The penis is attached to a sheath of skin called the foreskin.
Some children may develop foreskin problems. Many of these issues either go away on their own or with the help of prescription medicine. Proper foreskin care is the best way to prevent many of these issues.
Other foreskin problems, such as an accidental injury are more serious. These types of issues need treatment right away.
Adhesions and smegma
As a child gets older, the foreskin naturally separates from the head of the penis (glans). As this happens, the following may occur.
- Parts of the foreskin may remain attached (adhesions). This is normal and does not need any treatment. The foreskin fully separates by the time a child reaches puberty. Adhesions should not result in pain with peeing.
- The foreskin naturally sheds, leaving small white or yellow clumps behind that may be stuck under the foreskin. These clumps are called smegma. The smegma eventually goes away on its own. There is no need for treatment.
Balanitis
Balanitis is an infection which may cause the foreskin to become red, swollen and itchy. You may also notice a build-up of fluid and your child may experience pain while urinating. Proper foreskin care can prevent balanitis.
Treating balanitis
If the balanitis is mild, your child’s health-care provider may prescribe an antifungal cream, such as nystatin, clotrimazole or miconazole. If the foreskin infection is severe or keeps coming back, circumcision may be an option once the redness and swelling go away. Talk to your child's health-care provider to learn more. Proper foreskin care can also help prevent balanitis from coming back.
Bacterial infection
If there is a cut or sore on the foreskin, bacteria can enter the skin and cause an infection. The bacteria can quickly spread along the entire foreskin. This can cause a bacterial infection called balanoposthitis. The penis and foreskin swell, become red and feel painful and very sensitive to the touch.
Treating bacterial infection in the foreskin
If your child has developed a bacterial infection, talk to their health-care provider about treatment. In most cases, bacterial infection inside the foreskin or penis can be treated using either:
- antibiotics by mouth
- topical antibiotics (antibiotic creams for the skin)
- both antibiotics by mouth and topical antibiotics
To ease pain or discomfort, your child can sit in a warm bath with epsom bath salts (do not use bubble baths or perfumed soaps). They can also take pain medicine such as ibuprofen or acetaminophen. If your child develops a fever, they should see a health-care provider.
Zipper injury
Your child may accidently injure their foreskin by getting it caught in the teeth of a zipper. Aside from being very painful, a zipper injury may damage the tip of the tube inside the penis through which urine flows, called the urethral meatus.
If a zipper injury happens, take your child to the emergency department right away. Trying to remove skin trapped in a stuck zipper may cause more injury. Leave it alone or cut the clothing around the zipper to make it easier to take them to the hospital.
Treating a zipper injury
Before detaching the zipper from the penis, your child's health-care provider may give your child some pain medicine. The health-care provider may inject a small amount of anesthetic medicine at the base of the penis to numb it for a short time.
Hair tourniquet
In babies, a hair or thread may tightly twist around the penis, interfering with blood flow. This is called a hair tourniquet.
The hair or thread may appear as a thin line around the penis, and the affected area usually swells and reddens. Sometimes the hair or thread may be very difficult to see. If you notice swelling, discoloration or redness of the penis and suspect a hair tourniquet, take your baby to the hospital right away. If it is not dealt with right away, a hair tourniquet can damage nerves or blood vessels.
Treating a hair tourniquet
Your child’s health-care provider will try to remove the tourniquet by applying a hair removal cream to the area. They may consult a urologist if the hair is deeply embedded in the skin. More serious cases may require surgery.
Paraphimosis
As a child gets older, their foreskin loosens, and they can pull back (retract) the foreskin. They can also push the foreskin back to its original position (unretract), covering the head of the penis (glans).
If the foreskin is not returned forward to its usual position, it can become stuck, creating a tight band around the penis shaft. This is a condition called paraphimosis. It causes swelling and pain and is considered a medical emergency.
Treating paraphimosis
If your child develops paraphimosis, take them to the nearest emergency department right away. Paraphimosis rarely requires surgery, but only a health-care provider should unretract the foreskin.
Before unretracting the foreskin, the health-care provider will apply an anesthetic cream and provide pain medications. Some children may also require sedation to gently unretract the foreskin.
Phimosis
Phimosis occurs when children are unable to retract the foreskin. In newborns, the foreskin is usually not retractable. As your child gets older, the foreskin will slowly become easier to retract. The foreskin is usually retractable by late childhood or early adulthood. Children who are not experiencing any discomfort or symptoms do not need to be seen by a health-care provider, even if they cannot fully retract their foreskin.
Sometimes, children are unable to retract their foreskin due to scarring from a previous infection, trauma or inflammation. In these cases, your child should see a health-care provider.
Your child should also see a health-care provider if they experience:
- irritation or bleeding at the tip of the foreskin
- a ring of white scarring at the tip of the foreskin
- severe ballooning of the foreskin when urinating, requiring pressure to push the urine out (If your child has ballooning of the foreskin while urinating that resolves on its own, they do not need to be seen by a health-care provider)
- recurrent foreskin infections that require antibiotic treatment
For information on treating phimosis, see Phimosis.