American parents in ever increasing numbers are rejecting routine infant circumcision. Today there are nearly as many intact male infants and young boys as there are circumcised. With this transition there is an urgent need for parents and the medical profession to be educated regarding the anatomy and function of the foreskin and the simple and proper care of the INTACT non-circumcised child.

Retraction of the Foreskin

At birth, the foreskin is usually joined by a mucosal bond between the glans penis and the inner foreskin fold. This bond is intended by nature to protect the sensitive glans from urine, feces, and abrasion during the diaper years. This natural bonding begins to separate as the child matures. By a well designed plan of nature, this separation commonly begins about the time the child is out of diapers. However, there is no set age by which the foreskin and glans must be separated. Each child develops retraction according to his own individual time table and it need not be hurried. By puberty, the penis will usually have completed its development, and the foreskin will have separated from the glans and can readily be retracted.

Even if the glans and foreskin separate naturally in infancy, the foreskin lips may open only enough to allow the passage of urine. This ideal feature protects the glans from premature exposure to the external environment. The penis develops naturally throughout childhood. Eventually, the child will, on his own, make the wondrous discovery that his foreskin will retract. There is no reason for parents, physicians, or other caregivers to manipulate a child's penis. The only person to retract a child's foreskin should be the child himself, when he has discovered that his foreskin is ready to retract.

A child's foreskin should NEVER be forcibly retracted. Doing so will disrupt and tear apart the natural protective mucosal bonding of the glans and foreskin. This will cause pain, bleeding, and open the route for irritation, infection and a host of other potential consequences. Repeated forcible retraction of the foreskin can cause scaring and a scar tissue bonding between the glans and foreskin making future retraction more difficult. Forcing the foreskin back may also cause a condition called "Paraphimosis" whereby the foreskin gets "trapped" behind the coronal sulcus ridge of the glans and is difficult to return to its normal position. If this should happen, the foreskin can generally be returned to it's normal resting position by gently squeezing the glans between the thumb and forefinger and pushing the foreskin forward back over the glans. A lubricant may help in this process. If the foreskin cannot be returned forward, seek immediate medical attention. Surgery is NOT required.

The Care Concern

Many physicians, including those who specialize in child care, are not familiar with the proper care of the non-circumcised natural child. They are not taught penile anatomy or the function of the foreskin in medical school. Many of these male physicians will themselves have been circumcised. They have little understanding or experience with the natural penis. Consequently, there is a tendency among the medical community to recommend circumcision not only of infants but for INTACT boys from toddler age through their teens for any medical condition that involves the penis. The causative factor can be as simple as diaper rash, irritation, tightness, presumed phimosis, suspected Urinary Tract Infection, minor infection and a host of other conditions that should never warrant surgical intervention. There is rarely ever a medical condition that would warrant circumcision of the infant and young male child. Parents should be wary of anyone who tries to retract their child's foreskin, and especially wary of anyone who advises circumcision of their child.

The greatest concern to parents and the greatest danger to the INTACT boy is for the child to be cared for or treated by physicians or nursing staff who are not well educated regarding the functions of the foreskin and the care of the natural penis. It is shocking that most parents of natural non-circumcised boys are generally better informed on proper care than those to whom they entrust the care of their son.

During our thirty years of educating and counseling parents and their young children, the greatest number of calls we received are calls from parents concerned over their doctor's improper care - forcibly retracting a child's foreskin, advising parents to routinely retract and clean the child's foreskin; or doctors who advise, intimidate, or badger parents to have their son circumcised.
The following are arguments you may have presented to you by the medical profession to persuade you to have your INTACT son circumcised. You need to be well informed and exercise extreme caution to protect your son from harm by those who are uninformed and make such recommendations.

