DO YOU KNOW THE REASONS WHY THE FORESKIN MAY "CLOSE DOWN"?

This is the sixth in a series of informational essays by Marilyn Milos, RN, founder of the National Organization of Circumcision Resource Centers and a pioneer in the movement to end the forced circumcision of boys in the United States. Marilyn is also a member of Intact America's Steering Committee. If you have a question you'd like Marilyn to address, send us an email!

As more and more men learn about sensitivity loss from circumcision and aging, they look for ways to feel more. Various products purporting to meet this need and improve sexual sensation have entered the market.

The foreskin is a normal part of the penis. At birth, only one to two percent of baby boys have a fully retractile foreskin, while the remainder of intact males have foreskins that will become retractile — each in its own time. The average age of foreskin retractability is 10.4 years. No one should hurry the process, and the first person to retract a boy's foreskin should be the boy himself. Everyone else — parents, caregivers, and healthcare professionals, too  hands off! No peeking and no fiddling. Worry about something else and leave that boy’s penis alone! 

About half of all boys entering puberty have fully retractile foreskins, and 98 percent of males have a fully-retractile foreskin by the end of puberty (18-25 years). A few males live problem-free their entire lives with a foreskin that does not fully retract.

The word “phimosis” (from the classical Greek, meaning “muzzled) is used to describe a non-retractile foreskin. In infancy and childhood, we speak of "physiologic phimosis"  a normal condition. The term “pathologic phimosis” is often used to describe the condition in older boys; however, a non-retractile foreskin is rarely pathological, it is simply a variation on a theme. If the foreskin isn’t causing any problems or pain, again, just leave it alone  at any age.

Prior to or during early puberty, some boys with a retractile foreskin find that it is becoming less rather than more retractile, and is “closing down.” I’ve never learned why this happens  no one seems to know  but I do know that these boys' foreskins will become retractile again by the end of puberty if they are treated properly.  A foreskin that is closing down should never be forced to retract, because the small tears caused by forcible retraction heal as scar tissue which inhibits the elasticity of a normal foreskin.

When I am consulted about a boy or man whose foreskin has become non-retractile, I will ask a few question, including his age, whether his foreskin has ever been retractile, how long it has been non-retractile, whether it retracts when his penis is flaccid, and whether it balloons when he urinates. (The latter is a normal part of penile development in some boys, and indicates that the foreskin is in the process of separating from the glans.)

I will also want to know if the boy or young man takes bubble baths, uses soap on his foreskin or shampoo in the bath or shower, or spends time in a chlorinated swimming pool. Finally, I’ll ask if the tissue at the tip of his foreskin has changed in texture or color. Depending on the answers to these questions, I’ll advise one of the following courses of action.

If the foreskin is red and inflamed, this is usually an indication of yeast overgrowth. Bubble baths, soap and chlorine kill bacteria, upsetting the normal “ecology”of the penis. In such cases, I recommend that all of these behaviors be stopped, and that the affected boy or man be treated with bacterial replacement therapy. 

Bacterial replacement therapy consists of dipping the foreskin into liquid Acidophilus culture (the active, good bacteria ingredient in yogurt) and allowing it to drip dry. (Liquid Acidophilus can be found in the refrigerator section of your local natural foods store. It can be warmed up by pouring it into the palm of one’s hand, and the foreskin is then dipped into the solution.) Do this six times a day for three or four days. If the foreskin condition is caused by yeast overgrowth, this therapy will usually clear up the resulting inflammation, itching, and stinging with urination.

A less common cause of the foreskin becoming non-retractile is a condition called lichen sclerosis (also referred to as balanitis xerotica obliterans, or BXO). Lichen sclerosis can be treated with a combination of two over-the-counter creams  1% clotrimazole and 1% hydrocortisone. Mix the two together and apply them to the foreskin three times a day for 2-4 weeks.

If these therapies don’t work to make the foreskin more retractile, there are other options. Gentle stretching techniques may help but the foreskin should never be forcibly retracted. Be wary of the dorsal slit suggested by some physicians; this cut often leaves a cosmetically undesirable result, with the foreskin hanging on either side of the glans and not working properly because the musculature that closes the foreskin has been severed. The y-v- and z-plasties, which are cuts in the foreskin to realign the tissue and widen the foreskin opening, allow retractability and preserve the most sensitive part of the male body, the ridged band that encircles the opening of the foreskin. This ridged band, with its tens of thousands of specialized, erogenous nerve endings is worthy of protection, because these are the nerve endings that let a male know what his penis is feeling and where he is in relation to the orgasmic threshold.

Remember! The foreskin should be considered indispensable except in dire circumstances. Circumcision should be done only as a last resort, after trying the alternatives I’ve discussed above to maintain the integrity and wholeness of the male genital system. 

Finally, if you have any questions about the issues raised in this article, please do not hesitate to contact Marilyn Milos through [email protected]

—Marilyn Milos, RN

For more information about the foreskin, please download our  Foreskin Facts  information sheet and share it with your friends, doctors, and anyone you know who may have a baby on the way or is thinking about becoming a parent.