But what if…

Most people will not even need to read this page. In America, we are often given the impression that keeping a little boy intact will inevitably lead to complications. For the overwhelming majority of children, this is absolutely not the case. However, in extremely rare circumstances where minor but recurring foreskin issues occur, more conservative interventions than amputation are always the appropriate measure. The links below provide information about less invasive treatment options, as well as a doctor database of pediatricians who are knowledgeable about the foreskin and supportive of your decision to keep your son intact.

The Whole Network

The risk of urinary tract infection (UTI) in circumcised vs. intact boys is often cited as an argument in favor of circumcision. A number of studies have been done to prove that circumcision reduces the rate of UTI in boys, and the results are hard to argue with. While approximately .1-.2% of circumcised boys contract UTIs, 10 times that, or .7-1% of intact boys get UTIs. If UTIs were an absolute evil, a mortal, untreatable affliction, this would be a compelling argument, but in practice, this laser-focus on the risk of UTIs is arbitrary and nonsensical. UTIs are almost always treatable with simple antibiotics. The consensus among physicians is that the prevention of UTIs is not sufficient cause for circumcision when considered alongside the risks.1 The risk of infection or hemorrhage as a result of circumcision is at 2%.2 If the goal is to prevent infection and injury to an infant boy, leaving him intact is a course of action which reduces his chances of infection by 50%. Leaving an infant intact reduces his chances of surgical complication by 100%.

Studies on circumcision and the benefits or risks therein are highly subject to cultural relativism. In the United States, for example, the data on UTI risks in children is difficult to control given the lack of preemptive education given parents who choose to keep their children intact. With less than 30% of American infants being left intact, there is very little accurate common knowledge in reference to the care and cleaning of foreskin. It is unclear how many infant boys’ UTIs were caused by the parents’ use of caustic soaps and/or forcible retraction of the foreskin, which is a significant risk factor for balanoposthitis, a common cause of recurrent UTI. The focus on UTIs can only be interpreted as political, religious, or cultural bias.

Three conditions that a small percentage of intact men may experience include balanitis, phimosis and para-phimosis, conditions which are almost always able to be alleviated with the aid of non-invasive therapies.

Balanitis

Balanitis is a swelling of the penile glans, or head of the penis. Balanitis affects both men and boys and can occur at any age. Symptoms can include swelling, redness, soreness of the tip of the penis and discharge under the foreskin. An effective intervention is the application of a topical cream, such as Diflucan, and the avoidance of irritants like harsh or perfumed soaps. Rarely is circumcision a necessary corrective measure unless precipitated by a pre-existing condition such as phimosis.

Phimosis

Phimosis is a condition where the foreskin of the penis is narrowed to the point that it cannot retract over the glans of the penis. In the United States, Phimosis is frequently over-diagnosed in children, largely due to the doctor’s inexperience treating an intact patient population. During fetal development, the foreskin is fused to the base of the glans in utero and in eighty percent of boys does not fully retract before age ten. A non-retracting foreskin in boyhood is NOT a pathology, but rather a completely natural phase of development.

In instances of adult men experiencing true phimosis, a small number of cases will require medical attention. Highly successful interventions used in the United Kingdom and other parts of the developed world include topical ointments such as Betamethasone. If the condition persists despite non-surgical therapies, less invasive surgeries than circumcision, such as a dorsal slit, can be performed to relieve the tightness of the foreskin while still preserving all of the penile tissue.

Paraphimosis

Paraphimosis is a rare condition where the foreskin becomes stuck behind the head of the penis. When this occurs prompt medical attention is required, as the swelling band of skin could block blood supply to the penis. Paraphimosis is typically the product of a retracted foreskin that has not been returned to its original position for a considerable amount of time. Treatments include medication to reduce swelling, or minimally invasive surgery to protract the foreskin over the head of the penis. The “dundee” technique is one such surgical procedure performed under local anaesthesia which involves puncturing the swollen foreskin and draining the accumulated fluid. Circumcision is again considered a last resort and generally only needed if the condition goes untreated.

Additional reading on alternatives to circumcision which preserve the foreskin:

Annals of The RCSE [study]: Prepuceplasty: An alternative to circumcision

JRSM [study]: Is preputioplasty effective and acceptable?

Dorsal Slit Procedure [Wikipedia]

The British Association of Urological Surgeons Dorsal Slit Information