Arguments Often Given in Recommending Circumcision

• Circumcise Him To Provide Better Health And Hygiene
  Circumcision is definitely NOT needed to facilitate penile hygiene or improve the child's state of health. Indeed the foreskin provides far better hygiene and protection than would be provided by circumcision. The foreskin keeps the glans safe, soft, sensitive, and clean. A recent article in the prestigious British Journal of Urology confirms the protection provided by the foreskin
  

  "Not only do circumcised boys require more care, they are also more likely to develop penis problems."

  
  The American Academy of Pediatrics (AAP) further states
  

  "The foreskin shields the glans: with circumcision this protection is lost."

• Circumcise Him To Correct A Tight , Adherent, Unretractable Foreskin (Phimosis)
  The foreskin of an infant and young boy is naturally bonded by a mucosal bond during early childhood. It is the foreskin's function to provide covering and protection to the developing glans and penis throughout life. As the boy matures, these "adhesions" separate and retraction is achieved. Often doctors will tell you the boy has "Phimosis". This is a medical term meaning that his foreskin does not retract. What they fail to understand is that this is "normal" in a young natural INTACT boy. It is NOT a legitimate reason to recommend that the boy be circumcised. Some misinformed doctors may suggest that these natural "adhesions" be broken by a probe inserted into the child's foreskin or by forcibly retracting the foreskin. Not only is this unnecessary, it is improper medical advice. The foreskin of an INTACT boy should NEVER be forcibly retracted by anyone. Be certain your child's physician understands this.
  
• Circumcise Him To Correct A Long Foreskin, Ballooning And Spraying When Urinating
  The length of the foreskin varies widely among natural INTACT boys. It seems nature knows that the child will need that additional length to "grow into" as he matures. Ballooning of the foreskin of a young natural child is common. The foreskin of many young toddler age boys is generally tight with a small opening. With an INTACT foreskin the urine leaves the glans opening and exits through the narrow foreskin opening. Ballooning and spraying is rather common and not a condition that requires circumcision. The argument that it may cause back pressure or damage to the kidneys is unfounded. This ballooning and spraying, although often disconcerting to parents, is a delight to most little boys. As long as he is able to void there is no danger or problem that warrants surgical intervention. Be assured that as his foreskin becomes more pliant and retractable, the ballooning will subside and spraying will not be a problem. As he is being potty trained, you may have him retract his foreskin gently while urinating. This should provide better aim and reduce the spraying.
  Circumcise Him To Stop His Playing With His Penis And Fixation To His Genitals
  This is the old circumcise him to stop "Masturbation" argument theme that prevailed during the post Victorian period and that which accelerated the practice of infant and child circumcision in the early 1900's. It is nonsense! All boys discover their penis during childhood and will naturally explore their genital area as they would their hands, feet, face and other body parts. INTACT boys will naturally tug and pull on their foreskin because it is there and it feels good when the foreskin moves over the glans. Circumcised boys likewise discover the pleasant feelings invoked by tugging on the penis or rubbing their exposed glans. Natural boys are vastly more sensitive than circumcised boys and quickly discover the good feelings playing with their foreskin provides. It is through this natural process that INTACT boys develop retraction of their foreskin. It is as though nature intended for the lad to discover his natural penis. You should not deter his curiosity and natural exploration of his genitals. As he begins to bathe and care for himself, you should teach and encourage him to retract his foreskin during his shower or bath. He will not develop a fixation toward his penis or genitals. By these normal and natural activities, he will develop an appreciation and healthy regard for his natural body.
  
• Circumcise Him To Prevent UTI, Inflammation, Irritation or Infection
  The argument that an INTACT boy may have a greater chance of developing a Urinary Track Infection (UTI) has been argued at length and is medically unproved. This is NOT a valid reason for having a child circumcised. The American Academy of Pediatrics and the American Medical Association (AMA) have stated this quite clearly. The appropriate treatment, should any child, male or female, develop a UTI is to treat the UTI with antibiotics as would be the treatment for UTI of the female child who is much more susceptible to UTI than boys. If they can be treated by conservative means, then why suggest circumcision for boys? Surgical intervention is extreme and uncalled for. It would never be suggested in any European nation where nearly all boys are INTACT.
  
