Foreskin, medical circumcision and other treatments
Advice for parents and carers
What is foreskin?
The end of the penis is covered by a collar of skin called the foreskin. In most new-born babies, the foreskin is attached to the end of the penis to protect it from rubbing, which may be caused by dirt or wet nappies. As children get older, the foreskin will separate from the head of the penis.
For some boys, this happens when they are very young – for most it occurs during primary school. For other children, though, it happens a lot later, even in late teens or early adulthood.
Why do some people not have a foreskin?
In many different parts of the world, children may have their foreskin removed when they are a baby because of their religion or culture, through a procedure called a circumcision.
Other boys might have their foreskin removed in childhood or adulthood due to a medical condition. Circumcision used to be a common procedure but we now know that most foreskin problems will get better with age. Circumcision can reduce the risk of boys getting urinary tract infections so some boys with kidney problems will be recommended to have a circumcision when they are a baby. The procedure can also reduce (but does not stop) the transmission of sexually transmitted infections.
Much like our faces, everyone’s penis is different. If your child has been circumcised, the head of the penis will always be visible, as illustrated.
Is my child’s penis normal?
Penises come in many different shapes and sizes and change with age. Between a boy being born and starting puberty the penis doesn’t grow very much at all. Some boys develop some ‘puppy fat’ around the pubic area before they go through puberty which can make the penis look smaller too.
When boys start going through puberty their penis gets a bit bigger. This happens at different ages for different boys, but most boys will notice that their penis has started to change by the time they are 14 years old. Penises grow in different ways, but they still work in the same way, no matter what size.
Keeping the penis and foreskin healthy
It’s important that your child keeps their penis and foreskin clean by washing under the foreskin regularly in the bath or shower. This will help stop any build-up of a natural white or yellow-ish substance called smegma. The penis produces smegma to help keep it lubricated and prevent dryness. But if smegma builds up, it can start to smell, become infected, or become red, swollen and painful, and you may need to take your child to see their GP for treatment.
If your child’s foreskin is still attached to the head of their penis, it’s really important that they don’t try to force it to move backwards before it’s ready because this can be painful for them. The foreskin will naturally separate from the tip eventually. But if the skin is being pulled tight and this is causing your child pain or discomfort, then you should seek advice from their GP.
Foreskin conditions
Like any other part of the body, your child might injure or notice changes in their penis or foreskin, such as redness, irritation, swelling or pain. If you notice or if your child tells you about any of these symptoms, it’s important that you make an appointment with their GP or practice nurse to find out what’s causing the symptoms and how they can be treated. The GP or nurse will ask you some questions and, depending on the condition, may take a swab to test for infection.
Below you’ll find a list of common foreskin conditions and the different range of treatments which your child’s GP or a specialist doctor – called a urologist or paediatric surgeon– should discuss with you and your child after they’ve diagnosed what the problem is. You can click here to download a leaflet to help you and your child make the most of your appointment and ask the right questions.
Phimosis (tight foreskin)
A tight foreskin that can’t be pulled back or ‘retracted’ is known in the medical community as phimosis.
Phimosis (tight foreskin)
A tight foreskin that can’t be pulled back or ‘retracted’ is known in the medical community as phimosis. This occurs naturally because the foreskin hasn’t separated from the head of the penis. For most children, this separation happens before they start secondary school. Even as a teenager, phimosis can improve on its own, but it can be painful, especially when boys have an erection. If your child is experiencing pain, redness or irritation of their foreskin, it is important that they see their doctor.
A condition called balanitis xerotica obliterans (BXO) can cause phimosis. This is a skin condition which causes scarring of the foreskin and the head of the penis. It stops the foreskin from retracting and sometimes can make it difficult to pass urine. It doesn’t get better on its own and will usually need some form of treatment.
Treatment options
Doctors will recommend one of a range of different treatment options based on what’s best for your child’s specific situation.
Watch and wait
If your child is not experiencing discomfort then their doctor might recommend that they watch and wait to see if the foreskin separates from the tip of the penis on its own. The doctor might recommend gently pulling back the foreskin twice a day. This should never be painful and is usually combined with using a steroid cream.
Topical steroid creams
The doctor might prescribe you a steroid cream to rub onto the narrow part of foreskin to reduce inflammation of the skin and help the skin stretch. The combination of stretching and steroid creams is successful in treating most cases of phimosis, including when a child has BXO.
Preputioplasty
Preputioplasty is an operation that is performed in hospital under general anaesthetic. A surgeon makes up to 3 cuts to widen the foreskin enough so that it can be pulled back fully and replaced back over the head of the penis. Sometimes a steroid injection is given at the same time. This option is good for people who want their penis to look very similar to before the operation and to keep their foreskin.
