By Jennifer Coais, M.D. © 2011
They are the occasional delight of growing up as an intact boy.
I always have to giggle when I hear stories about pediatricians who ignorantly warn parents that their son’s ballooning penis is now prone to infection or other complications and must be treated promptly. This makes me laugh primarily because my own son, who is now three, delights in this normal developmental process every single day, and has done so since he was around ten months of age. In fact, I'd venture to say that most intact boys will enjoy the fun of making penis balloons at some point or another during their childhood, whether his parents realize it or not. Honestly, though, I don’t know whether to laugh or cry because these types of statements from medical doctors are not only ridiculously false, but they speak to a serious delinquency in the basic understanding of the intact penis. This is a topic I revisit time and time again with parents and it seems that, despite all the information now available, parents are still being fear-mongered into unnecessary, harmful treatments and/or prepuce amputations on the grounds of one of the most normal, natural phases of the development of the intact child: ballooning.
What is Ballooning?
Ballooning occurs when the foreskin begins to separate or has separated from the glans (head) of the penis but the foreskin opening remains narrow. As a boy urinates the urine will fill the empty space between the foreskin and glans, and create a ballooning effect. As the urine escapes through the narrow opening the balloon will slowly decrease in size (deflate) and the foreskin will return to its normal state.
ballooning penis of a two year old male child
What Parents Need to Know
1. As discussed in Basic Care of the Intact Child
, the foreskin is fused to the head of the penis at birth by a thin membrane known as synechia. At some point this natural adhesion will begin to release, allowing the foreskin to differentiate from the glans. This can happen at any age, but is quite common in toddlers and in early childhood. Keep in mind that just because the foreskin has separated from the glans, it is not an indication that the foreskin can be retracted
. In order for retraction to take place a second process must occur, a widening of the foreskin opening.
The opening of the foreskin generally remains very tight and non-elastic during infancy and early childhood. This serves to protect
the developing penis from feces, bacteria, viruses, and harmful pathogens. Essentially, the opening acts as a sphincter and only relaxes to allow urine to pass. With the release of hormones, predominantly during puberty, the tissues of the foreskin will become more elastic and the opening will widen. Naturally, when the foreskin opening widens in later childhood, ballooning that may have once occurred no longer happens as the urine stream is unobstructed by the once narrower opening. As noted in The Phony Phimosis Diagnosis
, retraction of the foreskin is a sexual function and usually occurs after the age of ten.
Full retraction of the foreskin may only take place at the end of puberty -- this is normal. Ballooning may occur for many years during toddler/childhood until a boy has the hormones of puberty kick in.
2. Ballooning actually serves a few important purposes in the development of the intact penis. The body, in fact, knows exactly what it is doing! First
, because separation of the foreskin often occurs many years before the opening widens, ballooning serves to rinse out any expired skin cells from underneath the foreskin. It’s nature’s perfect way of keeping things tidy and ridding the body of old skin cells. Second
, this process serves to maintain a differentiation between the glans and foreskin during the years in which a boy remains non-retractable. Ballooning serves to gently, and over time, stretch the two organs into their own separate space, discouraging a re-adhesion of the foreskin to the glans (re-adhesion is something we commonly see in boys who have had their foreskin amputated via circumcision surgery - the body attempts to heal itself with the tissues it has left, and there is no natural ballooning process that can take place, because no foreskin any longer exists). Third
, ballooning aids in helping the entire foreskin separate from the glans over a normal duration of years. Typically only a small portion of the foreskin will separate from the glans at a time, and the pressure of the urine will slowly release other areas of the foreskin, little by little. Of course, just as every girl experiences a unique separation of her prepuce ("clitoral hood") from the glans of her clitoris, every boy experiences separation unique to his foreskin and the glans of his penis. It may happen all at once, almost overnight, or over many years - all variations are normal. Nature makes very few mistakes, and this ballooning phase, when it occurs, is not only normal, but beneficial to the overall development of the intact child.
