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Tuesday, November 07, 2006

Penis Pain

Dear Lisa,

Why would my son complain of his penis hurting or feeling weird in the morning only? He is 8.

“Hurting in the Morning”

Dear “Hurting in the Morning”,

It is common for the skin around the penis to become irritated. Scented soaps, touching the area, contamination with stool and foreign bodies in the area are all potential sources of irritation. (1) Mild irritations without evidence of redness, swelling or infection usually go away on their own if the offending irritant is removed and avoided. If the penis appears red or swollen or if your son has complaints of discomfort with urinating then medical attention is needed. In such cases Balanitis or an inflammation of the penis and foreskin may be present.

Balanitis is more common in uncircumcised boys, in children with redundant foreskin(extra foreskin present around the penis) and in children with Phimosis. (1) Symptoms of Balanitis include painful urination, difficulty voiding, and redness and swelling of the penis. In some cases a secondary skin infection can occur.

Soaking the child in a tub of warm water with a couple of tablespoons of salt can help soothe the area. Typically cleansing the area, keeping the area dry, good hygiene and the application of an antibiotic ointment are recommended to remedy the situation. (1) Your Doctor may need to take a urine sample and a sample of penile discharge in order to determine if there is a secondary infection causing the inflammation.

Phimosis occurs when the preputial opening of the foreskin of an uncircumcised boy is narrowed. Because of this narrowing, the foreskin becomes tight and canot be retracted or pulled back. During the first year of life the foreskin of an uncircumcised child is not expected to retract and should not be forced to be pulled back. (2) As the child ages the foreskin gradually gains the ability to be pulled back. It is not until 3 to 4 years old that an uncircumcised boy will be able to retract the foreskin. Inability to retract the foreskin after this age should be evaluated by a physician since there is an increased risk of Balanitis in children with Phimosis.

Urethritis can also cause pain or discomfort of the penis. Urethritis is an inflammation of the urethra which is the small tube that connects the floor of the bladder to the exterior of the body. In young children urethritis is caused by fecal contamination, physical irritation or chemical irritation. (1) For older, sexually active children, Urethritis can be caused by sexually transmitted diseases. The symptoms of Urethritis include tenderness of the meatal opening which is located at the tip of the penis, itchiness and diminished urinary stream.

Penile adhesions are a potential source of discomfort and often occur in circumcised and uncircumcised boys. An Adhesion is an abnormal connection between tissues and tends to occur at a site of previous inflammation. Tiny adhesions can occur between remaining prepuce or redundant foreskin and the glans penis of a circumcised child. (1) Adhesions can also occur between the glans penis and the prepuce in an uncircumcised boy.

Most mild adhesions do not need intervention because they take care of themselves and naturally separate as a child gets older. (1) This natural separation of adhesions occurs as a child grows and through repeated erections of the penis, which are normal responses.

If your son has redness, swelling or discharge from his penis, pain with urination or change in his urinary stream he should be evaluated by a Physician. If his penis appears normal and he has no other complaints throughout the rest of the day the symptoms he is describing may be due to normal separation of tiny adhesions. A change in the type of soap used, frequent use of bubble baths or recent diarrhea that may have contaminated the area are other factors that should be considered.

Many times touching and handling of the area can lead to irritation. Hand washing with warm soapy water is recommended if this is the case.

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:540,862.
(2) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company.1994:127.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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