• Circumcise Him When Having Another Anesthetized Procedure
• Frequently, when an INTACT boy is admitted to a hospital for any treatment or corrective surgery requiring general anesthesia, his doctor or hospital staff doctors may recommend that you have him circumcised as an optional secondary procedure while he is anesthetized and in the hospital. In past generations, this was a common practice on older INTACT boys. Many boys were circumcised when they had a tonsillectomy, hernia repair or appendectomy procedure. Parents, be extremely cautious that you protect and specify that your INTACT son is NOT to be circumcised, should he require hospital treatment of any kind. Circumcision of a young boy during the "Phallic Period" of childhood can have very serious physical and psychological consequences and should never be allowed.
  
• Circumcise Him Now As He May Need It Later
  In our thirty years of working with parents and their children, We have never seen a case where a child had to be circumcised for medical reasons. The likelihood of a boy requiring circumcision during his lifetime is practically non-existent. If your doctor recommends circumcision of your young child on the argument that it is better now than later as it will hurt more if he is older, you can be assured that this physician is woefully uninformed regarding the natural foreskin and care of the INTACT boy. Our advice is that you find another doctor for your son who is better informed. Be especially wary of this argument with respect to the above concern of a child entering a hospital for other surgical treatment.
  
• Circumcise Him To Look Like His Father, Male Siblings, or Peers
  This is the most illogical of all arguments used by advocates of routine circumcision. Those fathering children in the U.S. today were most likely subjected to a medically unjustified circumcision at birth without their consent. Now that medical arguments have been discounted, we have medical professionals suggesting that a child be circumcised to look like his father, older male siblings, or peers. Obviously, a young boy's genitals are never going to look like his father's during childhood. With simple explanation, he will NOT be caused any concerns because his father was circumcised and he was not. He will be grateful that you had the wisdom to protect him. No baby boy should be subjected to any surgery, especially surgery that is medically unjustified and not recommended, simply to look like others or to conform to our image of what he should look like. The risks are far too great. There are literally hundreds of thousands of families in the United States where the father is circumcised and his son's are not. We have never had a parent tell us this was a concern to their son. The problem seems more a problem with the circumcised father's inability to accept his own circumcision as being medically unjustified and subjecting his son to circumcision to bolster his own self-image. Peer look alike concerns are likewise unfounded. By the time these young INTACT boys enter school, they will be among the majority of their peer age group. Circumcision in the U.S. is ending.
  
• Circumcise Him Since His Foreskin Is Getting Tight And No Longer Retracts As Before
  Sometimes, a previously retractable foreskin may tighten and become resistant to retraction. His foreskin may be red irritated and chaffed. This is not an indication for circumcision as the foreskin is doing it's intended protective function. Except for the protection of the foreskin, the glans and urinary opening would be attacked causing much more serious concerns. We have observed that this condition is often associated with the use of bubble bath, applying soap to the glans when bathing or showering, or swimming in highly chlorinated pools. These conditions generally subside when the offending irritant has been eliminated. Apply a soothing ointment to his foreskin to clear up irritations. Acidophilus culture (available at health food stores) taken internally or applied to the foreskin several times a day has also been found effective. Should the condition of tightness persist, the use of topical steroids such as "betamethasone valerate (.05%)", applied to the foreskin has been found to be a safe and effective treatment in alleviating the tightness. Consult your doctor regarding this form of treatment. Circumcision is NOT necessary.

Mr. Peron is a medical research writer, educator, lecturer. He is the founder and executive director emeritus of the Childbirth Education Foundation. He has devoted over thirty years researching birthing and newborn care concerns. He is regarded as an authority on the subject of routine circumcision and the care of the natural non-circumcised boy. Additional free information regarding the Health Fallacy of infant circumcision and the simple and proper care of the INTACT boy is available from

Childbirth Education Foundation
PO Box 251
Oxford, PA 19363
(717) 529 - 2561
jpncef@aol.com