You decided not to circumcise. Now what?
5 questions answered from The Doc Smitty
Circumcision rates vary across the world. The most recent study showed around 80 percent of parents in the United States do get their child circumcised, but this varies significantly by region, race and religious affiliation. And that’s still a large number of people who have decided not to get their child circumcised.
Here are some of the most important questions about boys with an uncircumcised penis.
How do I tell people we didn’t circumcise?
For the most part, you don’t have to. This is a personal decision, so don’t unless you want to.
If you have a particularly invasive friend or family member who insists on asking questions, it might be wise to be prepared with an answer, but as far as I’m concerned, it’s a medical decision that was yours to make and you shouldn’t feel the need to defend it.
How do I take care of the skin (or clean the penis)?
Treat it just like any other piece of skin. Wash the outside with whatever soap you would wash their big toe with. Heck, use the same technique. You wouldn’t try to peel the nail back to clean under it. Would you?
When should I start to pull the foreskin back?
Really, YOU shouldn’t. Ever. Retraction, even if not that forceful, can cause severe pain, bleeding and tears in the skin.
If you decided that at a certain time you were going to, you would almost certainly decide to do it too early. At birth? Only 4 percent of boys have a fully retractable foreskin at birth. When they start school, 8 percent of first grade boys are fully retractable. Even at seventh grade, only 58 percent of boys are fully retractable.
Boys should be taught that eventually things will start to change down there but there’s no reason to force the issue.
How do I keep someone else from retracting?
Because the teaching of the care of the penis might have changed since your parents had newborns, it’s important to express your desires to anyone who might be changing the baby’s diaper.
Grandparents, aunts, uncles and babysitters might just need a quick reminder how you want them just to use a wipe to clean off any poop they can see there but not try to pull back and clean underneath.
How do I keep a doctor or nurse from retracting?
Ok, here’s the real question and actually the question that prompted this post.
This is tricky.
I’ve heard of parents who were so concerned about this issue that they hesitated to take their children to a good pediatrician just because they might try to retract their foreskin. And it’s not a concern without merit. Good nurses and doctors in good hospitals still occasionally teach that a baby boy should have their foreskin retracted for cleaning.
Even if your baby’s foreskin survives the newborn period unscathed, there’s no guarantee that something won’t happen at an early pediatric visit. In the office, it’s unlikely that a nurse would retract the foreskin. They typically are not doing a full physical exam. The major offender here will be the doctor. So, watch us like a hawk.
One of the most common recommendations I’ve heard is to leave the baby’s diaper on. I’m not sure who thinks this will work. If the pediatrician leaves the diaper on and doesn’t take a second to check for both testicles and that there are no hernias just because you left the diaper on, they aren’t really a pediatrician you want to trust your child’s life with.
I have another suggestion. Play dumb. You made this choice and you’ve made it this far into this article so it must be important to you. You’re not dumb. You know how this is supposed to happen. But I suggest that you play dumb.
Go to a prenatal consult with your prospective pediatrician and ask a simple question, “Since we aren’t planning to circumcise, how do we clean our boy’s penis?” Their answer to this question should tell you what you need to know. If they try to convince you to circumcise, it’s probably time to move on. If they teach anything that is contrary to what you want done for your child, find someone else.
Bottom line is that the answer from the doctor should be …leave it be.
Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page.He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.