Decided to go au naturale, have we?
Yesterday, I posted arguments against circumcision. If you checked out that blog, you know that this is a very, er, sensitive topic.
But you’re a natural parent. You’ve done your research. And you figure, “What the hey! It’s not my body. Would I want someone to make this lifetime choice for me?”
Next step: How to Care For an Intact Penis
Pencils sharpened? Here goes:
Bathe. Your. Son.
Got it? I’ll repeat it: Have him wash with soap and water.
As he gets older, you can discuss with his pediatrician whether is foreskin has retracted enough. But remember, there is a wide range for when normal retraction should occur.
My older son’s pediatrician suggested I pull back the foreskin starting when my son was 2. Little L did not like me to do it, and I tried to reason with him. Then I decided that I wanted my son to have autonomy over his body and know that how it should be touched was his choice. I stopped doing it and will no longer discuss foreskins with that doctor. (Just a note: that ped is wonderful in every other way, which is why my boys continue to see him.)
Or, as I read at an “Intactivist” site:
The pediatrician of a friend of mine told her the only thing she needs to take care of her son’s foreskin is a ruler … to smack anyone’s hand who tries to touch it!
At 3 ½, my intact boy can aim at the bushes with the best of ’em, thank you very much!
Now, as the wonderful Dr. Greene (of “Raising Baby Green”) says,
- Only the outside of the foreskin needs to be cleaned during the first year.
- Wash with soap and water like you would the rest of the diaper area.
- If urine can flow freely, the hole in the foreskin is big enough.
- Do not try to forcibly retract the foreskin or to clean under an adherent foreskin with swabs, antiseptics, or even water.
- Over time, the foreskin naturally retracts because of erections or handling. Both are completely normal for boys.
The summary? Wash his penis area like you would his rump. Teach your son to bathe. And don’t stress it! This is the way his body was meant to be!
Image: nathalielaure at Flickr under a Creative Commons License.
I’d be even simpler lol… Caring for an intact penis: Leave It Alone. Regular bathing takes care of the outside, and once the inside is, um, ‘available’, it’s pretty self-explanatory to give it a rinse once in awhile.
And you actually should NOT use soap, it can be very irritating under there. The site you link to with that sentence says this: “Avoid most soaps or cleansing agents because they can irritate the penis; water is usually sufficient for cleansing.”
Just as you wouldn’t use soap for cleaning inside a girl’s labia or vulva. Even using soap externally is an irritant ‘down there’ for lots of women.
Also, with the advice “As he gets older, you can discuss with his pediatrician whether his foreskin has retracted enough” I would give a HUGE caveat. Your own experience corroborates it… MOST pediatricians do NOT know how to properly care for an intact penis and will attempt to forcibly retract, even with a newborn.
My own dr when my son was a baby instructed me to gently retract, just as far as it would comfortably go, with each diaper change to “encourage” it to retract. I didn’t know any better at that time so I followed the advice. In the long term my son was fine but we did have some redness and adhesions for a certain time, and I’ll never know for sure if that yanking we did on it before I learned better was at least in part responsible. And this was in Canada, where intact is by FAR more “normal” than mutilated, our universal health care does NOT cover circumcisions and there are actually very few doctors who will even perform them. Even here, there is ignorance about proper care.
You’re right: don’t put soap on female or male sensitive areas. I only mean: let there be washing. My boys just took a (light on the bubbles) bath. I always add a little soap to the water. But please! No scrubbing. No soap directly on it!
And for young ones? Just like for a circ boy: change diapers frequently.
Could you please make your ped aware of the following:
AAP – “Care of the Uncircumcised Penis”
http://www.aap.org/publiced/BR_Uncircumcised.htm
“foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant’s. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin.”
RACP policy statement on circumcision
http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
“The foreskin requires no special care during infancy. It should be left alone. Attempts to forcibly retract it are painful, often injure the foreskin, and can lead to scarring and phimosis.”
(the words “It should be left alone” are in bold in their policy statement)
Canadian Paediatric Society
http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
“Keep your baby’s penis clean by gently washing the area during his bath. Do not try to pull back the foreskin. Usually, it is not fully retractable until a boy is 3 to 5 years old, or even until after puberty. Never force it.”
http://en.wikipedia.org/wiki/Forcible_retraction_of_the_foreskin
“The American Academy of Pediatrics caution parents not to retract their son’s foreskin, but suggest that once he reaches puberty, he should retract and gently wash with soap and water. The Royal Australasian College of Physicians as well as the Canadian Pediatric Society emphasize that the infant foreskin should be left alone and requires no special care.”
