The penis has two main parts, the shaft and the head (called the glans). One continuous layer of skin, called the foreskin, covers the shaft and glans. When a child is not circumcised the foreskin is firmly attached to the glans. Gradually, the foreskin will begin to separate. As this occurs you may notice a white, cheesy material, called smegma, released between the layers of skin. You also may see ‘white pearls’ develop under the fused layers of the foreskin and the glans. These are not signs of an infection or a cyst. Smegma is just skin cells that are shed throughout life; it is normal.
When the foreskin separates from the glans of the penis it can be pulled back (retracted) away from the penis to expose the glans. Never forcibly retract your child’s foreskin. This can cause pain and bleeding and can lead to scarring and adhesions (where skin is stuck to skin).
Phimosis is a constriction of the opening of the foreskin so that it cannot be drawn back over the glans of the penis. Phimosis is a normal occurrence in the newborn boy. Some boys’ foreskin can be retracted as early as infancy, others not until age 5 or 6 years. Once potty trained, the uncircumcised boy should learn to retract his foreskin when he urinates and bathes and then pull it back forward again.
You should seek treatment if your child has the following symptoms of phimosis:
- Ballooning or bulging of the foreskin during urination
- Inability to completely retract the foreskin by age 10
- Frequent infections of the foreskin (balanitis)
Treatment of phimosis varies depending on the severity of the condition. In the Division of Urology, we have found that phimosis can be safely and effectively treated with a topical steroid cream. Your child’s doctor will give you instructions on the proper use of the cream. If the steroid cream fails and the foreskin remains narrowed, a circumcision may be necessary.
Reviewed by: Division of Urology
Date: May 2011