Common penis problems in infants

Private parts have all sorts of names – from Willy to Ugwayi. Over the years I have heard all sorts of variations for these little boy parts. These names are more comfortable for parents to say but for the purpose of this article we are going to be brave and call it by the proper name…penis.

Understandably, moms in particular, are often concerned about a little boy and how best to care for the penis and what to look out for in case there is a problem. The penis is a very important part of your boy’s body and it will have a huge impact on his life as an adult so care is a topic which needs to be addressed.

Before we look into the topic it is necessary to give some definitions so we all know what we are talking about:

• Glans – the tip or head of the penis
• Shaft – the finger like part which extends from the tip and connects to the lower belly
• Foreskin – a patch of skin that covers the head and provides protection (This is what is cut away during a circumcision)
• Scrotum – a pouch of skin below the penis which holds the testicles
• Testicles – two organs, oval in shape that are housed in the scrotum. They are responsible for producing sperm in men.

Keeping things clean

• At birth, the foreskin of most little boys doesn’t pull back (retract). Please do not force it back as this may result in bleeding from a tear. Repeatedly forcing the foreskin back before it has released naturally may actually result in a serious condition known as Phimosis (this will be discussed later). Simply wash the penis with a hypoallergenic soap and water at bath time.
• In uncircumcised boys, the foreskin may begin to retract from around 12 months of age. This varies from boy to boy but we do find that at least 50% of boys are able to retract the foreskin by the age of 10 years and certainly the majority of boys (90%) by the age of 17 years. A non-retractable foreskin is different from the condition known as Phimosis. There is no need to interfere with the normal process of retraction unless a boy begins experiencing problems.
•  As soon as it does retract then it is very important to clean under the foreskin daily. This is done by gently pulling the skin back, cleaning with a mild soap and water and rinsing the soap off. The glans should be dried properly and the foreskin gently pulled back over the glans. A little boy can be taught to do this himself from about two years of age as long as a caregiver ensures it is done properly to avoid problems.

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Concerns about erection

First and foremost an erection is normal! It is a very natural function for a healthy boy. It begins as early as in the womb. A newborn may have an erection while in the bath or just having his nappy changed.

It has nothing to do with sex and is probably just a response to the air, warm water or the fact that he needs to pass urine. As your little boy grows up he will discover his penis just like any other part of his body. Touching his penis may cause an erection. This is normal but as he gets a little older you may need to explain to him that his penis is private and that touching is private as well. Only from about the age of 11 years and upwards will an erection lead to ejaculation.

On the whole little boys do find their penis pleasurable but for some an erection is uncomfortable, distressing or even painful. If this occurs try explaining to him that is normal but help him overcome the discomfort by giving him a bath, removing his underwear and putting some loose fitting trousers onto him.

A normal erection will not last longer than an hour. If it does then you should seek medical help.

Penis problems that are of concern

While there are a number of conditions which may cause boys problems, I would think it is safe to put these into three specific groups. These are the ones most likely to occur and therefore of greatest concern to parents:

Physical problems

• Buried penis The penis may be hidden inside a fat pocket in the lower part of the tummy. Another cause may be that the skin of the penis covers the penis unevenly and the penis is concealed. The condition usually resolves by the time the child is two years old. In rare cases the child may develop scarring in which case your doctor may recommend a steroid cream and possible surgery.
• Chordee Another name for this is penile curvature. This is often caused by tissue pulling the penis down especially during an erection. Unfortunately surgery is required to correct this problem.
• Webbed penis This occurs if the penis doesn’t separate well from the scrotum. A baby may either be born with this abnormality or it can happen following a circumcision where too much of the foreskin has been removed. This webbing can be corrected with minor surgery.
• Balanitis This refers to inflammation of the glans. It can be as a result of infection, allergy or irritation. Balanitis may be painful but is generally not too serious. Depending on the cause the doctor will either recommend an antibiotic cream or a steroid cream. Sometimes the balanitis is caused by a tight foreskin and then surgery might be necessary.
• Penile adhesions This condition occurs in boys who have been circumcised. The edges of the cut skin stick to the head of the penis. The skin can’t retract from the penis. It doesn’t cause pain and this will usually resolve on its own as the penis grows.
• Phimosis This condition often occurs because of scarring of the preputial ring. It prevents the foreskin from retracting at all. This condition may be as a result of the foreskin being forced back repeatedly or an infection. It would also be considered if the opening of the foreskin is too small or when a boy’s foreskin is still not retractable at the end of puberty. This condition makes it difficult to pass urine and ballooning of the foreskin may be noticed. The tight foreskin may also cause pain during an erection. The first step in treating this condition would be a steroid cream. If this fails then surgery may be necessary to release the foreskin.
• Paraphimosis Here the foreskin retracts behind the glans and it is not able to go back. This is a medical emergency because the foreskin acts like an elastic band around the shaft and cuts off blood to the tip of the penis. Urgent care is needed.
• Torsion of the testes In this condition the testicle twists and cuts off blood supply. This is a very painful and serious condition. It can happen at any stage of your child’s life and requires urgent medical attention. If you notice a swollen scrotum, treat it as an emergency.