And this is the link for DOC’s statement:
http://www.doctorsopposingcircumcision.org/info/info-forcedretraction.html
This is great information but I think it needs to be expanded. Parents need to understand why retraction and cleaning is not only not necessary but can be dangerous with long term consequences.
First, a little anatomy lesson. In infants and children, the foreskin is bonded to the glans (head of the penis) just like the fingernails are bonded to the nailbeds and with the same tissue, the epithelium. Forcible retraction tears this tissue just the same as pulling the fingernails off would cause tearing of the nailbeds. As the child nears the age of natural retraction, this bond disolves and releases the foreskin from the glans. There are two dangers of forcing the foreskin back, the tears are an opening for opportunistic infections and the tears can heal back to the glans with scar tissue that will not disolve necessitating a surgical procedure later to release them.
There is also a tight band of tissue surrounding the foreskin opening. In children that are not yet naturally retractile, this band is not elastic. Stretching this band forcibly can cause microscopic tears in the internal structure that will heal with scar tissue and scar tissue will not be elastic so that when the time for natural retraction comes, this scarified tissue will resist stretching and may require a surgical procedure to facilitate retraction.
Next, parents must understand the environment within the preputial space. (the inners of the foreskin) This is called an anerobic environment meaning that it is colonized by beneficial bacteria. These bacteria are essential to the health of the penis and are the exact same bacteria that colonize the female vulva and vagina. Disturbing these beneficial bacteria can have serious health consequences just as vaginal douching can cause problems such as yeast infections. As a matter of fact, after a round of antibiotics, these beneficial bacteria can be destroyed and must be replaced. A popular method of re-colonizing the area is to rub plain unsweetened yogurt on the area. The yogurt contains the same exact beneficial bacteria. Just how bad could these bacteria be if we eat them in yogurt?
Soaps and especially deodorant soaps can also destroy these bacteria and should not be used in this area. Besides the risk of infection, eliminating these bacteria can cause undesirable bacteria to flourish causing undesirable odors.
So, just when should a male start cleaning inside the foreskin? Strictly speaking for health, it never needs to be cleaned just as the vagina does not need to be cleaned. However there is the esoteric consideration. Just as a female that does not rinse her vulva will experience smegma (vernix) accumulations, a male that does not rinse inside the foreskin can accumulate smegma accumulations. This could be disturbing for sexual partners. Other than that situation, no cleaning inside the foreskin ever needs to be done and the male will not suffer health consequences. The preputial space exudes an enzyme in addition to the beneficial bacteria. This enzyme is called lysozimme and is the same enzyme that protects the eyes from infection. Excessive cleaning inside the foreskin can disturb the enzyme leaving the area unprotected from infections.
So, the question becomes “When should the foreskin retract naturally?” That is an open question. The first study that attempted to answer this question found that 2/3 of boys will be retractile by 3 years old. That means that 1/3 will not be retractile. Apparently many doctors have read this study and forget about the other 1/3 and insist that all boys should be retractile by 3 years old and if not, are in desperate need of a circumcision. Later studies have found that the average age of retraction is much later. One found that 70% of boys are not retractile until after puberty. The one that seems to be most reliable found that the average age of retraction is 10.5 years. It is well documented that some boys do not become retractile until the late teen years.
Generally, boys are quite capable of determing when their foreskins become naturally retractile. It usually happens when they have an erection and the glans pops out. It is normal for the foreskin to retract on erection.
The best advice for cleaning the genitals I have seen is a three step process: Wash just like a finger, rinse and dry. This is all that is needed. Never ever try to retract a child’s foreskin as it is easily damaged, not even just a little bit. Also, carefully stand guard over your child at doctors visits. Incidences of doctors forcibly retracting a non-retractile foreskin are quite common. Tell the doctor at the begining of the examination that he/she is not to retract the foreskin not even a little bit. It is good advice to tell the doctor if he/she needs to examine the genitals, he/she is not to touch them that you as the parent will do any manipulation necessary to facilitate the examination.
.
Great article. Let me just add that, once the foreskin is retractable, soap should not be used on the glans (head of the penis) or the inner lining because these are mucous membrane. Soap will dry out the tissues and disturb normal bacterial balance (subjecting a person to the possibility of a yeast overgrowth).
Once retractable, cleaning is easy: retract, rinse, and replace. Simple as that!