In this ballooning child, you can see that the prepuce (foreskin) has separated on one side from the glans where ballooning is taking place, while still remaining tightly adhered on the other side. This is normal, as the prepuce typically takes several weeks, months or even years to separate completely.
3. Ballooning will not cause infection, in fact, it is quite the opposite. As mentioned above, urine serves to wash out dead skin cells. Urine is sterile, and a narrow foreskin opening prevents fecal bacteria, a primary cause of urinary tract infections (UTIs)
, from entering the urethral opening, while urine flushes out anything that potentially enters or meets the tip of the penis. Urine does not linger or fester under the foreskin - it exits, and takes with it the body's natural waste cells and any other irritants that have come into contact with the penis. For more about the ways that the foreskin serves to protect against UTIs, see this article.
4. At onset, ballooning may be accompanied by discomfort, itching, redness and/or swelling. Often, a boy’s foreskin will separate from the glans with few or no symptoms. However, in other cases a boy will experiences one or more of these symptoms at the onset of separation. Swelling and redness are common because the foreskin is very vascular and, like the lips of the mouth when stretched or irritated, it tends to react to small traumas in this way. Some boys will experience discomfort as urine stings the freshly separated glans that is now exposed for the very first time in this child's life. This discomfort may be acute (like a quick sting) or more pronounced, depending on the situation, and is commonly mistaken for a UTI because the pain only occurs when the boy is urinating, and almost always when a child is very young and the glans has separated for the first time. The good news is that the freshly separated glans smooths over within a few days and the stinging with urination will cease. Sometimes parents can ask their son to urinate in a bucket or bathtub of water as a way to ease this temporary discomfort; however, this will not work for a many boys as the foreskin opening is simply too small to allow the water to dilute the urine prior to contact with the glans. [Note that the intense pain and stinging that would occur if the foreskin is torn and cut from the glans in infancy due to circumcision is much more intense than this natural, gentle separation of the two organs with normal development.]
After ballooning, the penis returns to its previous state.
Premature separation caused by forced retraction or manipulation of the foreskin by a care provider can make for a very painful separation experience later.
After forced retraction occurs (especially if it has been a repeated event) the foreskin typically re-adheres to the glans in an effort to heal itself. Tiny tears and areas of scar tissue are left from forced retraction, that are then torn and cause an increase in pain when natural separation occurs months to years later. This is one of the many reasons that no one
should ever manipulate, "mess with," or retract an intact baby or child.
Foreign microbodies on the hands of well-meaning care providers can change the pH of the genitals when introduced into the penis during forcible retraction. This change in pH may increase the likelihood of yeast spore overgrowth. Yeast infection has been known to instigate premature and painful separation episodes, so parents should be watchful for any symptoms that could indicate a yeast infection (creamy discharge, itchiness, bright red spots around the groin or anus). As with girls, yeast infection is most common during the diaper wearing years, or after exposure to chlorinated swimming pools or other harsh chemicals that interfere with the body's natural pH. Yeast (naturally present on all human beings) is only problematic when it gets out of hand and is easily treated with acidophilus and other medications. Check out Basic Care of the Intact Child
for more about yeast. Symptoms of normal separation can come and go throughout childhood, as the foreskin continues to differentiate itself from the glans. These symptoms resolve themselves, are not cause for concern or doctor's visits, and do not require special medical attention. For more about this subject in particular, please refer also to Painful Urination During Prepuce Separation
Hopefully, as circumcision rates in the U.S. continue to plummet, information on the normal penis and its natural development will become as commonplace as it is in the rest of the intact world. For now, we can be thankful that there are research based locations like peaceful parenting
, where physicians, educators, and parents can come together with experiences and informed insight. I can remember how worried and uncertain I felt when my first son started to balloon. At the time I knew little about this normal phase of development. Thankfully, I had a fantastic network of well-educated mothers and professionals to help me decipher what was happening, and can now share this important information with others. Don't be afraid to speak up as well, you may be the only one who ever does in your circle of influence.
Extreme Ballooning in the Intact Child: This, too, is normal
Intact Care Resource Page
Also by Dr. Jennifer Coias: