Made to Stick™

Intact America has launched Made to Stick™, its Foreskin Protection Campaign to stop healthcare professionals from intentionally harming boys' penises. Intact America’s plan is to mobilize the nation’s health care establishment to end the practice of forcible foreskin retraction.

Doctors have been warned against forcible foreskin retraction (FFR) for over a century. But with the rise of almost universal circumcision beginning in the mid-20th century—and the resulting near absence of foreskins among American men—this health advice has been all but forgotten. The few boys lucky enough to escape having their foreskins removed at birth are now being harmed by FFR, out of the mistaken belief that the foreskin should be retractable from infancy or shortly thereafter. It seems that so many Americans’ lack of familiarity with the foreskin is leading them to intervene inappropriately, rather than simply leaving boys’ genitals alone.

The medical literature is unequivocal: Do Not Forcibly Retract a Boy’s Adherent Foreskin! The American Academy of Pediatrics’ (AAP) Healthy Children webpage explicitly states that a baby’s or young boy’s foreskin should never be forcibly separated from the glans: “Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.” And Urology Care, the official foundation of the American Urological Association, cautions parents to “treat the foreskin gently,” and to not forcibly retract it.

FFR is both persistent and pervasive. New parents too timid to confront their child’s doctors or nurses when they observe them mishandling their sons’ foreskins are afraid to say something, while parents who speak out in protest are dismissed – or even accused of bad parenting. Parents should not have to stand guard over their children to protect them from doctors and nurses. But because FFR practice is ingrained and so many health care professionals vigorously defend it, a concerted effort is required to stop this practice.

Two All-Too-Common Stories

Scenario 1:

A mother takes her 6-month-old son to the family pediatrician for a well-baby visit. Years ago, she carefully researched local doctors for her daughter; now, he’s almost a family friend. The examination room is decorated in pastel colors with animal posters on the wall. The doctor wears a colorful tie printed with cartoon characters. The end of his stethoscope is in the shape of a green frog with bulging eyes, which he warms before pressing it to the boy’s chest, listening to his heart and lungs. When he begins a genital exam, he apologizes to the boy in advance for any cold draft he might feel. Then, after checking his testicles for normal growth, he inspects the end of the boy’s penis. Without warning, the doctor snaps back the boy’s foreskin with an apparently well-practiced yank. The boy screams and recoils. Mom, as equally stunned as her son, isn’t sure of what just happened, or if it was medically appropriate or not. Stunned, she decides to say nothing as her son whimpers. The doctor tells her that from now on, she must pull the boy’s foreskin back every time she bathes him. She nods but makes a mental note to do some research on the Internet. When she learns that FFR is both unnecessary and harmful—and still hoping that her son has not been permanently damaged—she makes the decision to look for a new pediatrician.

Scenario 2:

A father picks up his three-year-old son from daycare. They had called him and said the boy was running a fever and feeling sick. He takes his son to his local urgent care clinic. After examining him, the doctor says he wants to order some tests. The attending nurse returns with a tray of instruments and says she is going to collect a urine sample. She removes the boy’s underwear and picks up a catheter. The dad, who has a foreskin just like his son, is unconcerned since he once had experienced the indignity, but necessity, of a catheter. To his horror, instead of simply slipping the catheter past his son’s foreskin, the nurse forces it back, tearing it from its foundation. The boy screams as the dad pushes the nurse’s hand away from his son’s penis and yells, “Stop!” The damage has been done, though, and now the nurse is telling him that this is standard practice when collecting a urine sample from an intact boy. Hearing the commotion, the doctor returns and, in an authoritative tone, agrees with the nurse.

In neither of these two scenarios are the medical professionals held accountable for their actions. And it’s likely that they have not only done this in the past but will continue doing it in the future. For every story we hear, there are many we don’t hear.

Penis Anatomy 101

At birth, a boy’s foreskin is attached to the glans (head of the penis) by a connective membrane – the same type of tissue that secures a fingernail to the nail bed. The foreskin guards the entrance to the boy’s urinary tract, protecting it from germs and irritants. Over time, the membrane gradually dissolves. The age at which the foreskin naturally detaches from the glans varies – from early childhood in some boys, to well into adolescence or even adulthood for others. All of this is normal and no cause for alarm or intervention. (Now that you’ve read this paragraph, it’s likely you know more about the development of a boy’s foreskin than what has been taught to the average American physician or nurse.)

