Care of the
Guidelines for Parents
At birth, the penis consists of a cylindrical shaft
with a rounded end called the glans. The shaft and glans are separated
by a groove called the sulcus. The entire penis - shaft and glans
- is covered by a continuous layer of skin. The section of the penile
skin that covers the glans is called the foreskin or prepuce. The
foreskin consists of two layers, the outer foreskin and an inner lining
similar to a mucous membrane.
Before birth, the foreskin and glans develop as
one tissue. The foreskin is firmly attached - really fused - to the
glans. Over time, this fusion of the inner surface of the prepuce
with the glans skin begins to separate by shedding the cells from
the surface of each layer. Epithelial layers of the glans and the
inner foreskin lining are regularly replaced, not only in infancy
but throughout life. The discarded cells accumulate as whitish, cheesy
"pearls" which gradually work their way out via the tip of the foreskin.
Eventually, sometimes as long as 5, 10, or more
years after birth, full separation occurs and the foreskin may then
be pushed back away from the glans toward the abdomen. This is called
foreskin retraction. The foreskin may retract spontaneously with erections
which occur normally from birth on and even occur in fetal life. Also,
all children "discover" their genitals as they become more aware of
their bodies and may retract the foreskin themselves. If the foreskin
does not seem to retract easily early in life, it is important to
realize that this is not abnormal and that it should eventually do
Infant Smegma: Skin cells from the glans
of the penis and the inner foreskin are shed throughout life. This
is especially true in childhood; natural skin shedding serves to separate
the foreskin from the glans. Since this shedding takes place in a
relatively closed space - with the foreskin covering the glans - the
shed skin cells cannot escape in the usual manner. They escape by
working their way to the tip of the foreskin. These escaping discarded
skin cells constitute infant smegma, which may appear as white "pearls"
under the skin.
Adult Smegma: Specialized sebaceous glands
- Tyson's Glands - which are located on the glans under the foreskin,
are largely inactive in childhood. At puberty, Tyson's Glands produce
an oily substance, which, when mixed with shed skin cells, constitute
adult smegma. Adult smegma serves a protective, lubricating function
for the glans. [Editor's note: The "glands" identified by Tyson are,
in fact, neurovascular end-organs.]
Foreskin Hygiene: The foreskin is easy to
care for. The infant should be bathed or sponged frequently, and all
parts should be washed including the genitals. The uncircumcised penis
is easy to keep clean. No special care is required! No attempt should
be made to forceably retract the foreskin. No manipulation is necessary.
There is no need for special cleansing with Qtips, irrigation,
or antiseptics; soap and water externally will suffice.
Foreskin Retraction: As noted, the foreskin
and glans develop as one tissue. Separation will evolve over time.
It should not be forced. When will separation occur? Each child is
different. Separation may occur before birth; this is rare. It may
take a few days, weeks, months, or even years. This is normal.
Although many foreskins will retract by age 5, there is no need for
concern even after a longer period. Some boys do not attain full retractability
of the foreskin until adolescence.
Hygiene of the Fully Retracted Foreskin:
For the first few years, an occasional retraction with cleansing beneath
Penile hygiene will later become a part of a child's
total body hygiene, including hair shampooing, cleansing the folds
of the ear, and brushing teeth. At puberty, the male should be taught
the importance of retracting the foreskin and cleaning beneath during
his daily bath.
Summary: Care of the uncircumcised boy is
quite easy. "Leave it alone" is good advice. External washing and
rinsing on a daily basis is all that is required. Do not retract the
foreskin in an infant, as it is almost always attached to the glans.
Forcing the foreskin back may harm the penis, causing pain, bleeding,
and possibly adhesions. The natural separation of the foreskin from
the glans may take many years. After puberty, the adult male learns
to retract the foreskin and cleanse under it on a daily basis.
Copyright © 1990. American Academy of Pediatrics