There is a small risk of bleeding after a preputioplasty but it is very rare to need to return to theatre. Often the foreskin becomes swollen afterwards and this takes 1-2 weeks to settle. Sometimes when the swelling has settled down, the end of the penis looks a little bit uneven because of the cuts needed to make the foreskin wider. This is often not very noticeable.
About 2 weeks after the operation, boys and men are advised to retract and replace the foreskin twice a day because there is the chance it can become narrow again. This happens in about 1 in 5 boys or men who have it done and if it does occur they may be offered another course of steroid cream or a circumcision.
Circumcision
If manual stretching and steroid creams don’t work, and your child continues to experience pain and discomfort, their doctor may have a conversation with you and your child about having a circumcision. Usually, a choice is offered between a preputioplasty and a circumcision and it is important to take some time to think about which option is the best for your child and what they might prefer.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and your child should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and it might feel uncomfortable for your child to pee. If your child continues to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact their doctor to check their penis is healing well.
Side effects
Side effects from circumcision are rare. Around 1 out of 100 people will experience bleeding and may need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The head of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important for some people, as otherwise they can feel dissatisfied and don’t like the way their penis looks after the circumcision.
Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after circumcision or that sex feels different. It is important to take this into consideration or, if your child is a teenager, have a conversation with them if the need for a circumcision arises.
If you have any concerns about circumcision and possible side effects, it’s an important to discuss them with your child’s doctor, and you can always seek a second opinion if you’re not sure.
Frenuloplasty
Frenuloplasty is an operation that is sometimes performed to lengthen the bridge of skin than attaches the foreskin to the underneath of the penis shaft. It is often used when boys or men can retract their foreskin over the head of the penis, but the bridge of skin holds it up underneath. This can cause pain, especially during erections or sex. A frenuloplasty can be done under local or general anaesthetic and doesn’t take long so your child should be able to leave hospital on the same day.
Side effects of the procedure are rare but include bleeding and tightness of the frenulum because of scarring where the operation has been done. It is recommended not to have sex for 6 weeks after the operation.
Paraphimosis
Paraphimosis is a medical emergency and is common in teenage boys.
Paraphimosis
Paraphimosis is a medical emergency and is common in teenage boys. The condition can occur if the foreskin is pulled back to reveal the head of the penis for too long and can’t be moved forward again. The foreskin can become tight behind the head of the penis, restricting blood flow and trapping fluid so the head becomes swollen. If this happens, it is important that you take your child to A&E or urgent care centre for treatment as quickly as possible.
Treatment
There are different ways to treat paraphimosis. Treatment should only be attempted by a doctor or nurse and it is important that they see a healthcare professional as soon as possible.
Manual reduction
Your doctor will give pain relief as medicine or an injection and may wrap the penis in swabs soaked in sugar or cold swabs that help to reduce the swelling. Then they place their fingers and thumb on the penis to gently apply pressure and attempt to push the foreskin up towards the tip of the penis.
If the foreskin cannot be moved forward again using this method, then your child may have to have this attempted whilst they are asleep with a general anaesthetic. If it is still not possible to return the foreskin to cover the head of the penis, then an operation is performed to widen the foreskin to let it be pulled back over the head of the penis and relieve the swelling.
Balanitis
Your child may have balanitis if the head of their penis is red, swollen, sore, itchy or feeling really hot.
Balanitis
Your child may have balanitis if the head of their penis is red, swollen, sore, itchy or feeling really hot. They may also find they have a thick discharge underneath the foreskin. This can start to smell and might cause pain when they pee. In some cases, there might be bleeding around the foreskin.
If your son has these symptoms, it’s important you make an appointment with their GP. If your child finds it painful to pass urine or if they won’t pass urine because it hurts, giving pain relief (paracetamol and ibuprofen) and sitting them in a warm bath will make it much more comfortable for them to urinate.
Possible causes
When you talk to a GP, you should tell them everything you can remember that might have caused balanitis so your child receives the right treatments. Balanitis is usually caused by drops of urine getting caught behind the foreskin and causing irritation. It can also occur because of:
Phimosis
A very tight foreskin that cannot be pulled back, which can make it difficult to clean.
Sexually Transmitted Infection (STI)
Diseases that are commonly passed on through sex can lead to balanitis. To avoid catching any STIs, it is important to wear a condom during sex and have a regular STI check.
Eczema, psoriasis and skin irritation
If your child suffers from eczema or psoriasis in other parts of the body, the same condition might be affecting the skin around their penis. In some people, certain types of soap, shower gels or condoms can irritate the skin and cause balanitis.
Diabetes – People with diabetes can have high levels of sugar in their pee which can cause thrush – an infection by a yeast known as Candida albicans. Thrush can lead to balanitis.
Treatment
The treatment for balanitis depends on what is causing the condition:
Topical steroid cream
Using a steroid cream can reduce the inflammation caused by eczema, psoriasis, allergies to soaps or the inflammation caused by having a tight foreskin (phimosis).
