By the time the child hits puberty, foreskin and glans have become two discrete entities and only about 1% of 17 year olds are still unable to retract their prepuce, often due to scarring through a medical condition like diabetes.
However, modern thinking into personal hygiene advises mothers to encourage their young sons to pull back their foreskins to clean underneath them at ever younger ages. For children born in the latter part of the last century, some healthcare policies even advocated that mothers should actually force the tight forskin back themselves.
Penile balanitis is the reason for this focus on foreskin cleanliness. The natural juices of the penis produce a build up of white residue called smegma and it should be washed away carefully every day with warm soapy water.
If it is allowed to collect for any length of time under the foreskin, it can become infected, forming a smelly, cheesy-like substance. This prevents the foreskin from being able to retract and so the glans itself becomes red, sore and inflamed, making it painful to urinate.
In some cases, penile balanitis in young boys can also be due to an allergy to soap or a skin condition like eczema or psoriasis, in which case an emollient or aqueous cream can be substituted.
A visit to the doctor should be made as soon as possible to ascertain the cause and obtain antibiotics to clear up the infection.
Whilst a lot of three year olds will be able to accomplish the retraction and cleaning of their own foreskin, many are not and forcing it to retract before proper separation has occurred can cause scarring on the delicate inner lining. This damage can result in the inside of the prepuce becoming fixed to the shaft or glans of the penis by the scar tissue and then retraction becomes impossible.
This condition is known as phimosis and, in days gone by, the young man may well have found himself the subject of a circumcision. However, advances in science have developed a much less invasive operation called a preputioplasty where a small vertical cut is made in the tight ring of skin at the end of the foreskin which is restricting the movement and then stitched together horizontally to make the opening looser.
As a side note, researchers have also noted that masturbation techniques can also be linked to problems with scarring. Boys who lie face-down and rub themselves against the mattress have been known to give themselves a mild phimosis but, when encouraged to turn over and revert to a technique which more closely simulates the back and forth movement of sexual intercourse, the condition resolves itself without need for medical intervention.
Whilst talking about boys and tight forskins, paraphimosis should also be mentioned. This is a condition where, after retraction, the foreskin gets stuck behind the glans and it becomes impossible to return it to its normal position. If the problem continues for more than an hour or if there are signs that blood flow is being impeded, the situation should be treated as a medical emergency. To prevent this, boys should be educated about the need to return the prepuce to its flaccid position over the glans after it has been retracted for washing.
In all cases, retraction and replacement should only be done by the child himself when he has shown that separation has occurred and it is possible to achieve.
