Protecting Children From Forced Foreskin Retraction
See below to empower yourself at the doctor’s office
Forced retraction — pulling back a child’s foreskin (prepuce) to any degree — is an ongoing issue in the United States. Forced retraction can happen at the hands of, or the advice of, medical professionals. The nonprofit organizations Doctors Opposing Circumcision and Your Whole Baby receive hundreds of forced retraction complaints annually from parents of boys with intact (uncircumcised) penises, and many of these incidents happen at baby well-checks. It is likely that far more incidents go unreported, as some parents are unaware that the practice is harmful and not evidence-based. We mail educational materials on normal foreskin development and penis care to healthcare providers to help prevent patient injuries.
The natural state of childhood non-retractability is often called “physiologic phimosis,” but it is not a condition requiring treatment. “The majority of referrals to pediatric urologists for circumcision constitute developmentally nonretractile foreskin rather than true [pathological] phimosis,” (5) a condition that can actually result from forced retraction of the foreskin. Paraphimosis, a rare emergency condition where the foreskin becomes stuck behind the head (glans), can be avoided by not forcibly retracting the foreskin. Parents and healthcare providers sometimes express concern that a boy's foreskin is “too tight” if they are unable to see the urinary opening, but this is normal. Ballooning, spraying, and smegma pearls under the foreskin are also all normal aspects of development.
Doctors’ Statements on Forced Retraction
“Forced retraction also may lead to cracking and bleeding of the foreskin tip. Over time, this may cause scarring of the tip making retraction impossible.” (Canadian Urological Association)
“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.” (The American Academy of Pediatrics)
“At birth, the inner foreskin is usually fused to the glans. . . . This prevents it from being pulled back or retracted to uncover the glans. . . . The foreskin should never be retracted forcefully.” (The Canadian Urological Association)
“It has become quite common in the United States for doctors, nurses, and other parents to tell mommies that they need to retract their son's foreskin when he bathes. This is not true . . . your son's foreskin is able to separate on its own, with time. . . . Pulling on this sensitive tissue can cause tearing and lead to infections and scarring. Many boys who need emergency care and even circumcision . . . do so because of premature retraction of the foreskin . . .” (Dr. Adrienne Carmack, Board-Certified Urological Surgeon and author of The Good Mommy's Guide to Her Little Boy's Penis)
At What Age Does Foreskin Become Retractable?
Current research demonstrates wide variance in normal age of retractability. Some boys will be able to retract their foreskins before puberty, while other boys may not have retractable foreskins until the late teens.
A 2005 Danish study of more than 1,000 male children found 10.4 years to be the average age participants were first able to retract their foreskins. (1)
Two Japanese studies, together following 845 boys from birth, found that between one quarter and one third of healthy participants ages 11-15 were not yet able to retract their foreskins. (2,3)
While some medical professionals may mistakenly assume the naturally adhered foreskin of a male patient is problematic, “The fused mucosa of the glans penis and the inner lining of the prepuce separates gradually over years, as a spontaneous biological process” (4) and should not be forced apart. This natural fusion, sometimes incorrectly referred to as “adhesions,” dissolves on its own with hormone production and self-exploration.
Forced retraction is painful and can cause complications requiring corrective surgery. As the number of intact U.S. males increases, it is important for healthcare providers to educate themselves on correct intact penis care.
Empower Yourself to Prevent Forced Retraction at the Doctor's Office
The saying "Knowledge is power" holds true when it comes to being an advocate for your son and protecting him from harm. The more you know and understand about the natural, whole male body's development from infancy to puberty, the more confident you will feel talking to, and sometimes disagreeing with, your son's healthcare provider.
It is important that you understand proper intact care so that you feel comfortable and confident discussing this topic with your son's doctor. Many American doctors will direct you to retract your son's foreskin to clean or bathe. Your doctor may also try to forcibly retract your son during his well visits.
These tips will be helpful in keeping your son protected from forced retraction.
Use the Your Whole Baby Intact Friendly Doctor List to find a doctor in your area. If there is not a doctor in your area or one that fits the needs of your family, be sure to ask the doctor to specifically describe care of the foreskin before s/he examines your child. Find out if the doctor encourages manipulation of the foreskin in any form. (This list is meant to guide you in finding a great doctor for your son and family, but you still need to be vigilant and ask about their practices. For example, sometimes a parent will recommend a doctor who is great with newborns, not realizing that they push retraction at the preschool age.)
Send any doctor who might examine your child a preventing forced retraction brochure to help ensure the office is well versed in care of the intact penis. (Or, even better, print one and hand deliver it.)
Ask your doctor to read and sign an Intact Care Agreement.
Prior to your son’s diaper being removed by a medical professional, inform them that they may not manipulate your son’s foreskin in any way. Stand close to the doctor and your son to ensure that no manipulation occurs.
Establish a “look, but do not touch” policy where during visits the doctor may use only their eyes to examine your son’s penis. Stand in close proximity to your son and the doctor to ensure this is followed.
You might also consider establishing a more cautious “diaper on” policy. Ask that your son’s chart indicate that his diaper is to remain on during visits unless he has an issue with the genital area that requires examination. In this case, be sure to remind the doctor not to retract the foreskin and stand close by to ensure this is followed. For visits where the diaper area is not a concern, be sure to remind the medical professional before they begin the exam that child’s diaper is to stay on.
Do not go into the appointment assuming that your doctor wouldn’t attempt to retract your child’s foreskin. A good portion of the complaints we receive about forced retraction are about doctors who had not previously tried to manipulate the child’s foreskin. Be on guard. Assume the doctor will try to retract and act accordingly before the situation is one that can’t be reversed.
Be brave. Doctors can be intimidating. They can try to make you doubt yourself. Speaking up and being assertive can make your hands and your voice shake, especially for a new, first-time parent. Know that the information you have is correct. If you are bullied, it is due to the insecurity and ego of the doctor and not something you are doing wrong. You know your child better than anyone and you must advocate for him. Stand your ground and protect his body.
Purchase Educational Materials in the YWB Shop
Help ensure your son’s foreskin is not forcibly retracted by sharing these informational materials with caregivers and healthcare professionals.
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 http://pediatrics.aappublications.org/content/102/4/e43