Natural (uncircumcised)
This is the normal appearance of an infant who is uncircumcised. The foreskin will not yet retract (pull back) to see the head of the penis. This is called “physiologic phimosis”, and is the normal situation.
The foreskin begins to pull back naturally, and the head of the penis can be seen in most boys by approximately age 3 years. However, the inner aspect of the foreskin may still adhere to the head of the penis and not fully separate to show the entire head for several more years.
This process of retraction and eventual separation of the inside of the foreskin from the head takes longer in some boys. Unless the boy has symptoms, this is still physiologic phimosis and is considered to be normal all the way until the end of puberty.
This means that it is not necessary for parents to retract the foreskin of their sons to clean inside of it. Nor should parents try to pull back the foreskin to help it become retractable. There is no need for care-givers to manipulate the foreskin in boys who are not circumcised. Occasionally, trying to retract foreskin that is not yet ready to pull back causes problems, such as paraphimosis, that is discussed below!
Smegma
Part of the natural process of separating the inside of the foreskin from the head is the build-up of dead skin and oils between them, creating whitish balls called “smegma”. Again, this is natural, and these do not need to be scrubbed away.
Whitish smegma on the inside of the foreskin.
Circumcised Penis
Here is a normal infant after newborn circumcision. The arrow indicates the line going around the penis where the circumcision was done. The head of the penis may have a purplish color initially after circumcision, which is normal.
Growth charts show the length of the penis does not change much during childhood until hormones stimulate it at puberty. The stretched length in infants averages 4cm (1.5 inches), while the same measurement in 10 year olds is only about 6cm (2.4 inches).
At approximately 6 months of age, normal fat in healthy boys around the base of the penis may make the penis look short, or even hide it completely. Parents and primary care providers may think the skin was left too long during the circumcision. However, when the fat is pushed away, the full size of the penis is seen.
This boy had newborn circumcision and the parents were concerned not enough skin was removed, since they did not see the penis. When the normal fat pad was pushed back, the true size of the penis was revealed. The skin was the correct length, and no revision of the circumcision was needed. This appearance changes as toddlers begin to shed this chubbiness, and certainly goes away by puberty when the penis grows to adult size.
Parents of older boys who have not yet begun puberty sometimes worry their son has a small penis, especially if they are chubby since that gives the same appearance of a hidden penis.