Having narrow foreskin means not being able to pull the foreskin back over the eyelid. Up to the age of the school, it is common to not be able to withdraw the foreskin. Usually, no care is needed as the foreskin can usually be retracted when the child reaches school age.

Treatment may be needed if the foreskin is still unable to retract at 8-10 years of age or if inflammation occurs under the foreskin. It can hurt masturbation and intercourse if the foreskin is so tight that it cannot be retracted.

Symptoms of the narrow foreskin

Children often have narrow foreskins without being bothered by it. If the child has any problems, it may be one of the following:

  • It can hurt if the foreskin is tight and is withdrawn violently, as fouling on the eyelid or foreskin opening fails.
  • When it’s time to pee, the foreskin can blow up, like a small balloon. This is because the urine first stays in the space inside the foreskin. The foreskin is then stretched out before the urine flows out through the narrow opening. This is common in young children and often does not cause any problems.
  • It can be formed as a kind of funnel when a narrow foreskin is withdrawn because the inner foreskin is slightly pushed forward. This is very common in smaller children, up to the age of five. It does not need to be treated unless it causes trouble.
  • The child gets the balance

The foreskin can also be difficult to retract if it is partially stuck to the eyelid with so-called coalescences so-called synechias. This does not have to mean that the foreskin is narrow. Adulterations usually do not need to be treated. 

How can I reduce the risk of a narrow foreskin?

As a parent, you can avoid withdrawing your baby’s foreskin prematurely as it can cause more trouble. Leave the foreskin and do not pull it back, for example, to wash clean before it is easy to do. It is very well noticed when possible and you should not try if it does not go very easily. As urine can collect under the foreskin, it is good to wipe the foreskin as far as it will go once the baby has kissed, you do not need to wash clean anymore.

Children can stretch the opening themselves by pulling a little in the foreskin as long as it does not hurt. If you stop when it hurts, which usually happens automatically, no cracks are formed.

As a parent, you can talk to your child from the age of five or six about how important it is to gently pull the foreskin back and forth. You can encourage the child to play with his penis, for example, in the bath to wash it.

The best way to avoid the foreskin getting stuck is that boys, especially those who have had narrow foreskin problems, are taught to always return the foreskin and hide the blemish again.

When and where should I seek care?

Contact a health care provider  if a child has one or more of these symptoms of the narrow foreskin:

  • the foreskin appears to be inflamed
  • the foreskin is still tight when the child starts elementary school
  • the foreskin looks swollen and irritated
  • the child has pain in the penis or foreskin
  • the beam is so weak that it is almost impossible to pee.

If it’s in a hurry

If a foreskin gets stuck in a retracted position, contact a health care center or an on-call reception immediately. If it is closed at the health center or on-call reception, seek care at an emergency room

The longer the foreskin gets stuck, the more swollen it becomes. It will then be more difficult to bring it back over the eyelid. Most often the doctor can pull the foreskin back over the eyelid again but sometimes an emergency surgery is required.

How is a survey done?

When examining a narrow foreskin, an assessment is made as to whether any treatment is needed or whether the foreskin will stretch itself.

A healthcare professional examines the foreskin by trying to retract it to see what it looks like when the outer and inner foreskin meet. The child may try to retract the foreskin himself.

Treatment for narrow foreskin

Any treatment for narrow foreskin is done in different ways depending on the cause of the inconvenience. The child may receive a referral to a surgeon who decides if the foreskin needs surgery.

Treatment for narrow foreskin without surgery

If the foreskin opening is narrow but soft and can be pulled over the eyelid, the treatment consists of the foreskin being pulled back regularly, preferably at bathing and after the baby has kissed.

Cortisone ointment treatment

Treatment for narrow foreskin with cortisone ointment is given if the foreskin is tight and cannot be withdrawn over the eyelid when the child has started school, or if there are problems with inflammation under the foreskin.

The cortisone ointment makes the foreskin a little thinner and more stretchable. The ointment is applied once or twice a day for about one to two months. The amount of ointment is so small that the cortisone does not affect the entire body but only the area where the ointment is applied. The ointment is a prescription.

