Last week’s column elicited a number of comments from friends, acquaintances and parents, particularly with regard to the normal, day-to-day care of the foreskin. Foreskin retraction is obviously overdone in our society, and the idea seems to be that if it is not done, the foreskin will not retract and the adult son will not be able to enjoy sexual relations. This is not true if one understands the normal anatomy of the penis and foreskin.
All this confusion reminds me of a statement by Desmond Morris, taken from his book Body Watching, in which he says: “These, then, are the human genitals. Considering their great delicacy, complexity and sensitivity, one might imagine that an intelligent species like man would leave them alone. Sadly, this has never been the case. For thousands of years, in many different cultures, the genitals have fallen victim to an amazing variety of mutilations and restrictions. For organs that are capable of giving us an immense amount of pleasure, they have been given an inordinate amount of pain.”
The foreskin serves several protective, biological and sensory functions.
Since it is fused to the glans, it acts as a natural protective cover for the sensitive head of the penis (glans), shielding it from abrasion, drying out and irritation from clothing, especially during the period when the male child has no control over his bladder or rectum, when it would be very easy to irritate the glans and urethra. It also contains specialised white blood cells, which offer local anti-germ protection around the urethral opening.
The foreskin also has a role during sexual activity. The double-layered skin provides a gliding motion and natural lubrication that reduces friction for both the individual and their sexual partner.
Only the outside of the foreskin needs to be cleaned for the first two or three years. Like any other part of the body, the genital area also needs to be kept clean. If mothers were to pay more attention to changing those irritating plastic nappies and cleaning the genital area, and less attention to tugging at their sons’ foreskins, we would have fewer nappy rashes and painful foreskins.
As the foreskin gradually retracts over the years, any whitish material (smegma) found on the exposed tip of the glans should be cleaned with warm water. Smegma is simply the accumulation of dead skin cells that are normally shed from the glans and foreskin throughout life. Sometimes, a collection of smegma can be seen underneath the foreskin. It looks like a fingernail-sized bump interrupting the smooth surface of the foreskin. This is often misdiagnosed as a “boil”, and multiple courses of antibiotics are wrongly prescribed. This collection of smegma under the foreskin should be left alone until normal separation exposes it. Unfortunately, when this happens, more “infection” is then diagnosed, and more antibiotics and creams are prescribed. No wonder the poor mother begins to think that something is wrong with her boy.
By the time the boy is five or six years old, he needs to be taught to retract his foreskin and clean beneath it once a week during a bath. Usually, only water is needed for this. Soap or soapy water, if left under the foreskin, can cause irritation, swelling and pain.
Finally, a word about circumcision.
There are cultural and religious reasons for circumcising a child. Some people decide to do it because it is easier to care for, or, as some mothers say, “it looks prettier”. There may also be some health benefits, including reduced risks of STIs, UTIs, phimosis and penile cancer, but the evidence is iffy at best. It is interesting that some of the same people eager to cut off a baby’s foreskin at birth are reluctant to do the same to themselves at 18 or older.
