Problematic Boy-Bits (Part 2)
Hello again all of you parents of boys out there!
I know you have all been so EAGERLY awaiting the sequel to last week’s “What can go wrong with a ding-dong” article, and here it is…
“How we fix things wonky boy-bits!”
(sorry, I know… terrible.)
You might remember from last week, these are the problems we have been discussing.
- Phimosis and paraphimosis (and ballooning of the foreskin)
- Undescended testes and retractile testes
- Testicular torsion (torted testis)
We dealt with the first 3 topics last week – so today, the next 4 issues on the list.
Circumcision is an operation to remove the foreskin of the penis. It can be done for medical reasons (eg phimosis, paraphimosis or recurrent urinary tract infections) or sometimes it is done because of parent’s choice.
I do not have a strong opinion either way about elective (non-medically indicated) circumcision, but I do have a very strong opinion about HOW it is done when it is done. When parents ask me about ‘Plasti-bell’ circumcision, I DO NOT recommend it. In my opinion, circumcisions should be done under an anaesthetic, by a skilled paediatric surgeon, and professionally trained staff who are on hand to manage any potential post operative complications as well as to administer adequate pain relief medication.
- Testicular torsion (torted testis)
A testicular torsion is a sudden and often extremely painful situation, where the spermatic cord (the blood vessels that connect the testicle to the body) twists upon itself and cuts off the blood supply. It is a surgical emergency – meaning that if it occurs, you need to get your child to hospital as quickly as possible for surgery to preserve/save the affected testicle (ie call an ambulance). Even if the spermatic cord spontaneously untwists itself (which it can possibly do), the child is at much higher risk of it happening again, so medical attention is still warranted. Other symptoms might include: swelling, tummy pain, nausea, vomiting, or one testicle appearing to sit higher than the other.
This condition can occur in boys of any age, but is most common in 12-18 year olds. It can be triggered by exercise or an injury, but often no cause is found. Boys who have a condition called a “bell clapper deformity” are at higher risk of torsion. This is when the testes, which are usually attached to the scrotum, are not attached – meaning they can move around and twist.
A hydrocoele is a collection of fluid inside a sac next to or around the testicle inside the scrotum. It is really common, makes the testicle look swollen and is usually not painful. Most hydrocoeles self-resolve and shrink (without need for any medical intervention) within a few months of birth. No specific tests are done to diagnose a hydrocoele but the doctor examining your child might shine a torch against the lump, to see if it glows – this is called ‘transillumination’ (indicating it is full of fluid, not a solid testicle). Hydrocoeles can happen on one or both sides. If they haven’t disappeared by 18-24 months of age, usually an operation (that is the same as an operation for an inguinal hernia) is considered to correct it.
A hypospadias is an abnormality of the penis, where the opening of the urethra (the tube that urine is passed out of) is not in the right place. Normally the urethra opening is on the tip of the penis, but in hypospadias,
- The opening is instead on the underside of the penis
- The penis has an abnormal curve (called a “chordee”)
- Part of the foreskin might be missing (usually again on the underside).
In cases of mild hypospadias, no intervention is necessary. Otherwise, surgery is usually undertaken some time between 6-18 months of age with the aim of straightening the penis and making the hole (urethral opening) closer to the tip of the shaft (enabling the child to urinate straight and whilst standing up). It is advised NOT to circumcise the child prior to the surgery, as the foreskin is often needed to be used during the repair operation.
RED FLAGS – when you should definitely take your child to see a doctor
- If there is a dusky colour change in the penis or scrotum in the context of a paraphimosis
- Sudden onset, severe pain (even if the pain improves – seek urgent medical attention)
- If your child has a continuous erection that lasts longer than 4 hours
- If your child has his genitals caught in a zipper (this is more common than you think)
- If your child cannot pass urine
Now I think that is QUITE ENOUGH about male genitalia to last us a while!
Next week I promise something quite different!
Till, then, stay well,
For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/