Birth through age 18 Introduction The genital organs are in a very immature stage physical development of boys 7 8 years development at birth. The growth and development continues through puberty and into adulthood. This page and the indexed articles provide information on that normal development.
Articles are indexed in chronological order. The Phony Phimosis Diagnosis” The normal growth and development of the prepuce of the human male has been greatly misunderstood both by the medical community and by the public. This misunderstanding has led to many unnecessary, contraindicated circumcisions being performed on young boys. Typically, when a baby boy is born, the prepuce is long with a narrow tip. 4,5 Retraction is not possible in the majority of infants because the narrow tip will not pass over the glans penis. Moreover, the inner mucosal surface of the prepuce is fused with the underlying mucosal surface of the glans penis.
The fusion of the foreskin to the underlying glans penis is often improperly called “adhesions. The fused foreskin and glans sometimes will separate by age 3-5, but usually this takes longer. As the infant matures into a boy and the boy into a man, a number of changes occur: The tip of the prepuce becomes wider, the tip seems to become shorter as the shaft of the penis grows. The membrane that bonds the inner surface of the prepuce with the glans penis spontaneously disintegrates and releases the prepuce to separate from the glans.
2 Normal foreskin at 15 months of age. Many medical doctors in the United States receive no training in the normal development of the prepuce. Thus they improperly diagnose a normal developmental condition as “phimosis. As noted above, a large number of medical doctors have not had the benefit of the information contained on this page, because it has not become part of the standard medical curriculum. Nor are they able to answer with accuracy when the prepuce should become retractable.
The prepuce contains muscle fibers that work to keep the tip closed when the child is not urinating. 1,9 This may cause parents and physicians to believe that the opening is smaller than it really is. Catzel explains how to examine a child’s prepuce correctly to avoid misdiagnosis. The false diagnosis of phimosis in boys is very common in the United States and the United Kingdom. Ballooning There is a phase of development during which some boys may experience “ballooning. Ballooning is the inflation of the prepuce during urination by the pressure of urine inside. This can occur if the inner layer of the prepuce is separating or has separated from the glans, which typically happens around three years of age, before the prepuce has become fully retractable.
The maturation of the penis may take years to complete. Each boy develops at his own rate. The maturation of the prepuce continues beyond puberty as described below. The appearance of the infant penis does not reflect on the appearance of the adult penis. Sexual development after puberty causes many changes, which include retractibility of the foreskin. Gairdner, a British pediatrician, observed 100 newborns and about 200 boys of varying ages through age 5. Gairdner also noted that the separation of the prepuce was incomplete at these ages and this incomplete separation is the cause of the non-retractabality.
He said the surfaces should not be torn apart because this causes bleeding and infection. Gairdner in 1949 had collected no data beyond age 5, which led some authors improperly to assume that circumcision was necessary if the prepuce was not retractable by that age. Gairdner’s figures on percentage of retractability, collected in the 1940s,4 are now known to be too high. 12 17,18 Unfortunately, many doctors still erroneously use these outmoded figures and this causes improper diagnosis of phimosis in normal boys and leads to unnecessary circumcisions. The normal development of the prepuce beyond age 5 was first documented by Jakob Øster, a Danish pediatrician, who published his work in 1968.
Neonatal circumcision is not practiced in Denmark, so all of the boys were intact. 6 to 17 years old from school year 1957-58 through 1964-65. A non-retractable prepuce was termed phimosis, and a prepuce that could be retracted with difficulty he called tight prepuce. He found that the percentage of boys with “phimosis” or “tight prepuce” steadily declined with increasing age. Gairdner’s claims that 90 percent are retractable at age five, Øster found that the 90 percent retractable stage is not reached until about age 16. Grogono, a school medical officer, observed that boys, with a non-retractile prepuce at age 11, have a fully retractile prepuce by age 14 or 15. Grogono further reported that the non-retractile prepuce caused no problems.
Kayaba, a Japanese doctor, recorded the findings on examination of 603 Japanese boys. 13 Kayaba classified the prepuce types into five categories. Kayaba noted a steady progression to increasing retractability with increasing age. Kayaba’s work refutes the findings of Gairdner and confirms the work of Øster.