The average age for foreskin retraction is 10.4 years, so parents or the owner of the foreskin need not worry if the process of retractability lasts into the late teens or early twenties. This, too, is normal.
It looks like I can’t post links here, but you can find all these quotes at the organizations’ own websites:
Canadian Paediatric Society
“Recommendation: Circumcision of newborns should not be routinely performed.”
“Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary.”
“After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”
Royal Australasian College of Physicians
“After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision.”
(those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)
British Medical Association
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”
National Health Service (UK)
“Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest it has any medical benefit.”
Canadian Children’s Rights Council
“It is the position of the Canadian Children’s Rights Council that ‘circumcision’ of male or female children is genital mutilation of children.”
drops in male circumcision:
USA: from 90% to 57%
Canada: from 47% to 14%
UK: from 35% to about 5% (less than 1% among non-Muslims)
Australia: 90% to 12.6% (”routine” circumcision has recently been *banned* in public hospitals in all states except one, so the rate will now be a lot lower)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5%
It’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.
Both of those sound ridiculous today I know, but if you don’t believe me, then google this “A Short History of Circumcision in North America: In the Physicians’ Own Words”.
Over a hundred years later, circumcised men keep looking for new ways to defend the practice.
The record payout for a botched circumcision is $22.8 million. It was said at the time that the victim “will never be able to function sexually as a normal male and will require extensive reconstructive surgery and psychological counseling as well as lifelong urological care and treatment by infectious disease specialists.”
Sure, cases like that are very rare, but why should they happen at all? If you look up the galleries of botched jobs, one thing that may surprise you is just how many jobs were botched cosmetically, rather than medically. Skin tags and skin bridges and hair growing half way up the shaft are not normal, but would not be counted as medical complications.
We have this exact brand of temporal therm. and it’s GREAT. It’s waaaay more accurate than the old digital (under the tongue/armpit) therm. we used to have.
One swipe across the forehead and you have an accurate temp reading- this is especially invaluable when the kids are sleeping and I don’t want to wake them. We’ve had ours for about three years now and it’s using the same battery. Oh, and I got ours at the evil W*lmart because it was only $30 (compared to other places online at nearly $50).
“It’s only reversible from a cosmetic sense you never regain the nerves and other structures.”
-Well let’s hope it’s only a matter of time till they can. However since the nerves system in an infant is not developed are those nerves actually “missing” or do they proceed to develop fully in the area after circumcision? “When babies are born, they do not have fully developed nervous systems, and their systems run slower. Eventually, the nervous system matures.” This was taken from http://www.sciencedaily.com/releases/2009/02/090203162353.htm. Because there is (stated once again) “no way to support that a circumcised male has any less sexual pleasure than an uncircumcised male that is pure biased hearsay.”
“It can impede normal function especially to those unlucky enough to draw the proverbial short straw. And what words do you have to those boys and men who received more than the expected damage? Things that you mention (such as phimosis) are easily treatable non surgically in the rare cases they happen. But in the rare botch, the boy isn’t quite as lucky, he can face life long problems.”
-Once again “-I will agree with that however out of the numbers these are extremely rare occurrences as another poster (Crimson Wife ) mentioned, and since it is so rare it would be fair to bring up the fact that “There are sometimes medical reasons for circumcision, such as phimosis (a condition in which foreskin retraction is impossible).” In that rare case circumcision is in fact necessary. Also there are rare cases of unnecessary c-sections being botched causing a woman or her child life long problems it happens yes it is unfortunate yet fortunately very rare.
Well, everyone gets one right now and then. Yes, it is important to know the goals of the researchers because that can influence the results. In this case you might want to read the abstract of the study Hugh is referring to. You’ll find that they were quite surprised as they were out to demonstrate that female circumcision increases womens risk, they found the opposite. Funny, nobody followed this work. Now that’s biased.
-Why don’t you go back and read the whole statement” That is only one study out of many dealing with circumcision. Anyone can poke holes trough any studies as all are in some small way inherently flawed. However providing the history of the researcher and how they go into their research dictates whether they have a predestined bias and mess with the number or if they are genuinely looking for answers. This in conjunction with how many other studies support or deny the evidence gained from one study. You can get the general idea if one is indeed factual.” Please pay attention to the last line once more “this in conjunction with how many other studies support or deny the evidence gained from one study.” I would love for there to be studies in Africa where HIV and AIDS are infract an epidemic and female circumcision is more prevalent. Truth be told since that is a long standing practice in Africa and HIV/AIDS has still managed to become an epidemic there I think you will find the results would be quite the opposite from that one study.
It’s not always that way, would it make you feel better if they did it in a nice clean and sterile surgical theater? That’s how it’s done in many places like Indonesia and Egypt where Doctors and Nurses did/do most of the procedures. And not all women are against the procedure. As luck would have it there was a recent article/press release from a newly formed group which I am sure you’ll enjoy. All they want is the right to practice their traditions as they see fit, who are we to stop them? The facts are, the authors of that article got it right and there isn’t as much difference between these two procedures as we think.
-Sierra Leon is a small country in the whole of Africa this came up when I researched it “Sierra Leone is the lowest ranked country on the Human Development Index and seventh lowest on the Human Poverty Index, suffering from endemic corruption and suppression of the press.” With that statement I went ahead and researched the AWA-FC which turned up nothing on this so called newly formed group, which for all I know could be a farce and have been created by you. Please provide some better evidence to back that article up because it is discredited by the governmental control over the press and the fact that there is nothing on this women’s group. However this is not to say that all women are against female circumcision as I stated before “With regards to having it done here in the states I have actually met and spoken in depth with Todd Bertrang who is in jail for doing such surgical procedures as female circumcision out of his home, in addition to being the best person to go to for large gauge piercing, branding, other uncommon body modification procedures, and keeping (by choice) sex slaves. Female circumcision takes two weeks to heal as opposed to one week for male circumcision and it does, most commonly, involves the total removal of the clitoris and inner labia (labia minora). Which as Tori said on February 24th, 2009 at 1:29 am, “The clitoris is a tiny penis without a urethra. The hood around the clitoris which extends into the labia minora are very much like the foreskin.” Which would equate to male circumcision with having the whole penis removed. Once again more oftem then not female circumcision is the removal of the clitoris (not just the hood) and labia minora. Cate I assure you that I am not lying when I say I have researched this in depth.”
Joe you some how seemed to overlook this please read thoroughly next time or you do miss important tidbits like that statement and all of the other ones I’ve had to repeat. Also that second article fails to draw the similarities and it is a biased article where as they state their bias while trying to pass it off as a “medical based” document.
What Ever! Why don’t you campaign about something that really matters? Example: Take for instance the Ogoni People in Nigeria that oil companies are polluting to death. While they import millions of gallon of oil to the USA the Ogoni people are living in abstract poverty and have to fish and farm, which they depend on to live, in polluted waters and land. They have to drink water that is full of toxins. The profit from the oil extraction goes directly to the oil companies and the Nigerian government that ignores the pleas of the Ogoni people. And check history: they even destroy their villages and execute (murder) the people when they protest. And guess where the Nigerian government gets the guns to shoot down the people: from the oil companies. Think about that the next time you fill up your SUV and lament over foreskin. Get a real issue to protest over!
WhatEver,
Thanks for taking the time to write about a seemingly unimportant topic. The thing is, to people who leave their boys intact, not changing a boy’s genitals at birth is important.
I appreciate you bringing up a topic you are clearly passionate about. Perhaps you could write about it, and spread the word via various social networking venues.
If you read other blogs I have written, both here and at Nature’s Child, you would see that I cover many issues, especially focusing on natural parenting and children’s health.
I will not, however, discuss what type of vehicle I drive or how often. As a green parent, working toward sustainability, I have made good choices for my family. We only have what we need in this household.
Brettney Said:
Why hope, you just stop mutilating them and you don’t have to hope.
Brettney Said:
That doesn’t say the nerves aren’t there; it only says that the insulating material hasn’t formed around the pathways which seams to increase the propagation delay for impulses. It doesn’t demonstrate that they feel pain more or less acutely. And they aren’t suggesting that the nerve pathways aren’t already formed. They’ve suspended investigations on the pain response of neonatal circumcision without anesthetic because of the obvious distress it causes. Not that it matters since whether or not its painful or distressing is quite besides the point, just because something is painless doesn’t make it ethical.
Brettney Said:
That is really the only study. And I think it’s clear that those researchers were looking for the opposite result. They were desperately trying to show that female circumcision increases HIV prevalence. To their disappointment, they failed.
