Hands Off My Foreskin!

Written by Dr. Martin Winckler, General Physician & Writer
Originally published on November 20, 2005 in an article for L’Arbre à Bébés. Translation by Raphael Bauron. 

Many young mothers worry because they have heard from their mother, mother-in-law, or doctor that the glans (extremity) of their son’s penis needs to be “cleaned.” And for that, the foreskin (the skin that covers the glans) needs to be pulled back like a turtle neck. This is false information: retraction has no benefits and can only lead to problems.

1) What is your position on the matter of retraction, as a doctor and as a parent? Do you retract your young patients and have you asked your own children to retract?

I have never retracted the foreskin of any of my patients or any of my five boys. (And I think that if I asked them what they thought of it, they would look at me funny and say that I have some crazy ideas . . .)

I realized early (in the early 1980s, when I opened my practice and started reading articles from pediatrician Aldo Naouri), that this practice was not only useless, but also aggressive for everyone, from the patient himself to the mother. It is aggressive because a little boy’s penis gets aroused as soon as it is touched, naturally.

And not all mothers are comfortable with that . . . understandably. And if a baby boy giggles when his penis is tickled, he very quickly prefers to be left alone when dealing with this part of his body (just like a girl would . . .).

2) What do you think about the arguments typically brought forward by pro-retraction people (adhesions, possible phimosis)?

Phimosis is a condition in which the opening of the foreskin is too tight, preventing the glans from pulling out and being exposed when the penis is erect. It can therefore only be a problem for boys old enough to have intercourse. Most studies done on the subject prove that retraction has no function: it does not improve hygiene and does not prevent phimosis, which is a rare natural condition. It was said in the old days that foreskins had to be retracted to “clean” what was underneath.

Preputial secretions are just as normal as vaginal secretions, and no-one ever advocated “cleaning” vulvas with cotton swabs – but I saw mothers trying to wedge a cotton swab under their sons’ foreskins because their doctors told them to do so!

The foreskin is “self-cleaning.” The opening of the foreskin is tight at birth specifically to stop dust from getting in. Retraction (forceful stretching) is against nature. And it hurts. And it may lead to some tearing of the foreskin and para-phimosis, which will require urgent care.

Para-phimosis (induced) is much more common than phimosis. Here’s how it usually goes: a mother wants to retract her son (typically in the bath tub). The touching leads to an erection. Now the glans, with the foreskin rolled tight around it, swells and turns purple. The kid screams. And in warm water, it gets worse . . .

The mother calls the doctor who has two options: he or she panics and sends the kid to the hospital, or he or she is familiar with the problem and has a simple solution — no pulling on the foreskin to roll it back up (it does not work); first empty the tub, then pour some cooler water (not too cold) on the penis, while pressing gently on the swollen glans. As the glans gets smaller, it goes back inside the foreskin . . .

I saw a dozen cases like this one when I started practicing. It was always with boys whose mothers were obsessed with “cleanliness,” or who were guilted by a controlling mother, mother-in-law, or doctor, and who were retracting their sons three times a week, to the point that the boys were scared to see their moms approach them and pull down their pants.

Naturally, the more the mother touched it, the more it got irritated, the more it hurt and the more retraction became torture, until the kid had a severe case of para-phimosis and I was called to the rescue. A vicious circle . . .

I had to rapidly inform young mothers not to touch their kids’ foreskins. As years went by, I saw fewer cases of para-phimosis, more happy boys, laughing and pulling on their pee-pees, and more mothers happy not to have to deal with all that.

During my career as a general practitioner, I never sent a young boy to the OR, and I saw very few boys who needed surgery because in my region, no doctor promotes retraction.

3) When should parents start to worry and think about surgery if their son’s penis is not retractable?

It’s simple: parents should not worry, because there is no reason to worry. Retraction is a cultural practice in France, not at all in other countries. However, there are no more cases of phimosis outside of France than in France. This confirms that retraction has no purpose.

Every parent who had little boys can confirm that touching and masturbation are very common from a very young age, and sometimes up to 8-10 years old, but lead to no complications. The prepuce of a newborn is not designed to be retracted by anyone but its owner: it covers and protects the glans, stretches and softens as time goes by. As the kid grows, he dilates the opening of the foreskin himself when masturbating.

During the development of the child, the foreskin elongates with the penis, allowing worry-free erections. At puberty, in a vast majority of cases, boys are already retractable and have stretched their preputial orifice on their own. And they have no phimosis . . . they don’t even know the word!

Puberty is when boys may have issues, not earlier. (Or the problem is para-phimosis because they are being retracted non-stop . . . see above). I have had to circumcise, in my entire GP career (twelve years in the countryside), only one man, 22 years old, who had para-phimosis . . . because he had been brutally retracted as a boy, leading to a scarred, therefore tight foreskin.

It started to bother him at puberty, not earlier. It is repetitive retraction that causes inflammations and leads to phimosis!!! – the recurring tearing of the prepuce at an age when the boy should be left alone scarred the tissues and tightened the opening . . .

4) What is your advice to a mother who doesn’t know her pediatrician’s position on retraction? Or if her doctor is pro-retraction? (Or how not to feel guilty . . .)

When a problem is purely a matter of opinion and not prevention or health (and, again, nothing proves that retraction has any advantage, but drawbacks are obvious), never mind the “position” of the pediatrician.

Doctors should not dictate their opinions and there is definitely no reason to make a mother feel “guilty” because she decided not to touch the penis of her baby (this kind of mother is rather sane, in my opinion . . .).

Would a mother have her son circumcised to “please” a doctor who recommends the procedure for “hygienic” reasons? Of course not.

The same goes for retraction. Tell every doctor who may mention it that you will let your kid take care of the issue himself, and most importantly, do not let your doctor demonstrate on your son! Retracting a healthy baby boy cannot be justified, no more so than giving a healthy baby girl a vaginal exam!

The only time a doctor can touch (delicately) a young boy’s penis is when the penis shows a visible abnormality.

If it’s not the case, hands off!