Figure 1. The foreskin develops in the womb, attached to the glans, and normally loosens naturally years after birth.

Scope of the Problem

The core problem is that circumcision is so ingrained in American medical culture that health professionals these days know very little about caring for intact boys. Many doctors and nurses believe the foreskin must be forcibly retracted to clean under it and prevent infections. But it is attached! There is no “underneath” to clean!

A national survey conducted by Intact America revealed that a staggering 43 percent of intact (not circumcised) boys have had their foreskins forcibly retracted by an adult at least once by the age of seven. The survey also found that close to half of these forcible retractions were done by physicians, and nine percent by nurses. More than 25 percent of parents said either they or their spouse had forced their son’s foreskin back following doctor’s instructions.

Figure 2. Two out of every five boys are experiencing FFR at least once by the age of seven.

Another recent survey found that U.S. pediatric urologists are just as misinformed as pediatricians regarding foreskin function and development. This is unfortunate, but perhaps understandable, considering the survey participants’ circumcision bias: 78 percent of the respondents were men, and 92 percent of those were circumcised. Of all respondents, 88 percent circumcised their own son(s). One-third of all urologists responding to the survey reported they did not provide any information to their patients’ parents regarding foreskin retraction. And 61 percent mis-advised parents by telling them to begin retraction at age 2–5 years. Only one percent of pediatric urologists correctly advised parents to never retract their son’s foreskin.

Depth of the Problem

Parents’ accounts of witnessing their sons’ FFR and the impact of FFR on their sons run the gamut, but all are distressing. Sadly, many parents are better informed about proper intact penis care than are their doctors. Here is a very small sample of FFR accounts Intact America has received.

It was so quick.

She did it so quickly—before I knew what was going on. I couldn't stop her. I was so pissed! HG

OMG, I was so mad! Doctor was checking my 2-year-old and did it so fast I was frozen. I’ve never felt so guilty for not reacting faster. My son said his penis was hurting and complained and cried during his bath that night. I learned my lesson. I will let the doctors know before hand to NOT retract while they're little and the foreskin is still naturally fused. My poor baby. JT

They didn't listen.

My son was forcefully retracted at a doctor appointment today. I stood right next to him and repeatedly told her not to, and tried to stop her, and she continued to do it. SH

Ignorance.

Forcible retraction is the cause of so many of the "issues" that cause so many American doctors to prescribe circumcision for intact boys. The problem is ignorance, not anatomy. NC

I was disrespected.

Yes, he was retracted. Our first and last visit with her. I quoted from the AAP and she responded with, ‘Oh, I've heard about that in lay books,’ and treated me like I was an idiot the entire visit. JP

Banned from the clinic.

I got banned from the doctor's building when I complained about it. Not like I was going back, LOL. AH

Eventually circumcised because of bad advice.

We were told to retract my son when he was born. After years of not knowing better due to lack of knowledge from the local pediatricians, he built up scar tissue. When he was 10 he needed to be circumcised because there was so much scar tissue he could hardly urinate because it wouldn't retract on its own. SM

Flabbergasted.

Ugh, how do we educate these people, as a group? And why aren't doctors who know better stepping up and making a big stink about it? I mean, this is science. There is zero medical justification for it. LS

My son’s pediatrician said she wanted to make sure he can pee okay and retracted him a little bit. If I had a girl would she be digging around her labia and say the same thing? SP

Angry.

This angers me so much. I have, on multiple occasions, had to push medical professional hands away from my sons' diaper area at well-child checks. People who insist they know better. People who are supposed to be trustworthy but are uneducated about intact care. I'd even checked beforehand: "You know how to care for intact boys?" Always reassurance, then, "Yes. Now let me just pull back..." [Pushes hands away] "I'm gonna stop you right there," I said. This should not be happening! And what about the boys whose parents didn't know? JG

This is a huge problem. A boy's foreskin should NEVER be retracted. Then we have boys going in later in life for surgery because they have issues with the foreskin, when parents aren't realizing that the problem was caused by premature retraction. The foreskin is attached, people! STOP MESSING WITH IT! PT

Catheterization surprise and horror.

I once told a nurse to not retract because I knew she was going to try for the catheter and she asked why not, and I said because the foreskin is fused to the glans to protect it and she asked me, "Oh, that's neat when did they start doing that?" Like it was a new procedure they were doing now or something. PB

Afraid to go back.

