THE NORMAL FORESKIN

In most boys at birth the foreskin or prepuce is adherent to the head of the penis and cannot be drawn back. It is also rather long and projects well beyond the head of the penis in the infant. During growth and development the prepuce gradually separates from the head of the penis or glans. This process takes place earlier in some boys than others, but by the age of 4 most lads can retract the foreskin so as to completely expose the head of the penis. When the prepuce becomes retractable, washing this part with soapy fingers to remove the smegma (smelly cheesy material) which tends to accumulate can be included in the bath time routine. The boy should be taught to pull back his foreskin when passing water, which avoids soiling the glans and ensures that he can direct the stream in the right direction, getting less on his pants and the floor! If by the age of 4 the prepuce still cannot easily be drawn back, medical advice should be sought to see if separation of the adhesions under an anaesthetic, or circumcision is necessary. The age of 4 is arbitrarily chosen so that if intervention is necessary, it can take place before the child starts school. The mature youth should be able to completely retract his foreskin and replace it with his penis erect without any pain or difficulty because this manoeuvre is essential for sexual intercourse.

A prudent parent will ask his teenager about this matter before the lad leaves school, so that in the few cases where circumcision has become necessary it can be done in a school holiday before he starts work. This questioning is all the more important since routine medical examination of school leavers is no longer carried out - thus the boy and his parents may not realize that he is suffering from puberty induced phimosis. Although 10-15% of British schoolboys are circumcised there is evidence that at least 5% leave school needing the operation. The lad should also be instructed to retract his prepuce and wash his penis daily to maintain the standard of sexual hygiene required of an adult. The foreskin tends to shorten during development and the glans remains completely covered in only 45% of men, partially covered in 32% and is completely uncovered (auto-circumcision) in 23%. The fact that without surgery at least half the male population have the appearance of being partially or completely circumcised should allay the wrath of those who would regard operation on anyone with a persistent long infantile foreskin as an unnatural mutilation. There is also variation in the length of the prepuce in different races, the foreskin being typically rather long in Negroes, and very short in Chinese and Japanese. It has been suggested that the purpose of the foreskin is to protect the glans from urine during the time the child is in napkins, but it does not seem to have any essential function in the adult apart from retracting out of the way for sexual intercourse.