Reply to Circumcision - Not Enough Cut?!

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[quote=Anonymous][quote=Anonymous]Adhesions are what can regrow attaching the foreskin to the glans again, rendering a circed boy non-retractile.

As a side note, the "dead skin" you mention sounds like smegma, which is totally normal and not harmful -- we all have it.[/quote]

The white stuff is smegma and is normal and not harmful, but our peds (several of them) have always advised that we remove it as we clean the penis in the bath.

Peds. have also always advised us to retract the foreskin with each diaper change JUST to expose the head, and NEVER to force it back.  When the foreskin has gotten adhered, they've given us a steroid cream and advised that we retract gently, not forcing it, twice a day, and apply the steroid around the edges.  Apparently the steroid breaks down the adhesions.  We were told to do it for 2 weeks, then use vaseline for 2 weeks, and if the adhesion hasn't resolved itself by then go back to the steroid cream for another 2 weeks.

We do NOT use vaseline on a regular basis, but we DO (or should -- we're not always 100%) retract the foreskin slightly to reveal the head at every diaper change.  When we start getting bad about remembering to do it consistently, he gets an adhesion.  It sucks, b/c when he has an adhesion he doesn't want us touching him, and I can tell it's painful.

One thing the peds. have always been clear on though is that we should never force the foreskin back.  Gently retract, but don't pull if it sticks.

For the PPs saying that you should never retract the foreskin, you're just wrong, and anyone following your advice will find out the hard way.  And for the PP who posted the link saying that they now think adhesions resolve on their own and should not be messed with, you're misquoting the article.  They said that as children get older they develop fewer adhesions (God I hope so!), and that they don't recommend LYSING adhesions EXCEPT ON THE CIRCUMCISION LINE.  Lysing is a surgical procedure -- the study (I've pasted an extract below) does not say that you should not retract the foreskin to try to avoid adhesions.

We've been upset about and struggling with this issue since DS was born.  The smegma always bothered DH, and he feels like it wouldn't be as much of an issue if the circumcision were done correctly (i.e. not left too long).  The adhesions are, of course, the real issue, but he hates cleaning the smegma and doesn't think that would happen with a well-circumcised penis.  He also doesn't like having to retract the foreskin with every diaper change -- I'm sure that will become even more of an issue as DS (now 18 months) gets older and more aware of private parts.

Here's the extract:

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.

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