Care of the uncircumcised penis in infants and children
- Duncan Wilcox, MD
Duncan Wilcox, MD
- Section Editor — Pediatric Urology
- Professor of Urology, The Ponzio Family Chair in Pediatric Urology
- University of Colorado
- Section Editors
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr, MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
The care and complications of the uncircumcised penis will be reviewed here. The procedures, risks, benefits, and complications of circumcision are discussed separately. (See "Techniques for neonatal circumcision" and "Neonatal circumcision: Risks and benefits" and "Complications of circumcision".)
NORMAL ANATOMY AND DEVELOPMENT OF THE FORESKIN
The normal foreskin begins to develop as an epithelial fold that grows inward from the base of the glans penis at eight to nine weeks gestation with normal completion by 4 to 4.5 months gestation. The squamous epithelial lining of the inner prepuce is contiguous with the glans penis, resulting in the normal circumferentially initial adhesions between the inner layer of the prepuce and the glabrous epithelium of the glans penis.
Separation of the foreskin from the glans penis occurs by desquamation and begins late in gestation, but remains incomplete in most male infants at birth. Only approximately 4 percent of males have a completely retractable foreskin at birth, and in more than half of newborn males, the foreskin cannot be retracted far enough to visualize the urethral meatus .
After birth, penile growth and physiologic erection aid in the desquamation process and the formation of keratinized pearls (smegma) between the layers, which loosens the adhesions and allows retraction of the preputial skin.
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- NORMAL ANATOMY AND DEVELOPMENT OF THE FORESKIN
- FORESKIN RETRACTION
- ROUTINE CARE AND HYGIENE
- ASSOCIATED CONDITIONS
- Benign conditions
- - Physiologic phimosis
- - Smegma and preputial cysts
- - Foreskin ballooning
- Pathologic conditions
- - Pathologic phimosis
- - Paraphimosis
- - Recurrent urinary infection
- - Balanoposthitis
- - Balanitis xerotica obliterans
- - Frenulum breve
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS