Question: My baby is a year old and we decided not to have him circumcised. However, I believe that it is important to keep the baby’s penis clean, and I am wondering when I should start to push his foreskin back and wash underneath it.Answer: Wonderful that you have decided to keep your baby intact because of all the health and sexual benefits. Babies are born with foreskins because they are an important body-part with many functions. Cutting off the foreskin leaves the baby open to a number of medical problems that are never seen in intact babies. Moreover keeping the baby’s penis clean is really quite easy when you understand how, and in fact achieving good intimate male hygiene is easier than achieving good intimate female hygiene.
So far you have no doubt just washed your baby’s penis when you bath him, and it is good that you have not tried retracting his foreskin. In infancy the foreskin protects the glans and the urinary opening, allowing urine to pass out, but preventing faeces from getting in when he has a dirty nappy (diaper). At this stage the foreskin is probably still firmly attached to the glans underneath so there is no need to wash underneath at all and trying to push the foreskin back could do damage.
In the past it was believed that the baby’s foreskin should have separated from the glans by about four years of age, and was recommended that parents should start to push it back and wash underneath. Sadly this policy led to problems resulting in the unnecessary circumcision of many young boys. We now know that while the foreskin may start to separate at about four years of age, it often doesn’t separate on it’s own until puberty, so it is best to leave well alone. Pushing it back to wash can cause damage resulting in adhesions forming.
Also washing with alkaline soap can irritate the sensitive foreskin, causing inflammation and pain that can result in doctors suggesting cutting it off, though that is unnecessary and careful treatment can solve the problem. If you have strong feelings about wanting to use a cleanser, Sebamed has a range of cleansing products that are the same pH as the skin, pH 5.5. They are safe to use when washing his body (some of the foam will wash over his penis, and that’s fine). When we understand that in some boys the foreskin may not be retractable till they are up to 16 years old, we will understand why it is best not to touch it, and never to try to retract it. So when you bath your son, simply wash the penis as you would a finger, using clean water. (See the article on this site Should I have my baby son circumcised? for more information on the physiology of the foreskin and how it works).You may notice that your child’s foreskin “balloons” when he urinates, but that it not a cause for concern. It simply means that the foreskin is starting to separate from the tissue below it and is a healthy sign. A young child discovers that it’s pleasurable to touch his own penis and all toddlers do it. But if they pull it at all they tend to pull the foreskin forwards, not backwards, so retraction, which can cause problems, usually doesn’t happen. Also if the toddler does something that hurts, he will stop. So the general rule is that nobody but the toddler (including doctors) should touch the boy’s penis, or try to retract the foreskin.
As your son grows, his foreskin will separate from the glans. By puberty, if it hasn’t happened before, erections will help the separation to happen. At whatever age your son’s foreskin separates from the glans, he will probably pull it back in the shower or bath, and wash underneath. If he is not sure how, his father or an older brother can show him. Some grown men can tolerate ordinary soap by this stage, but if they find them irritating they can use one of the many intimate cleansing products with a pH of 5.5 like the one mentioned above.
The intact child’s charter: “I’M INTACT, DON’T RETRACT — ONLY CLEAN WHAT IS SEEN.” If your child needs to see a doctor for any reason, you may need to find a paediatrician who has experience with intact children. Not all do, and some will try to retract the foreskin on any child they see who is over four to six years old. If anyone tries to retract your son’s foreskin, you have the right to ask them to stop immediately!
In a few cases, the foreskin may still not be retractable in early adulthood (a condition called phimosis). If it is a problem for him, the young man can get medical help. The usual way of managing the condition is the use of steroidal creams along with the gentle stretching of the opening of the foreskin, done over time. In a tiny minority of men, total retraction of the foreskin never happens, and provided it doesn’t cause pain during intercourse, there is no need to do anything about it, so long as it retracts enough to wash underneath. If it does cause pain or if the problem is caused by a short frenulum (a bit like tongue-tie in a baby) fairly minor surgery can correct it without circumcision (cutting off the foreskin).
Your son’s foreskin is the most sensitive part of his genitals, and with your help and guidance he can keep it clean and healthy.
Written by Pat Törngren © 2012