Key points to remember about foreskin care
- the foreskin is the loose skin that covers and protects the end of the penis
- the foreskin and penis of an infant or child need no special care
- a child's foreskin should never be pulled back (retracted) by force
- there is no need to clean inside the foreskin in young boys; just wash their penis the same as any other part of your son's body and be careful to wash off any soap
- once the foreskin is ready to be pulled back, your son will most probably discover this for himself
- once the foreskin is easily pulled back, your son should learn to do this as part of normal washing in the bath
- make sure he rinses off any soap and pulls the foreskin back over the head of the penis afterwards
What is the foreskin?
The foreskin is the loose skin that covers and protects the end or head (glans) of the penis.
The inside fold of the foreskin is a mucous membrane which keeps the surface of the head of the penis soft, moist and sensitive.
See Acknowledgement for these graphics.
What care of the foreskin and penis is needed in infants, children and teenagers?
The foreskin and penis of an infant or child need no special care. A child's foreskin should never be pulled back (retracted) by force.
During the first few years of life, the foreskin is stuck to the head of the penis by a membrane (called the synechia). This membrane or connective tissue dissolves naturally – a process that should never be hurried.
The foreskin can be pulled back when its inside surface separates from the head of the penis and the foreskin's opening widens. This process happens naturally in childhood or during puberty, and has usually happened by the age of 18. Even if the head of the penis and the foreskin separate naturally in infancy, the foreskin may still not be able to be pulled back because the opening in an infant's foreskin may only be large enough for the passage of wee (urine).
When a young boy pulls at his foreskin, he usually pulls it outward. This is normal and natural and no cause for concern; he won't hurt himself.
Once the foreskin is ready to be pulled back, your son will most probably discover this for himself. He should be the first person to pull back his foreskin.
Telling your son about pulling back his foreskin beforehand will keep him from becoming alarmed the first time it happens.
How do I teach my son to wash his penis?
There is no need to clean inside the foreskin in young boys. Just wash the penis the same as any other part of your son's body and be careful to wash off any soap. When a boy is old enough to bathe himself, he can wash his own penis.
Once your son can pull back his foreskin, you can talk to him about pulling back his foreskin and washing. A simple explanation of 'how to' may be helpful:
- gently slip your foreskin back
- rinse the head of your penis and the inside fold of your foreskin with warm water
- slip your foreskin back in place over the head of the penis
Tell him to make sure he rinses off any soap before pulling the foreskin back over the head of the penis.
What happens if someone pulls back my son's foreskin too early?
Forcing the foreskin back before the natural separation of the foreskin from the glans has happened causes tearing of the connective tissue. This is painful and can lead to problems:
- tearing the foreskin from the head of the penis leaves an open wound which can lead to infection
- the raw surfaces touching each other can heal together and form areas that stick together (adhesions) between the foreskin and the head of the penis leading to permanent problems with pulling back (retraction)
- small tears in the opening of the foreskin can heal to form non-stretchable scar tissue, possibly causing acquired narrowing (phimosis)
- the foreskin can get 'stuck' behind the head of the penis (paraphimosis)
What is the white lump (smegma) under my son's foreskin?
The white lump (smegma) is made up of the cells that once attached the foreskin to the head of the penis. As new cells form on the head of the penis and the foreskin's inside fold, old cells form pockets that eventually work their way to the tip of the foreskin, where they can eventually be wiped away. So if you see a white lump (smegma) under the foreskin you know that the separation from the head of the penis is occurring naturally.
Why does my son's foreskin 'balloon' when he wees?
This is another indication that the natural separation of the foreskin from the head of the penis is occurring, but the opening of the foreskin is still narrow.
Ballooning can be normal but if it is severe so the flow of wee (urine) is restricted you should seek advice from your family doctor. Encouraging boys to gently try and pull back their foreskin as part of daily hygiene can help. Sometimes a course of steroid cream is needed. Your family doctor can advise you about this.
What if my son's foreskin can't be pulled back (phimosis)?
Phimosis refers to a foreskin that cannot be pulled back because its opening is too small to expand over the head of the penis. This is normal during infancy and childhood. In later childhood if the child is still unable to retract the foreskin, a course of steroid cream can be prescribed which thins the skin and helps it to stretch over the head of the penis. Your GP (general practitioner) can advise you about this.
What causes my son's foreskin to be red (balanitis)?
Sometimes the tip of the foreskin becomes reddened. This indicates the penis is irritated and the foreskin is doing its job of protecting the sensitive head of the penis and the opening in the penis where wee (urine) comes out (urinary meatus).
If children are still in nappies it may be part of nappy rash. When bacteria in the poo (stools, faeces) react with wee (urine), they produce ammonia, which burns the skin and causes nappy rash.
Ways to prevent a reddened foreskin and nappy rash can include the following:
- changing nappies more frequently
- allowing nappy-free times to allow air to circulate and help healing
- soaking in warm baths
- avoiding things that can irritate the skin (such as bubble baths, soap, highly chlorinated water, some laundry powders)
- encouraging your child to drink more so the wee is dilute (not too concentrated)
If the foreskin or penis is red, painful and swollen there may be an infection and you should see your GP (general practitioner).
What about circumcision?
Circumcision is the operation to remove the foreskin. There is no medical reason for routine male circumcision. For more information, see the fact sheet on circumcision on this website.
There is an operation called a dorsal split where the foreskin is cut to widen and loosen the foreskin, without removing any foreskin tissue.
This fact sheet has been adapted, with permission, from:
NOCIRC (National Organization of Circumcision Information Resource Centers) (United States): Answers to your questions about your young son's intact penis. http://www.nocirc.org/publish/pamphlet4.html [Accessed 7/08/2013]
Graphics of the infant and adult penis have also been reproduced from the above source.
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2016
Printed on 27 September 2016. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version