Forcible foreskin retraction, which is the practice of pulling back a child’s foreskin to any degree, is an issue in the United States. At Intact America, most of the complaints we have received about this practice come from parents of boys who have suffered from the irreversible harm caused by forcible foreskin retraction. Regrettably, these incidents often take place during regular check-ups for infants and children. Countless more incidents go unreported because many parents are not informed about the negative effects and long-term damage caused by forced foreskin retraction. Many of these attacks against the natural penis occur without warning, without a parent’s consent, and during routine well-baby visits and pediatric appointments. Some of the most horrific incidents of forcible foreskin retraction have happened when a parent has brought their child into an emergency room for a completely unrelated accident or illness.
“Early one morning, I received a phone call from a distraught mother, who had brought her intact 2-year-old son into the ER with a 104-degree temperature because she suspected he had COVID-19. The nurse opened his diaper and began messing with his penis. The mother realized she was trying to retract his foreskin and told her to stop. The nurse ignored her and continued to yank on the tender skin. The mother’s instincts proved correct on both fronts. Her son did have COVID-19 and the nurse had done considerable damage to her child. Heartbreakingly, the mother told her on the way home he was pointing to his diaper and crying ‘mommy, owee, owee.'”
– Georganne Chapin, Founding Executive Director of Intact America and Author of This Penis Business (Lucid House Publishing, 2024)
An intact baby’s foreskin naturally adheres to the penis, will retract in time with no force, and requires no treatment. This is called “physiological phimosis.” Although it is common for parents and even healthcare providers to be concerned about a tight foreskin, it is normal in babies and young boys. Foreskins will retract naturally, and almost all do so by the age of 17 (1). It is the natural covering of the highly sensitive head of the penis.
When the skin is forcibly retracted, “pathological phimosis” can occur, which can lead to bleeding, scarring, and psychological trauma for the child and parent. Because American culture has been underexposed to intact penises with foreskins, even healthcare providers sometimes do not know that a non-retractable foreskin is natural and normal in childhood, and they often force retraction, leading to pathological phimosis issues.
Is there a difference between forced retraction, foreskin retraction, and forcible retraction?
The answer is no. Forcing the foreskin of the penis to retract abruptly or excessively—separating the foreskin from the glans or head of the penis to expose it—goes against the natural development and anatomical state of the foreskin and can cause several complications.
Why is it done? Pure ignorance.
By whom? Parents, caregivers, and healthcare providers, including doctors and nurses. Many healthcare professionals are foreskin phobic and even medical textbooks often fail to show an intact penis.
Solution? Know the anatomical function of the foreskin and its characteristics, and inform everyone not to retract their baby’s foreskin.
Risks of Forcible Foreskin Retraction
1. Pain and Discomfort: Forcing the retraction of the foreskin can cause the foreskin’s delicate tissues to tear or become irritated, leading to inflammation, pain, and possible injury.
2. Infection: The foreskin provides natural protection to the penis from harmful bacteria and pathogens. When it is forcefully retracted, this natural protection is compromised, making the penis more vulnerable to inflammation, and urinary tract infections.
3. Balanitis (inflammation of the head of the penis): The balano-preputial lamina is a protective membrane that may be attached to the foreskin at birth acting like a “male hymen” to keep the sensitive area clean and safe. This will gradually recede and disappear.
4. Scarring and adhesions: Retracting the foreskin forcefully may result in scarring and adhesions that cause discomfort, limit movement, and make it hard for the foreskin to naturally retract later on.
5. Psychological impact: The experience of having the foreskin forcibly retracted is the same as any reaction to an aggressive assault on the body: fear, shock, and pain.
Why Is Forced Foreskin Retraction Still Happening?
“If we look at a penis with its prepuce intact and discard the myths we’ve been told (e.g. the foreskin is “dirty” and “extra skin”), we see that it is an integral part of the penis…The foreskin functions throughout a male’s life to protect the glans (head of the penis) from abrasion and other damage. Once the foreskin becomes retractable, its loose skin provides mobility and stretches to accommodate a full erection. Finally, an intact penis is a bit longer and chubbier than a circumcised penis.”
– Georganne Chapin, Founding Executive Director of Intact America and Author of This Penis Business
1. Lack of education: Insufficient education about normal foreskin development and care has resulted in misguided practices among parents, caregivers, and healthcare providers. This is a culture-wide problem in the United States due to unfamiliarity with the natural intact penis.
2. Cultural and social influences: The beliefs and norms of a culture or society regarding hygiene, cleanliness, and the appearance of the genitals have contributed to forcible retraction. The presence, particularly, of “smegma,” a harmless combination of oils, skin cells, sweat, and other fluids that can accumulate around the penis, and which can have a foul odor, can freak out parents, caregivers, and healthcare providers. The best way to prevent and treat it is to wash the area with warm water and to teach the child to do the same, from the base out, like washing a finger.
3. Outdated or inaccurate information: Outdated or inaccurate information about foreskin care and hygiene can still be a problem despite the progress made in medical knowledge and understanding. Some outdated medical literature and cultural beliefs may suggest forced retraction as necessary or helpful, contributing to its practice in areas with limited access to up-to-date information.
Important Definition: IATROGENESIS
Caused by the medical system, iatrogenesis refers to any effect on a person resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health that does not support the goal of the person affected.
How You Can Prevent Forcible Foreskin Retraction
1. Gentle cleaning practices: Gently clean the external area with soap and water to keep the genital area hygienic in infants and young children. During regular bathing, clean the outside of the foreskin with warm water without trying to retract it.
2. Allow natural development: Let the foreskin develop naturally. As a child grows, the foreskin will become retractable on its own. Allow the foreskin to separate from the glans and become retractable at its own pace.
3. Promote body autonomy and consent: Teach children about their bodies and stress the significance of consent. Encourage them to communicate any discomfort or concerns with how someone has touched them, and make sure they understand that their bodies belong to them.
4. Education and awareness: Spread the truth to parents, caregivers, and health professionals. Refer them to intactamerica.org and other websites with accurate information regarding the physiology of the intact foreskin and forced retraction. SPEAK!
Why Is Forced Foreskin Retraction a Human Rights Issue?
In the Spring of 2018, Intact America conducted a national survey of parents of children under the age of seven and found that 43 percent of intact boys had experienced the painful and unnecessary forced retraction of their foreskins, most of them at the hands of physicians.
A 2017 brochure published by HealthyChildren, a program of the AAP, states unequivocally:
“… foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.”
Unfortunately, messing with a boy’s foreskin can also cause infection and scarring, leading too often to doctors suggesting circumcision as a remedy for a problem they created.
As more and more boys are kept intact, it’s critically important that parents, childcare workers, and medical professionals understand that a boy’s foreskin will naturally separate over time (the age of retraction varies considerably) and that only the boy himself should touch his foreskin. Whether in the “service” of medicine or not, we believe any other approach should be considered an unnecessary and willful assault and violation of a child’s human rights.
Notes
1. See this free article in the National Library of Medicine Archives, an elegant cohort study published in 1968 by a Jakob Øster, a Danish medical officer, who conducted a longitudinal study with nearly 10,000 observations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2019851/?page=1Oster. In addition, Marilyn Fayre Milos and Donna Macris addressed this issue in their journal article “Circumcision: A Medical or a Human Rights Issue” in the Journal of Nurse-Midwifery (37, 2:87S-96S) March/April 1992,
https://www.cirp.org/library/ethics/milos-macris/.
