# Retracting remaining foreskin on a "generous" circumcision?



## Sirte (Jun 23, 2005)

*Disclaimer: I do not have a son and if I did, he would not be circumcised.*

I belong to a more mainstream parenting message board and a member who circumcised her son posted about adhesions. It sounds like her son had what some here would call a "generous" cricumcision. The child is 14 months old and she has been retracting at every daiper change in an effort to dislodge the adhesions.

Is this correct? I thought that you should never retract - even if you have a son whose circumcision resulted in a little foreskin remaining. I want to reply and tell her to stop but I am unsure about this. Anyone have any links or articles I can show her?

I know I can't take away the fact that her poor son was circumcised. But I'd like to end his suffering at every diaper change as a result of the constant retraction - which must be painful, no?

Any help is appreciated. Many thanks!


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## Frankly Speaking (May 24, 2002)

You are correct in your thinking.

When a child is circumcised, it is a wound and the body does it's best to repair that wound as closely as possible to what is normal. In young boys, normal is for the foreskin to be bonded tightly to the glans and his body is trying to restore that normal condition. Repeatedly forcing the adhesions apart is simply fighting the body's natural healing processes.

Intact boys foreskins will naturally separate from the glans and become retractile. If she will just leave it alone, her son's foreskin will heal and bond and sometime down the road at about 3 or 4 years old, it will separate naturally. Fighting it now is not only a hassle but it is also painful to the child and that hassle and pain is not necessary or even beneficial in any way.

The one thing is that when it does begin this natural separation process, there willl probably be some slight pain associated but nothing near the pain he is probably experiencing now and not of the duration that he will have to bear to get to the point that it will not re-adhere.

Frank


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## Quirky (Jun 18, 2002)

If you need it, there's a medical study showing what Frank just said. I can find the link if you want to post it on your other board.


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## Sirte (Jun 23, 2005)

Thank you both!

Quirky,
Please post any info that you can find. I would really like to link her to a source besides just me, KWIM? I have replied in her thread and mentioned not to retract anymore. But since I don't even have a son and would never circumcise one if I did, I don't think that my opinion carries much weight with her. I'd love some back-up if you can find it!


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## Quirky (Jun 18, 2002)

http://tinyurl.com/8dua9

Quote:

J Urol. 2000 Aug;164(2):495-6.

Ponsky LE, Ross JH, Knipper N, Kay R.

Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: The appropriate management of penile adhesions in circumcised boys is unclear. An important consideration is whether adhesions resolve spontaneously. We studied the incidence of penile adhesions as a function of patient age to assess the natural history. MATERIALS AND METHODS: We evaluated all circumcised boys presenting to our pediatric urology clinic. A standard form was used to classify adhesions as grade 0-no adhesions, 1-fine adhesions to the corona, 2-adhesions covering less than 50% of the glans and 3-adhesions covering greater than 50% of the glans. All boys were evaluated by 1 of 2 pediatric urologists. Previous treatment of adhesions was assessed and skin bridges were also noted. RESULTS: We enrolled in our study 254 boys 1 month to 19 years 8 months old. Only 7 patients had a history of treatment of adhesion, of whom 3 had recurrent adhesions at evaluation. Patients were divided into groups based on age, including younger than 12 months (61), 13 to 60 (78), 61 to 108 (51) and 109 months old or older (64). In these groups we noted an adhesion rate of 71%, 28%, 8% and 2%, respectively. The rate of adhesions more severe than grade 1 was 30%, 10% and 0% in boys 12 months old or younger, 13 to 60 and 61 months old or older, respectively. The oldest patient with grade 3 adhesions was 31 months old. Skin bridges in 6 cases involved the circumcision line in 4. CONCLUSIONS: *Penile adhesions develop after circumcision and the incidence decreases with patient age. Although there is debate on whether to lyse these adhesions manually, our findings suggest that adhesions resolve without treatment. Based on our results we do not recommend lysing penile adhesions, except perhaps those involving the circumcision line.*
Lysing means to separate.


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## Frankly Speaking (May 24, 2002)

Sirte, any time you need research, here's a great place to go:

www.cirp.org

Frank


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## Sirte (Jun 23, 2005)

Thank you both very much. Frank, I have bookmarked that site and will use it in the future.

I replied to the mom on the other board and feel more confident in my suggestions to her. She seemed receptive. Perhaps she will stop retracting her son and save him from the discomfort of that process at each diaper change.


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