Swedish Kids Symptom Checker
1. Does this describe your child's symptoms?
- Symptoms of the male genital area (penis or scrotum)
- Injuries are not covered here
- Penis symptoms include rash, pain, itching, swelling and discharge from the end of the penis
- Scrotum symptoms include rash, itching, pain and swelling.
- Any genital pain that is not due to an injury is included
- Foreskin retraction questions for noncircumcised boys are included
Types of Foreskin Retraction Problems
- The foreskin generally causes no problems. However, overzealous retraction can cause it to get stuck behind the glans (head of the penis) and cause severe pain and swelling. This is called paraphimosis.
- If retraction is forceful, it can cause a small cut with minimal bleeding and pain.
- Occasionally, the space under the foreskin becomes infected probably from a break in the skin caused by excessive retraction.
2. When to Call Your Doctor
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Scrotum is painful or swollen
- Foreskin pulled back and stuck (child not circumcised)
- Can't pass urine or only can pass a few drops
- Painful erection present more than 1 hour
- Severe pain
- Pain or burning with passing urine and fever
- Red rash or red foreskin with fever
- Pus or bloody discharge from end of penis
- You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think your child needs to be seen, but not urgently
- Pus from end of foreskin (child not circumcised)
- Swollen foreskin (child not circumcised)
- Pain or burning with passing urine without fever
- Rash is painful
- Rash has several tiny water blisters
- Looks infected (e.g., draining sore, spreading redness, etc) without fever
- You are worried about a sexually transmitted disease (STD)
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Itching present more than 3 days
- Small lump or warts
- All other penis-scrotum symptoms (EXCEPTION: mild rash for less than 3 days, transient pain, normal purple color of glans, foreskin retraction questions or smegma questions)
Parent Care at Home If
- Mild symptoms and you don't think your child needs to be seen
- Mild rash or itching or penis or scrotum present less than 3 days
- Transient pain of the penis
- Purple head of the penis and healthy child (Reason: this is a normal variation)
- Foreskin retraction, questions about
- Smegma (whitish material), questions about
3. HOME CARE ADVICE FOR MILD PENIS OR SCROTUM SYMPTOMS
- Since hand-to-penis contact is normal during urination, the rash is probably from an irritant that was on the hands.
- Examples are a plant (e.g., evergreen), chemicals (e.g., insecticides), Fiberglass, detergents, pet saliva or even food.
- This small rash sounds harmless. You can treat it at home.
- Reassurance - Normal Separation of the Foreskin:
- At birth, the foreskin is normally attached to the head of the penis (glans) by a layer of cells.
- Over the next 5 to 10 years, the foreskin will naturally separate from the head of the penis. It gradually loosens up (retracts) a little at a time.
- Normal erections during childhood probably cause most of the change by stretching the foreskin.
- Any degree of foreskin movement is normal as long as your boy has a normal urine stream.
- There should be no rush to achieve full retraction. Full retraction always occurs naturally by puberty.
- Smegma - General Information:
- Smegma is the name given to the small pieces of whitish material that can build up under the foreskin if it is not pulled back and cleaned regularly. It is also commonly seen through the part of the foreskin that is still stuck to the head of the penis before the foreskin becomes retractable.
- Smegma is the accumulation of dead skin cells that are normally shed from the glans (head of the penis) and lining of the foreskin throughout life, and trapped under the foreskin.
- Smegma is normal and harmless. It is not a sign of an infection.
- Cleansing: Wash the area once with soap to remove any irritants.
- Cleansing Before Age 1 Year:
- During the first year of life, only clean the outside of the foreskin.
- Don't make any attempts at retraction.
- Don't put any cotton swabs into the opening.
- Smegma Before Age 1 Year:
- Smegma that is seen through the foreskin but lies beyond the level to which the foreskin can be retracted, should be left alone until normal separation exposes it.
- During the first year of life, do not make any attempts at retracting the foreskin.
- Hydrocortisone Cream: For itchy rashes, apply 1% hydrocortisone cream (no prescription needed) 2 times per day for a few days.
- Foreskin Retraction:
- Begin gentle partial retraction at 1-2 yrs of age.
- It can be done once/week during bathing.
- Perform retraction by gently pulling the skin on the shaft of the penis backward toward the abdomen.
- This will make the foreskin open up, revealing the end of the glans.
- Antibiotic Ointment: For any cuts, sores or scabs that look infected, apply an antibiotic ointment (no prescription needed) 2 times per day until seen.
- Cleansing After Age 1 Year:
- As the foreskin becomes retractable on its own, cleanse beneath it to prevent infections.
- Cleanse the exposed part of the glans gently with warm water and dry it.
- Do not use soap or leave soapy water under the foreskin, because this can cause irritation and swelling.
- Wipe away any whitish material (smegma) that you find there.
- Prevention: Teach your son that if his hands are dirty, to wash them before urinating.
- Reposition: After cleansing, always pull the foreskin forward to its normal position.
- Call Your Doctor If:
- Rash spreads or becomes worse
- Rash lasts over 3 days
- Fever occurs
- Your child becomes worse
- Avoid Vigorous Retraction:
- This can cause pain, bleeding, or tears of the tissue.
- It also may cause the foreskin to become stuck behind the head of the penis (paraphimosis).
- Retraction is excessive if it causes any discomfort or crying.
- Teach Child: By age 5 or 6, teach your son to retract his own foreskin and clean
beneath it once a week during bathing to prevent poor hygiene and infection.
- Pain Following Recent Attempt at Retraction:
- The attempt to retract the foreskin has probably caused a small cut or tear. Raw surfaces are painful.
- Cover the raw area with a layer of antibiotic ointment.
- If you don't have one, use petroleum jelly.
- Once the raw surface is protected from the air, the pain should improve in a few hours.
- Continue twice a day until healed (usually 1 or 2 days).
- Call Your Doctor If:
- Pain lasts over 24 hours
- Foreskin looks infected
- Other foreskin problems occur
- And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
- This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
- Author and Senior Reviewer: Barton D. Schmitt, M.D.
- Last Reviewed: 10/13/2011 10:47:21 AM
- Last Revised: 10/13/2011 10:47:21 AM
- Content Set: Pediatric HouseCalls Symptom Checker
- Copyright 1994-2012 Barton D. Schmitt, M.D.
Swedish Kids Symptom Checker is designed especially for these times. The interactive iPhone application can help you make appropriate decisions on what level of care, if any, is needed and how to provide symptom relief for minor illnesses and injuries you can manage on your own.