however, the substance that looks remarkably like blood in a diaper is actually not blood at all, but rather what is known as urate crystals.*

Smegma (with Images)
"Imagine that you’re changing your two-year-old son’s diaper one day and you notice a lump on his penis that you hadn’t seen before. If you had to describe it, you’d call it a cyst. It is a little squishy and might even shift around when you press on it. You are worried and immediately call to schedule an appointment with your son’s pediatrician."


Professional Organizations

Doctors Opposing Circumcision
Doctors Opposing Circumcision is a non-profit, all-volunteer organization that works to empower parents and medical professionals with education, resources, and support, so that they can make thoughtful decisions regarding circumcision.

Nurses for the Rights of the Child
Nurses for the Rights of the Child is a non-profit organization dedicated to protecting the rights of infants and children to bodily integrity.  As health professionals, we specifically seek to protect non-consenting infants and children from surgical alteration of their healthy genitals.


Footnotes for "Avoiding Retraction Injuries: Correct Pediatric Foreskin Care" Brochure

1 Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger 2005;167(17):1858-62.
2 Ishikawa E, Kawakita M. Preputial development in Japanese boys. Hinyokika Kiyo. 2004;50(5):305-8.
3 Kayaba H et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys.  J Urol. 1996 Nov;156(5):1813-5.
4 Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44. 
5 Van Howe, R.S. (1998). Cost-effective Treatment of Phimosis. Pediatrics, 102(4). Retrieved from https://pediatrics.aappublications.org/content/102/4/e43