Antifungal cream/Antibiotics
If your child has balanitis as a result of an infection, the doctor will prescribe them an antibiotic or antifungal to clear the infection. Once the infection is gone, the pain or discomfort should go away. If it doesn’t go away, it’s important you book another appointment with a doctor to understand why and receive alternative treatment.
Preputioplasty
Preputioplastly is an operation that is performed in hospital under general anaesthetic. A surgeon makes 3 cuts to widen the foreskin enough so that it can be pulled back fully and replaced back over the head of the penis. Sometimes a steroid injection is given at the same time. This option is good for people who want their penis to look very similar to before the operation and to keep their foreskin.
There is a small risk of bleeding after a preputioplasty but it is very rare to need to return to theatre. Often the foreskin becomes swollen afterwards and this takes 1-2 weeks to settle. Sometimes when the swelling has settled down, the end of the penis looks a little bit uneven because of the cuts needed to make the foreskin wider. This is often not very noticeable.
About 2 weeks after the operation, boys and men are advised to retract and replace the foreskin twice a day because there is the chance it can become narrow again. This happens in about 1 in 3 boys or men who have it done and if it does occur they may be offered another course of steroid cream or a circumcision.
Circumcision
If these treatment options don’t work or the condition keeps coming back, the doctor may suggest that your child needs a circumcision.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and your child should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and might feel uncomfortable to pee. If your child continues to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact their doctor to check the penis is healing well.
Side effects from circumcision are rare. Around 1 out of 100 people will experience bleeding and may need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The head of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important so your son doesn’t feel dissatisfied with the way their penis looks after the circumcision.
Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after circumcision or that sex feels different. It is important to take this into consideration or, if your child is a teenager, have a conversations with them if the need for a circumcision arises.
Balanitis xerotica obliterans (BXO)
Balanitis xerotica obliterans (BXO) is a skin condition that can affect small numbers of people from the age of 4 onwards.
Balanitis xerotica obliterans (BXO)
Balanitis xerotica obliterans (BXO) is a skin condition that can affect small numbers of people from the age of 4 onwards. White, itchy patches form on the foreskin and head of the penis, causing pain and irritation, and can bleed if scratched. It is very common for this condition to cause pain and discomfort while peeing and during sex. Scar tissue can form in the affected area, causing tightness in the foreskin and increasing discomfort.
Cause
It’s not fully understood why people develop BXO. It is thought to be caused by the body’s immune system attacking the skin by mistake. In some people, certain types of soap, shower gels or condoms can irritate the skin. Some doctors think that it is also because of some genetic conditions which make it more likely for some people to get it than others.
Treatment
Topical steroid creams – Steroid creams that can help to reduce inflammation and keep the immune system at bay have been shown to stop the symptoms getting any worse, and in some boys and men, make the scarring better. These creams are initially prescribed for two months but can be used to help relieve symptoms if the condition keeps coming back.
Surgical options
Preputioplasty
Preputioplastly is an operation that is performed in hospital under general anaesthetic. A surgeon makes 3 cuts to widen the foreskin enough so that it can be pulled back fully and replaced back over the head of the penis. Sometimes a steroid injection is given at the same time. This option is good for people who want their penis to look very similar to before the operation and to keep their foreskin.
There is a small risk of bleeding after a preputioplasty but it is very rare to need to return to theatre. Often the foreskin becomes swollen afterwards and this takes 1-2 weeks to settle. Sometimes when the swelling has settled down, the end of the penis looks a little bit uneven because of the cuts needed to make the foreskin wider. This is often not very noticeable.
About 2 weeks after the operation, boys and men are advised to retract and replace the foreskin twice a day because there is the chance it can become narrow again. This happens in about 1 in 3 boys or men who have it done and if it does occur they may be offered another course of steroid cream or a circumcision.
Circumcision
If these treatment options don’t work or the condition keeps coming back, the doctor may suggest that your child needs a circumcision.
During a circumcision, the foreskin is completely removed by a surgeon so that the head of the penis will always be uncovered. The procedure can be performed either under general anaesthetic for children or younger teenagers, or with local anaesthetic for older teenagers and adults. The procedure doesn’t take long and your child should be able to leave hospital the same day.
It can take a couple of weeks to recover from the surgery. The penis often feels swollen and sore and might feel uncomfortable to pee. If your child continues to feel pain and discomfort for two weeks or more after surgery, it’s important that you contact their doctor to check the penis is healing well.
Side effects from circumcision are rare. Around 1 out of 100 people will experience bleeding and may need to go back to theatre, and the penis is often swollen for 1-2 weeks after the operation. The head of the penis can feel quite sensitive after a circumcision and it can take time for this feeling to go away.