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Infections

• Urinary tract infections: If your little boy gets a urinary tract infection your doctor may request an ultra-sound of the kidneys and VCU, to check that the kidneys are functioning correctly and that the bladder is able to empty completely when baby passes urine. Most often however, the infection is caused by bacteria which have been trapped under the foreskin and then travel up into the urinary tract. Your son might experience fever, strong smelling urine, difficulty passing urine, a burning sensation when passing urine, irritability or poor feeding. The urine should be tested so that the correct antibiotic can be prescribed. This is necessary to prevent any damage to the kidneys.
• Fungal infection: This is most often caused by Candida. It may occur in very hot, humid conditions or if too much time has passed between nappy changes. Signs of a Candida infection may be redness, scaling or a painful rash. An anti-fungal cream will probably be prescribed for this condition.
• Post circumcision: During circumcision the foreskin is separated from the normal tissue and removed leaving the glans exposed. It is common for the glans to become inflamed and crusted and this causes parents a lot of concern. Usually a good layer of nappy cream and a nappy liner is all that is required to prevent the sensitive area from rubbing on the nappy. It is important to watch for infection or bleeding as this can be serious. Seek urgent medical advice under such circumstances.
• Smegma: Pus-like clumps may form on the glans of the penis if the foreskin is not retracted and cleaned properly. Cleaning of the penis will usually resolve this issue.
• Rash: Boys hold their penis to pass urine. In most cases a rash is caused by an irritant that was on your son’s hand and now touches this very sensitive skin. These irritants may include pollen, grass or food. Gently washing the penis and applying a hypo-allergenic cream is sufficient to settle the rash. In severe cases your doctor may prescribe a medicated cream.

Injury

There are a number of ways that a boy can injure his penis or scrotum. Most often little boys will hurt themselves:

• While riding a bike or playing sport. Boys will experience pain and may even feel like vomiting. Parents should seek medical help if the child develops a fever, if the nausea continues, if there is swelling, bruising or a hole.
• Catching their penis in a zip. If you can’t safely undo the zip or if there is a chance that you will cause further injury, then this must be treated as an emergency.
• A hair or thread from underwear may also twist around the penis and cut off blood supply. If the parent is unable to loosen the thread then urgent medical care is necessary.

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Conclusion

Talking about penis problems is easier for parents when their son is little. As boys get older they get increasingly shy about such talk. It is really important that you keep conversation about illness, injury and normal development open when it comes to any body part. This way you can encourage your son to let you know if he is experiencing any discomfort or problem with his private parts.

There are a number of things that can go wrong and many may need medical intervention. Being able to talk to your son and give him the confidence to ask questions and raise concerns is important to normal male functioning.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557924/
https://www.hkmj.org/abstracts/v22n3/263.htm#:~:text=Parents%20often%20seek%20medical%20advice,short%20are%20the%20common%20complaints.
https://www.hkmj.org/abstracts/v22n3/263.htm
https://www.rch.org.au/clinicalguide/guideline_index/The_penis_and_foreskin/
http://www.stacommunications.com/journals/cme/2002/09-sept/penisproblems.pdf
https://my.clevelandclinic.org/health/diseases/15454-penile-torsion
https://www.medicinenet.com/phimosis_and_paraphimosis_penis_disorders/article.htm