Last updated on August 13, 2020
Question
I’m uncircumcised. The skin on my penis doesn’t pull back all the way to release the tip of the penis. I think it should, but I don’t know if I should see a doctor.
Answer:
Circumcised men have their foreskin removed so that the glans (the tip or end of the penis) is always exposed. In uncircumcised men, the foreskin either mostly covers or completely covers the glans.
When boys are born, their foreskin is attached to the glans. Over time, the foreskin detaches so that between ages three and five, the foreskin should be able to be pulled back to completely expose the glans. It is very important that foreskin should never be forced back as it can cause damage to the surface of the glans or the inner surface of the foreskin. The skin is supposed to be gently pulled back as far as it is able to go and then the inner surface is washed with water to remove accumulated oils and dead skin cells. Soap should be avoided, but if it is used, the penis needs to be thoroughly rinsed. Trapped soap under the foreskin will cause irritation.
For a few boys, this separation of the glans and foreskin doesn’t take place and it might not take place until after puberty when the penis begins to grow. Unfortunately, a large number of uncircumcised boys were never taught to wash under their foreskins. When you are small you rarely think that the foreskin can be pulled back. What ends up happening is that the build-up of oil and dead skin cells (called smegma) cakes up and basically glues the foreskin to the glans. In either case of not separating or getting “glued” down, boys with stuck foreskins have difficulty getting erections. As the penis increases in size, the foreskin is supposed to roll back, allowing the glans to be exposed. However, because the foreskin is fused to the surface of the glans, the erection causes discomfort or pain. The body quickly learns to avoid what is painful. The condition is called phimosis.
Fortunately, the majority of these cases can be solved simply. At every opportunity that you can, grasp the foreskin and pull it away from your body as if you were trying to cover the glans more. Only pull as far as it feels comfortable. The foreskin is amazingly flexible and you will find that you can pull it out several inches. What happens is that you are not only stretching the outer surface but also the inner surface much like a rubber band. Instead of pulling the foreskin away from the glans, you are sliding it sideways to it, which gently breaks any adhesions. While stretched, rub the area where the adhesion is at with your other hand to encourage further release. Do it multiple times each day: as you dress, using the restroom, and when you bathe.
Each time you bathe, gently pull the foreskin back as far as it will comfortably go. Soak the area in warm water for about 20 to 30 minutes. Then wash away any smegma you find. It will take several days or even several weeks, but you will begin to notice that you will be able to retract the foreskin further each time, and eventually it will pull back completely.
Once you get it to go back, keep the surface underneath clean by washing it each time you bathe.
In a few cases, this technique doesn’t work. If you are past puberty, your penis has increased in size, but the foreskin doesn’t retract, you should see a doctor who specializes in urology. Typically the first step in treatment is a steroid cream to get the foreskin to expand. If that doesn’t work, then minor surgery can correct the problem by making small slits at the outer end of the foreskin. Only rare cases actually require circumcision.
Further Information:
Answers to Your Questions About Your Young Son’s Intact Penis This is a pamphlet for parents of uncircumcised boys. It is short and easy to read.
Caring for the Uncircumcised Penis: What Parents (and You) Need to Know This is an article from Contemporary Pediatrics. It is heavy in medical jargon but contains useful details.