Is the white hard lump inside the foreskin pus?
Should the foreskin be opened and cleaned?
These two questions are the most common questions asked by parents in pediatric urology clinics, but urologists may have many different answers; in fact, most young boys are able to live with foreskin or prepuce.
However, some medical literature reports that the foreskin is a major cause of urinary tract infections in children and, when they grow up, is the main culprit of cervical cancer in the other half. So the general idea is to remove the foreskin as the culprit, the solution is circumcision, or else forcibly open the foreskin for cleaning.
Should every little boy be circumcised at birth?
The latest conclusion from the American Academy of Pediatrics is that circumcision has benefits and risks, but is not absolutely necessary.
Another troubling question is whether or not to open the child’s foreskin to clean the penis.
Many parents will notice that there are white pus-like things inside the foreskin of their children and think it is something very dirty, but in fact these things are the so-called “foreskin scale” (Smegma). This is the accumulation of secretions from the sebaceous glands on the inner surface of the foreskin, and because of its yellowish-white color, it can easily be mistaken for pus. Researchers have sent these foreskins for bacterial culture and only about 23% of the foreskins grew bacteria that cause urinary tract infections. As to whether circumcision can lead to cervical cancer in future sexual partners, there is no conclusive evidence yet. In fact, the occurrence of cervical cancer is caused by multiple factors and may have more to do with personal hygiene habits in adulthood. And there is contrary evidence that adult males in the Nordic countries, who are rarely circumcised, do not have a high incidence of cervical cancer in their partners.
Because boys before the age of five, the foreskin is mostly in a circumcised state and does not need to be reluctantly turned out and cleaned every day. The reason is twofold: First, the foreskin will not have any adverse effects in early childhood, it is a sterile secretion that will not necessarily cause infection, and most boys can easily turn their foreskin over after the age of five, so the foreskin will naturally be discharged smoothly; second, violently turning over the foreskin that completely encloses the glans is not only very painful, but also easy to cause infection and lacerations, which will result in the formation of foreskin scars. Secondly, violently opening the foreskin is not only very painful, but also easy to cause infections and lacerations, which can lead to scarring of the foreskin and make some boys’ circumcision more serious. Even if you want to open the foreskin early, you have to take a milder approach by applying a low concentration of steroid cream topically and gently pushing the foreskin back with both hands, but not too violently and causing foreskin lacerations. After the foreskin is opened, it will be discharged.
Although circumcision has now become quite simple and safe, the indications for the procedure remain the same: (1) Generally speaking, boys under the age of five have a higher chance of having their foreskin naturally opened to reveal the glans, so not every child with a long foreskin needs to be operated on, and boys with congenital hypospadias and anaplasia cannot be casually circumcised because the foreskin has to be left behind for future urethral reconstruction or penile circumcision. (2) If the foreskin is too long and tight for a boy who is close to five years old or older, causing problems when urinating, a low concentration steroid cream can be applied first, and there should be a 70% chance that the foreskin can be turned over to reveal the glans. (3) If the foreskin is too long and tightly wrapped, and if chronic scarring is the result of frequent recurrent infections, circumcision should be considered; (4) Boys who have received emergency treatment for swelling of the glans due to an ingrown foreskin should consider circumcision regardless of age.