The penis consists of two parts, the shaft, which is the main part of the penis, and the head (called the glans). At birth, boys are typically born with a layer of skin that covers the shaft (called shaft skin) and glans (called the foreskin).
When a penis is circumcised, the foreskin covering the glans is removed. If a child is not circumcised, the foreskin is left intact.
For the child who is uncircumcised, over time the foreskin will gradually separate from the glans of the penis. As this natural process occurs, you may notice a white, cheesy substance called smegma between the layers of skin. Likewise, you may notice small pockets of smegma, called “pearls,” that develop under the layer of skin still connected to the glans. These are normal occurrences and are not considered signs of an infection or a cyst.
As the foreskin separates from the glans, it can be pulled back (retracted) to expose the glans. When the foreskin is able to be retracted is different for each child. Being able to retract the skin may occur soon after birth, a year after birth, or even many years after birth as some individuals may not be able to retract their foreskin until their teenage years.
Note: Retracting the foreskin should never be forced. Doing so may cause pain, bleeding and tearing of the skin. It may also result in scarring and adhesions (skin attaching to skin).
Potty training
When potty training begins, your child should be taught how to retract the foreskin gently. Ideally, the foreskin would be retracted enough to see the hole on the glans where urine comes out (called the meatus). This is an important step as it prevents urine from becoming trapped under the foreskin which could possibly lead to an infection. If the foreskin becomes red, swollen and/or painful, or if the foreskin “balloons” when your child urinates, notify their pediatrician.
Cleaning
While the foreskin is unable to be retracted, clean the outside of the penis only. Once the foreskin is able to be retracted even the slightest amount, clean the exposed area of the glans with water. If soap is used, be sure to rinse well as it may irritate the exposed skin. If the foreskin is able to be retracted, it is important to always gently pull the foreskin back over the penis to its original position.
Self-care
As your child gets older, and the foreskin retracts easily and fully, they should be taught to clean underneath the foreskin when they bathe or shower. At puberty, your child should be taught the importance of cleaning the penis as part of their daily hygiene routine.
We offer several options for circumcision of infants up to 12 weeks of age in our outpatient offices.
If you are considering circumcision for your baby post newborn hospital stay, it is important that you contact our urologists to discuss the procedure as soon as possible after leaving the hospital.
