Is my child's foreskin normal?

Many Filipino parents have a lot of questions about what the foreskin normally looks like.

Because many male Filipinos are circumcised, it can be hard for some new parents to know what’s normal and not normal when it comes to the foreskin and the head of the penis in their young child.

Getting familiar

First of all, it may help to be familiar

with the parts of the penis.

Is my child’s tight foreskin abnormal?

Babies and young children are supposed to have a tight foreskin.

This is called “physiologic phimosis.”

When male babies are born, the head of the penis is a little stuck (“adhered”) to the foreskin around it. This is normal.

Over time—because of growth, normal erections, and children touching their own genitals—the foreskin gradually loosens and becomes detached from the head of the penis.

In Filipino we call this separation “tagpos.”

Sometimes this reveals some white, cheese-like substances under the foreskin. This is called “smegma” and it is normal, though it should be cleaned off gently when it’s exposed.

As your child gets older, the foreskin becomes loose enough that it can be pulled back to reveal the head of the penis. When this happens it allows you and the child to clean under the foreskin during baths and after urination.

Is ballooning abnormal?

Not necessarily.

If the foreskin opening is a little tight, sometimes, when a child pees, some urine gets under the foreskin, causing a “ballooned” appearance.

Later the urine can dribble out.

By itself, ballooning may not be abnormal.

Sometimes may just mean that you or your child may need to make sure that the urine is emptied out by gently milking the foreskin after urination.

Gradually, as the foreskin loosens and urine comes out more easily, ballooning resolves.

If it is associated with recurring infections of the foreskin, or with difficulty peeing, then your child may need medical attention.

Is some redness abnormal?

Sometimes parents become worried about a temporary redness of the foreskin.

It is helpful to remember that urine can be an irritant on delicate skin and can also cause itching.

In some children this may mean a greater need for hygiene to clean off the urine after peeing, and a gentle wash twice a day.

If it improves afterward, then you may not need to worry.

In some children, specially if the redness comes with pain, bleeding, or discharge, it can mean an infection. At this point medical attention is needed.

When do we have to intervene for a tight foreskin?

recurrent infections of the foreskin (“posthitis”) or the head of the penis (“balanitis”)
signs of “balanitis xerotica obliterans” – a scarring disease on the foreskin or the head of the penis. The image below shows white scar tissue and a cracked, tight foreskin with pinpoint bleeding.
Image source here.
extremely tight opening of the foreskin that no longer allows urine to pass through
the presence of urinary tract infections, specially those that come with fever
if it comes with other abnormalities of the penis

What will your doctor do for a tight foreskin?

Many pediatricians and urologists will prescribe a topical steroid cream.

Regimens vary, but our protocol is to use the steroid cream twice a day for six weeks as an initial course.

The steroid helps the foreskin to become more pliable and for the opening to be more loose.

In some situations, we may offer a circumcision, specially if the condition is severe or unlikely to respond to steroids.

What's an emergency of the foreskin?

If your child is having increasing difficulty of peeing. He may even get to the point where the urine no longer exits through the foreskin.
If the foreskin is retracted beyond the head of the penis, and cannot be put back to cover it again because of pain or swelling, this is an emergency situation that is called “paraphimosis.”
In either situation, your child will need to be brought to the emergency room for urgent attention.

In paraphimosis, the head of the penis is trapped by a swollen and tight foreskin, and the foreskin cannot be returned to its position of covering the glans.

Image source here.

Take home messages

It is normal for very young boys to have a tight foreskin. As part of their development, the foreskin later loosens and detaches from the head of the penis.
Your child needs medical attention if this tightness comes with repeated infections, pain, scarring, difficulty urinating, or situations where the head of the penis becomes trapped by a tight and swollen foreskin.
If the foreskin hasn’t developed fully, your child should be examined for other abnormalities of the penis.

The information in this infographic is for general information purposes only.

We encourage you to seek an individualized consult for the most appropriate management. You may book an appointment with us or with your preferred pediatric urologist or pediatric surgeon.

Please feel free to send us a message for questions on pediatric urologic health!