"Cleanliness is next to godliness", said Mahatma Gandhi. However, in
India there is a dearth of knowledge both among the medical fraternity
and the lay public when it comes to the care of a child’s foreskin.
Poor penile hygiene can lead to balanitis, balanoposthitis and
ascending urinary tract infections. Very rarely, it can even result in
childhood penile cancer(1). Non-retractile foreskin, balano-posthitis
and smegma collection comprises a significant number of referrals by
pediatricians and general practitioners to pediatric surgical centers.
A good number of children are referred for accumulation of "pus"
between the glans and the foreskin. Although some foreskins do not
become fully retractable until late childhood, in 90% of uncircumcised
males, it becomes so by the age of 3 years, when keratinisation of
subpreputial epithelium is completed.
Routine circumcision in neonates and infants is
unnecessary in any case for medical reasons. However, inability to
retract the foreskin and keep the area clean runs the risk of smegma
collection and inflammation from infection of inadequately cleaned
secretions. Chronic posthitis later in life can lead to adhesions
between the glans and prepuce causing closure of orifice of preputial
sac. This can even cause deposition of preputial calculi. There is
also a high association of strictures of the terminal urethra with
poor genital hygiene in males attending Urology clinics(2).
While one way to avoid all these problems is to
perform circumcision, in general this surgery can be avoided if good
hygiene is maintained. A simple method, which can be done by the
parents at home to release these adhesions gradually, is therefore
advised and is as follows:
The mother should positively be instructed to
observe the stream of urine. Normally this should be a good stream and
not dribbling. There should not be any preputial ballooning. If there
is, the child should be shown to a doctor for gentle, manual
retraction. The mother should also be encouraged to look for the
symmetry of the presence of both the testes.
During the first year of life, the parent should
clean only the outside of the foreskin and the meatal area without
trying to retract it. From the 2nd birthday, the mother should be
encouraged to gently retract the foreskin while bathing the child and
washing the area with simple soap and water. This will make the
foreskin open up, revealing the end of the glans. During retraction,
the exposed part of the glans should be cleansed with water and any
whitish material found there (i.e. smegma) wiped away. Soapy water
should not be left behind under the foreskin because this can cause
irritation and swelling. After cleansing, the foreskin should be
always pulled forward to its normal position to avoid the risk of
paraphimosis. An older child is also encouraged to retract the
foreskin while passing urine and to wash the area later regularly
during bathing. This should become a life long habit for every child.
Prema Menon,
K.L.N. Rao,
Department of Pediatric Surgery,
Post Graduate Institute of Medical Education and Research,
Chandigarh, India.
E-mail: [email protected]