Pull the foreskin back as far as it will go and stroke the ointment in a thin layer on the narrow ring of foreskin that spans the eyelid. It is important that you iron out the ointment in the right place, ask your health care center if you are not sure how to do it.

For the treatment to be successful, the child also needs to try to stretch the foreskin every day. The child can withdraw the foreskin, for example, every time they kiss, in the shower or in the bath. They should pull and stretch so that it does not hurt and without it becoming small cracks. The child needs to be able to pull the foreskin himself to be mature for this form of treatment.

Treatment with surgery

An operation may be needed if the anterior opening is narrow due to scars and if it does not help with the ointment. Sometimes the entire foreskin needs to be removed, sometimes it is enough that some of the foreskins are removed or that one or a few cuts are made in the foreskin.

Before the operation, you will receive more information from the department where the operation is to be carried out on the rules that apply.

How is the operation going?

Most often the child first receives an anesthetic ointment on the hand or in an arm fold. The ointment can sit for about an hour. With the help of a needle, a thin plastic tube is then inserted into a blood vessel where the anesthetic ointment has worked. Through the tube, the child receives sleep and anesthetic drugs. When the child is asleep and completely stunned, the foreskin is operated and the edges of the foreskin are sewn together.

The operation takes between 15 and 30 minutes. The child is in the hospital for about four to five hours.

As a parent, you can be with the child for the entire time until the child has become asleep.

After the surgery

After surgery, the penis is often swollen, sometimes for several weeks. The stitches do not need to be removed afterward as the thread used dissolves and disappears by itself after four to six weeks.

Complications and sequelae

Sometimes it can be a little sore, but it is unusual for the child to have real pain afterward. During the first day after surgery, it may bleed from the foreskin or edge of the operating wound. Often you can treat yourself with a pressure dressing. Sometimes the child may need to be anesthetized in order for the bleeding to be stopped properly. During the first week after surgery, there is also a small risk of infection in the wound. Infection may sometimes need to be treated with antibiotics.

It may feel different to pee. The child can then try to shower and pee at the same time. The first few weeks after the operation may be difficult to control, but it goes over.

The skin of the eyelid becomes slightly thicker over time as underwear wears against the eyelid. The actual urethra can also be slightly narrower. If the child has trouble peeing it may need to be treated by surgery, but it is unusual to have such problems.

Children have the right to be involved in the care they receive.

There is no age limit for when a child may be involved in determining a care situation, but it is determined based on the child’s maturity and care situation. You should talk to the child if they have any problems that require treatment. If you find it difficult to talk about it or want answers to questions, you can contact a pediatric nurse or receptionist for advice. When your child is younger than six, you can also ask for advice at BVC. An older child who can and wants to talk alone with health care professionals or student health can do so. 

What is the reason for the narrow foreskin?

The foreskin consists of an outer and an inner part. The inner part of the foreskin that lies on the eyelid and is not visible when the eyelid is covered. Only when the foreskin is retracted does the inner part become visible. If the foreskin is too narrow, it is common that the inner part is not visible at all, or that it is visible only slightly.

There are various reasons why the foreskin is too narrow:

  • There may be adhesions between the foreskin and the eyelid, which cause the foreskin to stick to the eyelid.
  • The foreskin opening is too small. It may be congenital or may be due to infections of the foreskin causing scars or cracks to form.

The foreskin has been pulled back on the baby prematurely and there have been small cracks in the opening. When the cracks heal, scars form and the foreskin opening becomes harder and not as stretchable as before.

Newborns often have the narrow foreskin

In most newborns, the foreskin opening is too small to retract.

Often, the inner part of the foreskin of the penis is stuck to the eyelid with the conjunctiva.

Adulterations usually loosen gradually if the foreskin is pulled in or retracted when the child bathes or showers. The convolutions can also loosen if the child gets an erection. Occasionally, growths may be partially up in the teens. They do not need to be addressed unless they cause problems. As long as they remain, the foreskin cannot be fully retracted.

Ehtisham Nadeem

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