My son is two and I'm afraid of taking him to the doctor because she always tries to retract. Now that he's two I'm certain she'll tell me he has phimosis. Which is why I haven't taken him since he was 18-months old. MM

Hyper-vigilance.

Healthcare workers ALWAYS try to retract intact children when inserting a catheter. You ALWAYS have to be on guard and up front when anything medical is involved regarding an intact penis. I ALWAYS hover in situations like this and make it is VERY clear before the diaper even comes off, what they are NOT allowed to do. I stand so close to them that it's almost uncomfortable, and my hands are ready to intervene if they do not comply. I have literally (gently) pushed away a doctor’s hands, when they tried to retract. You have to be ready to intervene at any time, and you can't expect them to know proper intact care, because most of the time they don't. AG

Parents Take Legal Action

In January 2018, Cassie N. Parks sued Children’s Healthcare of Atlanta and two of its staff members for allegedly forcibly retracting her two-month-old baby’s foreskin, causing the boy severe physical and mental pain and suffering. Ms. Parks had taken the boy to the emergency room because he was vomiting. The complaint states that the nurse “without warning” tore back the boy’s foreskin to insert a catheter to collect a urine sample.

Ms. Parks has described what happened next. “[My son] cried like I had never heard before. It pierced straight to my core, and I knew he was in pain.” She added, “For days after I would sit him in the sink filled with water to dilute his urine, because he would cry from the pain every time he urinated. I avoided leaving the house because the car seat buckle put pressure on his penis, and he would cry.” The Parks complaint states that the boy’s foreskin now has a permanent tear in it.

Permanent Damage – Warnings from Informed Professionals

In addition to the pain it inflicts, forcible foreskin retraction can permanently damage a boys’ genitals. The Pediatric Urology Department at Cedars-Sinai in Los Angeles advises parents of intact sons that: “The foreskin should be left alone until it can be pulled back easily. The head of the penis does not need to be cleaned until this occurs. Trying to pull the foreskin back too soon may result in tearing it from the head of the penis, with scarring, bleeding, and phimosis.”

Dr. Adrienne Carmack, a board-certified urological surgeon said, “It has become quite common in the United States for doctors, nurses, and other parents to tell mommies that they need to retract their son’s foreskin when he bathes.” In her book, The Good Mommy’s Guide to Her Little Boy’s Penis, Carmack warns parents, “Do not retract your son’s foreskin, and do not allow anyone else to do so… Pulling on this sensitive tissue can cause tearing and lead to infections and scarring. Many boys who need emergency care and even circumcision do so because of premature retraction of the foreskin by parents or caregivers.”

ACEs

Adverse Childhood Experiences (ACEs) are traumatic events children might endure or unsafe environments they might live in. Among other things, ACEs include inappropriate genital intrusions and painful experiences. The more ACEs a child accumulates, the higher is his or her risk for overall poor health, addiction, suicide, and psychological disorders. While FFR is not on the current list of ACEs, it is very likely that this experience meets the definition of an Adverse Childhood Experience that can lead to negative health outcomes in the future.

Our Motivation

Intact America receives many calls and emails every month from parents who have seen their sons suffer needlessly because of forcible foreskin retraction. We have amassed hundreds of complaints and stories about this ongoing harm being performed behind closed doors. Ironically, our success in reducing medically unnecessary circumcision has resulted in another problem—forcible foreskin retraction. Intact America is acting to redress this problem!

Our Strategy

Intact America has developed a multi-pronged strategic plan to stop the harmful practice of forcible foreskin retraction through advocacy, and public and professional education. We are calling upon medical and nursing associations to help us educate their membership about foreskin anatomy, proper foreskin care, and the guidelines issued by the American Academy of Pediatrics and the American Urological Association. Eliminating forcible foreskin retraction from pediatric medicine is a goal that will both protect boys and reduce the growing risk of legal liability for health care professionals.  

©2019 Intact America, all rights reserved.

Involved in a FFR incident? Tell us your story.

If you would like a PDF version of this page, click here.


i Intact America surveyed U.S. parents of intact boys under the age of seven in 2018. Of this group, 43.3 percent had had their foreskins forcibly retracted. The survey, which was conducted under the auspices of Qualtrics Research Services in Provo, Utah, has a five percent margin of error. Intact America announced the survey results at the 2018 International Symposium on Genital Autonomy and Children’s Rights in San Francisco.