Every second Saturday morning, a group of pre-school boys come into my clinic and, with their parents and brothers and sisters hanging around, the place becomes like a battle zone. They're there to attend a course called Bright Phimosis Treatment Without Surgery, and the place becomes like a virtual meeting place to discuss child raising.

Phimosis is the condition where the foreskin can't be fully retracted over the head of the penis, and these little boys are seeking treatment for it without undertaking the common method in Japan of undergoing surgery.

Looking after the course is Dr. Shinya Iwamuro, a urologist who graduated from the same university I did (though a bit after me). Anybody who suddenly came into my waiting room would no doubt hear children's voices coming out of the consultation rooms. Sometimes, those voices might be cries, other times they may be screams at the doctor. For the visitor, they may wonder why. When the kids come out of the waiting room, they have looks of great satisfaction on their faces. "Hey, look at me, I peeled it off," is written on their faces as they look around the waiting room at their buddies. At the same time, the boy next in line to see the doctor is often nervous and can sometimes seem on the verge of breaking into tears. As the clinic is supposed to be for pre-school boys, anyone under 7 can go, and even though these kids are only young, their reactions show a glimpse of the competitive outside world that awaits them.

"What's important is keeping the penis clean. In the old days when everyone went to the public bath, neighbors used to teach kids how to peel back their foreskins, but children nowadays have had that opportunity taken away from them, so it's up to their parents to take the time to show their sons how to keep their penises clean. But so many fathers are caught up in the myths surrounding phimosis surgery they have no idea about what they should be doing to care for their own children's penises. Dr. Iwamuro is one of the rare physicians in Japan who has consistently argued that surgery is not necessary in dealing with phimosis. The message he has constantly preached to junior high and high school boys across the years is: "If the foreskin completely covers the head, it's phimosis, but if you can pull it back, you're OK. If you can pull it back, wash it, then put it back in again."

Most Japanese men still have a foreskin covering the head of their penis. It's not like there is an inordinately large number of Japanese with phimosis, but because circumcision is common soon after birth among followers of religions such as Christianity and Islam, men who've undergone this process appear to have avoided the problem of phimosis. So it's out of the question to consider phimosis to be a bad thing. And that has given the opportunity for loads of cosmetic surgeons to pop up in the media offering to perform surgery on boys to "cure phimosis and let you get back your chance at a bright and cheerful youth."

"With full body anesthesia making surgery safer, there's a trend to push for phimosis surgery. But I have stubbornly insisted that surgery is unnecessary. Finally, the number of doctors who think along the same lines as myself and disagree with phimosis surgery has increased to become a majority," Dr. Iwamuro says.

So let's hear Dr. Iwamuro's advice on how little boys can learn how to retract their foreskins. There are three main points involved in pulling it back. They are:

SLOWLY peel back the foreskin, little by little as long as it doesn't hurt and even if you touch the glans;

WHEN changing a young boy's diapers, gently retract the foreskin and wash the penis head; and,

ENCOURAGE boys old enough to use the toilet by themselves that once they have pulled back their foreskin and had a pee, they should make sure after wiping that they put the head of their penis back in the position it was.

The reason why the foreskin can't be retracted is because of such things as the gap at the end of the foreskin being too small (if you gradually force the glans forward, the foreskin opening will also widen) or the head of the penis is stuck to the foreskin. In the later case in particular, it is necessary to have the foreskin surgically separated at a medical clinic. It's not such a difficult procedure, involving only the separation of skin that's stuck together. It's a medical procedure the government recognizes. And, of course, the boy with the problem or his parents can always do it themselves.

In a large majority of phimosis cases, the solution can often be enough to have a father take the time to help his son. But if they are worried about pulling back their foreskins, they can always come to my clinic for a consultation. Of course, they will have to be a pre-schooler to be able to take part in the program. (By Dr. Kunio Kitamura, special to the Mainichi)

Copyright 2005-2006 THE MAINICHI NEWSPAPERS. All rights reserved. Mainichi features the best news in Japan, current news in Japan, Japan news in English, Japan business news, Tokyo Japan news, and Japan entertainment news. Mainichi News is syndicated in accordance with editorial regulations: personal and noncommercial purposes.

