Tight Foreskin - Non Surgical Remedies,
Tearing During Intercourse and What is Ballooning?
Personal Accounts - Excerpts from Newsgroups & E-Mails

       If you have questions or concerns about any ofthe above topics, the posts I've gathered from various people provided belowmay be of assistance.  There are also links to additional informationor articles.

       They are on a thread from misc.kids.pregnancy(a newsgroup) where someone wrote about their son's "tight" foreskin.

       The mother wrote:

       My son, Kristofer, is 11 months old and isuncircumcised. My older son Niklas is 4 and also uncirced. Anyway, theopening to Kristofer's foreskin is extremely tight and almost nonexistent.When he is about to urinate, his foreskin "balloons" up and then deflatesduring the time that he pees. My pediatrician says that this is a problemthat can lead to infection, the tip of Kristofer's foreskin is very red andsticks together. My ped. told me to try stretching it gently and usinghydrocortisone and neosporin daily or that he might need to be circumcisedunder general anesthesia.

       I would of course get a second opinion but I'mreally confused at this point if Kristofer really has a problem or not. Idon't recall my other son's penis appearing this way when he was about tourinate. Please help or advise.

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Dear Tara,

       The ballooning that you describe is notnecessarily a problem. Many American doctors are quick to recommend circumcisionbecause they are not familiar with the normal (intact) penis and foreskin.

       The foreskin separates gradually over time. Unlessthe urine comes out as a fine mist, there is no need to do anything. Justleave it alone! This is very important, because by stretching the foreskinyou stand a very good chance of introducing bacteria into the area. Thisis how the vast majority of infections get started.

       The American Academy of Pediatrics has publisheda pamphlet about this entitledNewborns: Care ofthe Uncircumcised Penis.  It is available from the AAP or at thepreceding link.

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       Comments by a Dr. Robert Van Howe:

       Having researched this topic extensively, themedical literature describes "ballooning" as part of the normal developmentof the penis. It should only be treated if urine will only come out as finemist.

       There have been only three cases reported in theliterature of "phimosis" causing obstructive uropathy. Ballooning does notnecessarily equate preputial stenosis ("phimosis").

       If treatment is needed, radicalcircumcision is now considered obsolete. 80-95% of boys withpreputial stenosis will respond to topical steroid creams. 75% of boys willrespond to stretching under local anesthetic. If surgery is needed,preputioplasty has been shown to be effective with less pain and morbidityand does not remove any tissue (the tissue is moved around to allow a largeropening).

       If there is a concern of kidney disease, non-invasivebaseline studies should be performed now.

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Another reply:

       As others have said, what you describe is notabnormal and as long as he can urinate, shouldn't be a problem. Very gentlestretching may be a good idea. Even if he did have such a tight foreskinthat it was a real problem and didn't respond to stretching, he should *not*need circumcision.

> -- Angi

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From MBL Novoa:

       Angi is right. What is occurring when Kristoferurinates is perfectly normal. Ballooning of the infant foreskin is actuallya desirable ocurrence.....it is one of nature's ways of helping the foreskindifferentiate itself from the glans.

       At birth, the foreskin and glans are fused intoone unit, by a thin membrane. This membrane is actually called an epitheliallayer of squamous cells. Squamous means that the cells gradually break downand slough off over time, and as they do so they allow the tender, developingforeskin to differentiate itself from the glans. It is a normal adhesion,part of the developmental process of the penis, and this is why it is socritical for parents and doctors to never attempt to retract a healthy child'sforeskin. The delicate adhesions can be torn.

       But through normal body processes, like urinationand erections, this layer of squamous cells gets stretched and graduallybreaks down. This process can take from a few months to a few years, butusually is complete by puberty or early adolescence.

       My mom tells me that when I was an infant, I balloonedtoo. So have many of my friends' kids. It is completely normal.

