When should my child's foreskin retract?

Written by: Miss Marie-Klaire Farrugia
Published:
Edited by: Jay Staniland

Management of your child’s foreskin can often cause anxiety. Why doesn’t it retract? What age should it retract? Is it normal for my child to feel soreness? Don’t worry any longer, consultant paediatric urologist, Miss Marie-Klaire Farrugia is on hand to answer your questions.

 

What age does the foreskin retract?

 

A baby’s foreskin is initially adherent to the head, or glans, of the penis. It stays this way in more than 50% of children until at least the age of two, but often much later. In fact, a large cohort study in Denmark found that the average age of foreskin retraction was 10.4 years. Before the foreskin first retracts, the opening may look small and tight. As long as there are no restrictions to your child’s weeing, and no infections, there is no need to intervene medically or surgically.

 

Problems with the foreskin

 

As the foreskin begins to retract, there may be some soreness or discomfort, but this will usually go away after a day or two. If the symptoms last for longer than this, or if your child experiences swelling, infection ('balanitis') or a white scarring at the tip of the penis, a rare condition called balanitis xerotic obliterans (BXO), then it is a good idea to see a specialist paediatric urologist.

Options would then include medical treatment (a mild steroid cream or antibiotics if acutely infected) or surgery. Surgical options include preputioplasty, where the foreskin is stretched but preserved, or circumcision.


Once the foreskin is retractile, children should be reminded to pull the foreskin back into place after retraction, to avoid it getting stuck behind the glans (paraphimosis). If this occurs, urgent treatment should be sought.

 

Circumcision

 

Some parents choose to have their sons circumcised for religious or cultural reasons. In babies up to 6 weeks of age, this may be performed under a local anaesthetic, otherwise known as a penile block, which only numbs the penis.


In older babies and children, it is safer and more comfortable for them to have a general anaesthetic. In both cases, the post-operative recovery is the same, and it is usual for the procedure to be carried out as a day-case, meaning the child will be able to leave the hospital the same day as the procedure.

By Miss Marie-Klaire Farrugia
Paediatric urology

Miss Marie-Klaire Farrugia is a consultant paediatric urologist based at Chelsea and Westminster Hospital and the BUPA Cromwell hospital in central London. She specialises in all areas of kidney, bladder and genital anomalies that babies are born with or develop later in childhood. In particular, she counsels pregnant mothers whose babies are prenatally-diagnosed with a kidney condition, so that the best postnatal plan can be made for the newborn.

Miss Marie-Klaire Farrugia is the clinical lead for paediatric surgery in the North West London Network, and writes guidelines and teaches in the major North West London hospitals. Her research interests include the long-term outcome of prenatally-diagnosed urological problems such as hydronephrosis and posterior urethral valves and vesicoureteric reflux. She is an experienced open, laparoscopic and robotic surgeon and performs neonatal and childhood circumcision; repair of simple and complex hypospadias including staged graft repairs; hernia and hydrocoele repairs; surgery for undescended testes; pyeloplasty; ureteric reimplantation; surgery on duplex kidneys and ureterocoeles; posterior urethral valves; nephrectomy and hemi-nephrectomy; Deflux injection for kidney reflux with urine infections; amongst others.

Miss Farrugia is an executive member of the Society for Fetal Urology and a member of the British Association of Paediatric Urologists, the European Society for Paediatric Urology, the American Association of Pediatric Urologists and the Societies for Pediatric Urology.

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