A circumcision is not reversible so understanding what a circumcised penis looks like before the operation is important so your son doesn’t feel dissatisfied with the way their penis looks after the circumcision. Some studies have shown that men aren’t any less satisfied with their sex life after circumcisions, but others have reported that their penis is less sensitive during sex after circumcision or that sex feels different. It is important to take this into consideration or, if your child is a teenager, have a conversations with them if the need for a circumcision arises.
Meatotomy and meatoplasty
sometimes BXO can narrow the hole at the end of the penis where pee comes out of, causing difficulty passing urine and spraying. If this happens, then a number of different techniques can be used to widen the hole.
For most children, having a clinician stretch their foreskin whilst they are under anaesthetic can improve their symptoms. Sometimes it will have to continue to be stretched for a few weeks afterwards too but yourself or your child. If this does not help, or if it becomes narrow again, then an operation to widen the hole can be performed. This makes the hole wider towards the underside of the penis, meaning that when men who have had it done pass urine, their stream is sometimes directed downwards. There is still a risk that it can narrow down again after this, but it is less likely.
Urinary tract infection (UTI)
A UTI is an infection in the bladder, urethra (the tube you pee out of) or your kidneys.
Urinary tract infection (UTI)
A UTI is an infection in the bladder, urethra (the tube you pee out of) or your kidneys. Some symptoms of a UTI include: needing to pee a lot, a burning feeling when you pee, blood in your pee, pain in your lower tummy, as well as feeling tired and unwell or having a high temperature. You should see a doctor if your child has any symptoms.
Treatment
UTIs can normally be treated successfully with a simple course of antibiotics and circumcision is not routinely recommended for most boys and men. However, in very young boys with kidney or bladder problems, a circumcision can be very useful at reducing the number of UTIs that they get and can reduce the long-term risk of kidney scarring. If your child has kidney or bladder problems, especially if they have had a urinary tract infection, you can discuss with your child’s doctor whether a circumcision could be worthwhile.
Frenulum tearing
The frenulum, also known as the ‘banjo string’ is the bridge of skin that joins the foreskin to the shaft of the penis.
Frenulum tearing
The frenulum, also known as the ‘banjo string’ is the bridge of skin that joins the foreskin to the shaft of the penis. The frenulum can be tight and tear, sometimes during sex, and can lead to painful erections. Using a lubricant during sex can help to avoid this happening.
Treatment
Usually, a tear will heal without any treatment. If it doesn’t heal, or if tearing happens regularly, your son will need to go to see their doctor or a sexual health clinic to have it checked.
Frenuloplasty
If your son tells you his frenulum splits regularly, or that erections are painful because the frenulum pulls the underside of the foreskin up very tightly, they may need to have a small operation called a frenuloplasty. This makes the bridge of skin longer, to reduce the chance of any more tears. The procedure can be done under general or local anaesthetic and won’t take long so they should be able to leave hospital on the same day.
Side effects of the procedure are rare. Most people experience swelling in the days after the surgery, but the swelling will go down. They shouldn’t have sex for six weeks after the operation.
Lengthening the frenulum can change the way your penis looks and feels, so it’s important your child discusses the decision with the doctor and takes time to consider your options.
Circumcision
If these treatment options don’t work or the tearing continues, the doctor may suggest that they need circumcision.
‘Zipper trauma’
It’s quite common for boys and men to get their foreskin trapped in zips in their trousers.
‘Zipper trauma’
It’s quite common for boys and men to get their foreskin trapped in zips in their trousers, especially if they are not wearing any underwear, which can be painful and tear the foreskin. It’s important to make sure they are careful when zipping up trousers. Usually, a tear will heal without any treatment. If it doesn’t heal, they will need to go to see the doctor or a sexual health clinic to have it checked.
Hypospadias
A relatively common condition that boys are born with.
Hypospadias
Hypospadias is a relatively common condition that boys are born with. It can cause the hole where pee comes out of (the urethra) to be somewhere on the underside of the penis. This can be anywhere from the underside of the head of the penis in mild cases to the scrotum in severe cases. The foreskin can be a hood over the end of the penis, rather than a collar wrapping all the way around. Hypospadias can also cause some boys to have a downwards bend in their penis, especially when they have an erection.
Mild cases don’t necessarily require any treatment, but operations can be done to make the penis look like other boys’. However, some boys may need surgery to bring their urethra further towards the end of the penis and to straighten the penis. This is usually performed at a young age and sometimes needs to be done in more than one operation.
Children with hypospadias should not have a circumcision until they have seen a hypospadias specialist. This is because sometimes the foreskin is needed to help to correct the hypospadias condition. A circumcision may be performed as part of the hypospadias correction, but in mild cases of hypospadias, the foreskin can be reconstructed. It is worthwhile having a discussion about this with your child’s doctor if this is something that you or your child have strong feelings about.