TrackBack URI for this entry

Comments (5)

Subscribe to this comment's feed

There's a problem
written by Light , July 19, 2008

There's a problem with this philosophy of "pull it back as early and often as possible!" There are many cases where the foreskin doesn't pull back until later in childhood, up to the beginning of the teen years. Forcing it back too early can actually cause more problems with tightness. Hygiene is important, yes, but it the skin will come back when the time is right. For some reason, the culture seems to demand that the foreskin get pulled back and stay back, and this is not the way to address it.

report abuse

vote down

vote up

Votes: +4

This is just plain wrong, sorry.
written by Hadley , August 04, 2008

When boys are that young, the foreskin is naturally fused to the glans for protection, the way a fingernail is fused to the finger. This "clinic" is incorrect. The foreskin will separate when it's time, between the ages of 5 and 17. Forcefully retracting it can cause problems. I wish the doctors were better informed. Shame on them, I thought Japan knew better.

report abuse

vote down

vote up

Votes: +4

The information in this article is wrong.
written by Anonymous , August 05, 2008

Boy's foreskins should not be forcibly retracted. This can cause infections. The foreskin is fused to the glans, and forcibly retracting can cause infections. After puberty, most boys will be able to retract on their own. Before that retraction should NEVER be forced.

report abuse

vote down

vote up

Votes: +3

The wrong advice
written by David J. Llewellyn , August 05, 2008

These doctors are terribly ignorant of normal foreskin development and the proper treatment of the normal foreskin. The foreskin is attached to the penis at birth. According to a 1996 Japanese study by Drs. Kayaba, et al., available in the normal anatomy section of the library at www.cirp.org, the majority of boys do not have a fully free and retractable foreskin until about 10.5 years. Even then a significant percentage are still not fully retractable. Tearing the foreskin back like these doctors are doing is not only unnecessary, but potentially harmful. There is no need to worry about a non-retractable foreskin until the late teen years. If by then the foreskin is still not retractable a steroid cream such as betamethsone 0.05% can be used to dissolve any remaining adhesions or widen the foreskin opening or both. Tearing the foreskin loose at an early age is not only unnecessary but may cause scarring that will necessitate a circumcision later in life, which will have the effect of reducing sensitivity and changing the sexual experience for both the man and his wife. Until the foreskin is fully retracable the boy from say three or four onward can just gently pull the foreskin back as far as it can go comfortably and rinse the head of the penis with clean water. But even that is probably not necessary until puberty. Far too many irritations and infections are caused by early retraction. By the way, Christianity does not require circumcision. In fact the Christian scriptures discourage it. If Japanese Christians are circumcising their sons they are doing so through ignorance or due to the suggestions of those from the U.S., where far too many boys are circumcised at birth for essentially "bogus" medical reasons.

report abuse

vote down

vote up

Votes: +4

Wrong! Wrong! Wrong!
written by macshills (chris mccaw) , August 05, 2008

IDIOTS! No wonder Japan has such a high rate of "emergency circumcisions". The foreskin should absolutely NEVER be forcefully retracted by anyone and does NOT need to be "cleaned"! The foreskin is fused to the glans from birth for the next few years of a male's life. It will become retractable (((on its own))), (((in its own due time)))! NOCIRC.org indicates that the average age to achieve re tractability is now ten (10)-years-old.... ten!!!!!!! Only the owner of the penis should do the retracting and even then, not until older! Please don't accept read this (((trash))). www.nocirc.org

report abuse

vote down

vote up

Votes: +3

Write comment

Name

Email

Website

Title

Comment

smaller | bigger

Subscribe via email (Registered users only)

I have read and agree to the Terms of Usage.

Write the displayed characters

Add Comment