This article follows on from last month's article on Circumcision. Whilst I was writing that article I was amazed by the number of people who asked me how you could tell the difference between a circumcised and uncircumcised penis! Quite a few people also said to me that they had chosen to have their son circumcised as it made the penis so much cleaner and easier to look after. When I told them that boy’s penises needed virtually no looking after they were genuinely puzzled. Clearly, hygiene and care of the penis, is a topic shrouded in mystery!

What does a Babies’ Penis look like?

Perhaps the first thing I should say is when you see your baby son for the first time don’t be shocked if his genitals seem rather large. It is common for the testes to be swollen for a short time after delivery. This is most likely due to the testes holding extra fluid and he may also have received some hormones from his mother. The genitals will usually settle down to a more normal size after a few weeks!
The penis is made up of a shaft, which is tube shaped. The rounded end is called the glans. The shaft and the glans are separated by a groove called the sulcus. A continuous layer of skin covers the entire penis, including the glans. The skin covering the glans is the foreskin, and it has two layers, the outer foreskin and the inner lining. A baby’s foreskin is firmly attached to the glans by what looks like a tight, thick thread. It is not possible (or advisable) to pull the foreskin back and only part of the glans can be seen. The reason that the foreskin is not retractable is because, as the baby was developing in the womb, the foreskin and the glans developed as one tissue. Over time (and this can be as long as 10 years), full separation will occur and the foreskin may be pushed back from the glans towards the abdomen. In 80-90% of uncircumcised boys, the foreskin will gradually separate from the glans by 3 years of age, if left alone. (Gairdner, 1949:cited in AAP, 1989)


How Should I keep it Clean?
No special care of the penis is required. Bath or wash frequently, especially after the baby has soiled his nappy. The golden rule with keeping both baby girls and boys clean is that it is not necessary to probe any areas with cotton buds, sponges or antiseptic wipes. Do not attempt to pull the foreskin back, as forcible retraction can cause pain, bleeding and eventual scarring. Just wash the areas you can see, so in the case of boys, wash the testicles and the penis with water, and if very dirty a little mild soap. Make sure that all the soap is thoroughly rinsed off. Baby wipes are a very convenient means of cleaning but can dry or irritate the skin, so try not to use them all of the time. Bubble baths can also cause irritation to the end of the penis, so, if you are a big fan of these, use them sparingly. After washing, dry gently with a clean, dry towel. The use of creams, unless the baby has nappy rash, are not necessary and can actually affect the efficiency of the urine draining into the nappy. The cream may act as a barrier between the nappy and the urine, causing it to lie on the surface and irritate the babies’ skin.
When the time comes when your son is able to easily pull his foreskin back, show him how he should gently retract it in the bath or shower, to clean the area underneath. Encourage him to do this himself as he will know what feels comfortable and won’t force the foreskin back. Again, soap or bubble baths are not necessary, but if used should be rinsed well. You may also tell him to retract the foreskin back a little while urinating, as this will prevent the end from getting damp and possible irritation from the urine. It will also improve his aim!


What About “The White Stuff?”
The unfortunate sounding name for the white stuff (or “willy cheese” as some boys tend to call it) is Smegma. This is a natural oily, waxy lubricant found between the foreskin and the glans. It is produced throughout life as skin cells from the glans of the penis and the inner foreskin are shed. The shed skin cells work their way to the tip of the foreskin and often appear as white “pearls” under the skin. There tends to be quite a lot of confusion about what to do about smegma, with some old-fashioned baby books warning parents to carefully cleanse the penis of infant smegma. Yet smegma rarely exists in the uncircumcised child whose foreskin has not been forcibly retracted and should small quantities be produced then just gently wipe the tip of the penis, to clean it away. Once a boy reaches puberty he will produce adult smegma. This includes an oily substance, which serves a protective lubricating function for the gland. At this stage the foreskin is usually easily retractable and smegma may be cleansed in the bath or shower. Again, soap or bubble baths should be avoided and the area rinsed well.


Erections
All boys have erections, they even occur when the baby is in the womb. Erections can occur in some, though not all, babies. Baby’s erections are usually triggered by a full bladder and demonstrate that the nerves to the penis are normal. If you wish to know how much the foreskin has separated you may observe your son’s erection. If a full erection occurs then full retraction may also occur. Boys notice their erections around puberty. This is when they start to ejaculate (the average age is 13-14 years). Boys may first ejaculate when asleep (known as “a wet dream”). To prevent infection they should be encouraged to wash their testicles and penis after a wet dream. They have no control over wet dreams and should be treated sensitively without fuss or inquisition when they occur.


What About Problems?
In the case of infant boys, redness or irritation of the foreskin area and tip of the penis is best treated with small quantities of nappy rash cream or healing ointment. Antibiotic creams, prescribed by a Dr, may be necessary if the problem persists. Older boys suffering regularly from the above symptoms should seek a Dr’s advice should they persist. Remind your son not to force the foreskin back, especially if swollen, as this can eventually cause scar tissue around the opening of the foreskin or between the foreskin and the glans.
If your son is not able to retract his foreskin at puberty (called phimosis) then it is advisable to get advice from a paediatric urologist. Research has shown that the area surrounding the foreskin continues to develop until the age of 17 and that very few boys require surgery (circumcision) if the foreskin will not retract. Treatment is usually managed conservatively, such as with the use of topical steroids

As seen above, care of the penis is not a difficult task. The most important advice is to leave the foreskin well alone and keep the area clean Finally, encourage your son to share with you any anxieties he may have.

Written by Yvonne Heavyside from The Family Zone