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Should Your Child See a Doctor?

Penis or Scrotum Symptoms

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Definition

  • Symptoms of the male genital area (penis or scrotum)
  • Injuries are not covered here

Symptoms

  • 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.

See more appropriate topic (instead of this one) if

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 a.m. and 4 p.m.) 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, questions about

Home Care Advice for Mild Penis or Scrotum Symptoms

Treatment for Mild Rash or Itching of Penis or Scrotum

Reassurance

  • 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.

Cleansing

  • Wash the area once with soap to remove any irritants.

Hydrocortisone cream

  • For itchy rashes, apply 1% hydrocortisone cream (no prescription needed) 2 times per day for a few days.

Antibiotic ointment

  • For any cuts, sores or scabs that look infected, apply an antibiotic ointment (no prescription needed) 2 times per day until seen.

Prevention

  • Teach your son that if his hands are dirty, to wash them before urinating.

Call your doctor if

  • Rash spreads or becomes worse
  • Rash lasts over 3 days
  • Fever occurs
  • Your child becomes worse

Advice for Foreskin Retraction Questions

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.

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.

Foreskin retraction

  • Begin gentle partial retraction at 1-2 years 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.

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.

Reposition

  • After cleansing, always pull the foreskin forward to its normal position.

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

Advice for Smegma Questions

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.

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.

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Adelman WP and Joffe A. The adolescent male genital examination: What’s normal and what’s not. Contemp Pediatr. 1999;16(7):76-92.
  2. Adelman WP and Joffe A. The adolescent with a painful scrotum. Contemp Pediatr. 2000;17(3):111-127.
  3. Brown MR, Cartwright PC, Snow BW. Common office problems in pediatric urology and gynecology. Pediatr Clin North Am. 1997; 44: 1091-116.
  4. Darville T. Genital warts. Pediatr Rev 1999;20:271-272.
  5. Gatti JM, Murphy JP. Acute testicular disorders. Pediatr Rev. 2008;29(7):235-242.
  6. Kadish H. Painful subject: Pinpointing the cause of acute scrotal swelling. Contemp Pediatr. 2001;18(5):95-101.
  7. Kaplan GW. Scrotal swelling in children. Pediatr Rev. 2000;21:311-314.
  8. Langer JC and Coplen DE. Circumcision and pediatric disorders of the penis. Pediatr Clin North Am. 1998; 45:801-812.
  9. Vohra S and Badlani G. Balantis and balanoposthitis. Urol Clin North Am. 1992;19:143.

Disclaimer

This information is not intended to 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. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 7/7/2011

Last Revised: 8/1/2011 3:43:16 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D. 

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