The penis, the outer reproductive organ of the male, consists of two parts — the shaft and the head (called the glans). All boys are born with a foreskin, a layer of skin that covers the shaft and the glans. Some boys are circumcised, and the skin covering the glans is removed. Other boys are not circumcised, leaving skin that covers the tip of the penis.

In an uncircumcised boy, the foreskin will gradually begin to separate from the glans of the penis. As this occurs you may notice a white, cheesy material called smegma (consisting of skin cells that are shed throughout life) release between the layers of skin. You also may see white “pearls” develop under the fused layers of the foreskin and the glans. These are not signs of an infection or a cyst.

When the foreskin separates from the glans of the penis it can be pulled back (retracted) to expose the glans. Foreskin retraction may happen immediately after birth, or it may take several years. Some boys can retract their foreskin as early as age 5, but some may not be able to do this until their teenage years.

Retraction of the foreskin should not be forced. This may cause pain and bleeding and can lead to scarring and adhesions (where skin is stuck to skin).

As your son begins to toilet train, teach him how to retract his foreskin, this will get him used to this necessary step during urination. Eventually, the foreskin should be retracted far enough during urination to see the meatus (the hole where the urine comes from). This prevents urine from building up beneath the foreskin and possibly causing an infection.

As long as the foreskin doesn’t easily retract, only the outside needs to be cleaned. If the foreskin retracts a little, just clean the exposed area of the glans with water. Don’t use soap on this area, as it can irritate the skin. After cleaning, always gently pull the foreskin back over the glans of the penis.

As your child gets older and the foreskin has completely separated and retracts easily, begin to teach him to clean underneath it as he bathes. At puberty, your son should be taught the importance of cleaning beneath the foreskin as part of his daily hygiene routine.

When to call the doctor

If the foreskin becomes red, inflamed or painful, or if the hole where the urine comes from is narrowing and your child’s foreskin “balloons” when he urinates, notify your child’s doctor.