Foreskin care: Hygiene, importance of counselling, and management of common complications

Objective: To highlight the escalating need for enhanced education on foreskin care among patients and health care providers, particularly as neonatal circumcision rates decline.

Sources of information: This review is based on findings from a MEDLINE database search of the literature on care of the penile foreskin, foreskin complications, and their management. Articles were reviewed for relevance and quality of evidence was provided with the level of evidence in parentheses throughout the review. When available, evidence from systematic reviews, relevant clinical guidelines, and randomized controlled trials were incorporated. In the absence of high-level evidence, expert opinion on the topic was provided.

Main message: As neonatal circumcision rates decline, the importance of educating patients on proper foreskin care becomes increasingly vital to avoid complications later in life. This review highlights the role of primary care providers as crucial resources for patient education. Based on the available evidence, the following are reviewed: rates of circumcision in Canada and current circumcision practices; recommendations for routine foreskin care; and common preputial complications including urinary tract infections, pathologic phimosis, balanoposthitis, penile lichen sclerosus (balanitis xerotica obliterans), and penile cancer.

Conclusion: This review explored current trends and practices in circumcision, routine foreskin care, and common complications seen in uncircumcised patients. There is a need for education that extends to allied health professionals working with patients in health care facilities. Primary care providers have an important role in facilitating education for patients and providing recommendations on proper penile hygiene.

Author/s:

Cale Leeson, Humberto Vigil, Luke Witherspoon