There will be no follow ups because we’ve rightfully declared female circumcision to be a human rights violation, which is where we should be with male circumcision but because of ‘political correctness’ which seems to trump rational thinking, we’re not there, yet. There is biases in research, you’re right about that but perhaps not in the way you think. When researchers look into female circumcision they’re always going in with the preconceived notion that it’s harmful, with MC they ignore the harms and keep digging for incremental, often trivial benefits. Again the study I provided you shocked those who wrote it, and the went to great lengths to try and dismiss it. Actually, it makes biological sense why female circumcision would decrease HIV prevalence in the same way as male circumcision, less tissue (surface area) available to infect would probably decrease the chance of infection. But alas, our biases will prevent us from investigating it.
As far as HIV prevalence viz-a-viz female circumcision in Africa, it must also be pointed out that the US, with the highest rate (by far) of male circumcision amongst industrialized countries has the highest prevalence (by far) of HIV. It is quite clear that circumcision has heretofore not been useful to us here in the US.
Brettney Said:
That’s cold comfort to the boy or man who has to live with that result. I am courious how many botches are acceptable for a non-therapeutic medical procedure? How many deaths are acceptable for a non-therapeutic medical procedure?
All conditions circumcision is purported to prevent are not only rare but can be treated non-invasively. Your example, Phimosis, can be treated either with gentle stretching, or you can be prescribed steroid creams as a second option. Something like betamethasone 0.05% cream for 4 to 6 weeks has been demonstrated to be very effective working for most people who need it. Or if for some reason neither of these work, as a final option, one could opt for a Preputioplasty; the least invasive surgical option. Preputioplasty requires the surgeon to make one or more short longitudinal incisions to relieve the stenosis which would then be sutured transversely (There is even a sutureless option now). Preputioplasty is nearly always the most appropriate surgical option except in some very specific circumstances, such as a non-retractable foreskin which is complicated by significant scarring or tearing. Considering how uncommon these problems are getting to a circumcision because of them is especially rare.
I am aware of the increasing rates of sections. But at least in that case the person being operated on has provided consent. That makes it quite a different situation.
Brettney Said:
What does that have to do with anything? Are you saying because of the countries economic and political status that is why female circumcision persists? If that’s the case let’s take a look at the countries where MC is prevalent (we sure keep good company don’t we:
Albania, Syria, Iraq, Saudi Arabia, Yemen, Oman, Iran, Pakistan, Iran, Qatar, Kuwait, Afghanistan, Turkmenistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Indonesia, Israel, Tajikistan, Morocco, Western Sahara, Mauritania, Senegal, Gambia, Guinea Bissau, Guinea, Sierra Leone, Cortie D’ivoire, Togo, Nigeria, Mali, Niger, Algeria, Turkey, Tunisia, Libya, Chad, Sudan, Egypt, Ethiopia, Somalia.
Of course most of them do it just to please the sky fairy.
Brettney Said:
I am not sure what this is about that press release made in DC, two of the contact numbers are DC area codes the third is Maryland. If you want to corroborate veracity of the press release, there is contact information on the bottom of the page.
Brettney Said:
This is the problem, when people think about female circumcision they alway think of the worst situation. Rusty razor, mud hut, ect. And they lump all the procedures in together. The bottom line is that here in the US baby girls are protected no matter how severe or benign the ‘circumcision’ would be, no matter the culture, no matter the religion, no matter who does it or at what age. Boys deserve the same respect and protection for their bodies that girls are given.
Heather Dunham wrote: ““Avoid most soaps or cleansing agents because they can irritate the penis; water is usually sufficient for cleansing.”
Just as you wouldn’t use soap for cleaning inside a girl’s labia or vulva. Even using soap externally is an irritant ‘down there’ for lots of women.”
There is a reason for this. All of the inner surfaces of the penis (within the foreskin) and within the labia are mucosal skin. Some read this and think “mucous” but these skin surfaces do not produce mucous. It simply means that this skin type is designed to function in a wet environment. Other areas on the body where mucosal skin is present is in the anal cleft, inside the mouth and lips and the inner eyelids. The inner eyelids are most sensitive to soaps but all those areas are sensitive to soaps to some degree.
Women can relate to leaving soap in their vaginal cleft as it will produce a burning sensation with time. Soap within the prepuce will also have this effect and if there long enough will burn the inner surface of the foreskin and the surface of the glans. Not only will this be painful for the child but these burned surfaces will be more susceptible to infections.
Frank
There is so much controversy surrounding the practice of circumcision. I have a family of both circumcised and uncircumcised males and honestly, the circumcised males have had much less male health problems than the uncircumcised. Unfortunately, the uncircumcised males are dealing with UTI’s, other infections and foreskin issues. I am leaning towards circumcising my son when he is born to try to avoid such health problems.