       Another normal process by which children aid inthe development of the foreskin and glans is by pulling the foreskin outto amazing lengths. This helps break down the cells that may be startingto itch a little, and it feels f-a-n-t-a-s-t-i-c to the inner lining of theforeskin. Don't be alarmed if your 4-year-old starts doing this. It's notonly OK, it is beneficial (as long as it's done in private!).

       Teaching kids it's OK to explore their bodieswill ensure that they physically develop properly and won't need surgerywhen older, such as a needless circumcision. A quote I once read was "Whatappears to be a pinpoint opening in infancy will become a wide channel ofcommunication by adolescence."

       Tara, your kids sound perfectly normal.

Martin

       (PS -- I'd avoid the use of antibiotic creamsaround the healthy foreskin. The foreskin -- just like the mucosal tissueof little girls and women -- has "good" bacteria that help ward off infection,and these could be destroyed by the antibiotic. Don't mess with his naturalflora!)

More Information:
from Fathering Magazine:Care ofBoys with Tight Foreskins
from the Circumcision Information Resource Pages:
Articleon Balloon Dilationhttp://www.cirp.org/library/treatment/phimosis/he-zhou/

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From Someone named Patty:

       Try pulling downward on his penus rather thanpulling up. Do this daily for a while and see what happens. My son does thisnaturally and it works really well for stretching it out. I think it mustfeel good too(going down, NOT up) because he does it every chance he gets.It must be kind of like satisfying a itch. I was alarmed when he would dothis because he would stretch it down to his knees!! Im not kidding. I postedabout this and someone told me her son did the same thing and chuckled abit because they really pull so hard you think it would hurt.

       We just had our 2 year check up last month. Thedr was very impressed at how much his forskin had loosened. I really thinkits because of this pulling. Once I found out it was OK I started lettinghim run around each night for 45 minutes without his diaper on. He pulledand yanked, jumped and squeeled.

Patty


CIRCUMCISION IS ALMOST CERTAINLY NOT NECESSARY. The prescribed treatmentis correct. If it fails then do not worry unless the small preputial orificeis really causing problems. The next line of treatment is a"preputial plasty" a small cut and suture in the foreskin.

If a circumcision becomes necessary (probably because of iatrogenic problems)the child must be fully informed about was is to be done to him and giventhe opportunity to object. It is a shock to wake up to unexpected alterationof the genitalia.

John D Dalton

More Information:from theCircumcision Information Resource Pages:

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Tearing DuringIntercourse
...The most recent comment ... claims that an intact adult male "tore" duringintercourse. Is this possible? common? easily preventable?  MicheleMoorhouse, (AC Talklist), 12/22/98

Response:  As a male who was circumcised at birth, I tore while preparingfor intercourse... the reason why? I simply didn't have enough skin to covermy erection. It hurt like HELL and took weeks to heal... any erection, likea morning erection was excruciating and I often tore again during the healingprocess. ... I have first hand knowledge that even the circ'd guys tear. K'Tesh Kraigson, 12/23/98

Response:  Further to K'Tesh's observation. It is often reported ofmen who are tightly cut, no mobility of the remaining skin, to tear duringsexual activity. As for the foreskins of intact men tearing, this is probablynot uncommon. In particular in those who don't retract the foreskin for urinationand cleaning regularly. Failure to retract, especially during adolesenceduring the body's high growth period (also the peak period of penis growth)allows the skin, especially the ridged mucousa and frenar band to relax andtighten, a self-induced phimosis. This phenomenon has been seen in men/boyswho masturbate by only rubbing the glans through the foreskin without retracting.As a result, the foreskin may not retract properly during intercourse, andif it happens to be a particularly 'vigorous' session of lovemaking, certainlytearing is not only possible, it is very probable. It would seem that notonly masturbation during adolesence, but masturbation with the correct method,is an important part of a growing boy's life. Certainly, at least, retractionfor each visit to the toilet to urinate and for the daily bath/shower isvital to a healthy foreskin and a happy sex life in the intact male.  DonKettle, QB Man Foreskin Restoration Site, 12/23/98

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Last Revised:  2/11/99