Should you pull back the foreskin when cleaning an infant?

There is a small difference between little boys and little girls. Now that little bit of difference in boys is often in question when it comes to cleaning it. Most parents are aware that for men pulling back of the foreskin during the washing procedure is necessary to clean thoroughly and avoid infections. In young boys however the opening of the foreskin is mostly so small that effective pulling back of the foreskin is already difficult, if not impossible. This often sparks the questions: do we do it? when do we start doing it? do we do it with every bath? how far do we pull it back?

To answer this question it is important to understand that the foreskin is attached from birth to the tip of the penis. It only starts loosening once the boy becomes pubertal. (see graphic). Pulling the foreskin back when it has not yet detached is painful and causes small injuries that can heal with scaring. That scaring then leads to what is known as phimosis, where the foreskin is not retractible in adolescence or adulthood even with force, which makes a full erection and sexual function difficult and thorough cleaning at this stage impossible. To fix an established phimosis a medical circumcision under anaesthesia is required. So not pulling back the foreskin in infancy and childhood can avoid such a phimosis.

After explaining the above, I sometimes hear: But I can see the dirt underneath the foreskin…

Often a white secretion is visible under the foreskin which is called smegma. Now smegma is the body’s own antibiotic substance that prevents very effectively most infections. Cleaning it is therefore not necessary and wiping it away might even be counterproductive to a healthy environment. An infection might actually follow the pulling back of the foreskin and cleaning of the smegma. This infection is called a balanitis, it is very sore and will require antibiotics and pain medication.

In short:
Pulling the foreskin back until it does it by itself in puberty is not necessary and potentially dangerous. Best clean the penis with a soapy cloth only from the outside. No need to worry about infections, and if your son does get an infection be sure that it is not as a result from not pulling the foreskin back while cleaning.