Q: I have two sons, aged 7 years and 2 years. My younger son had some infection and problems passing urine. When we approached the doctor, he advised us that the skin covering the penis was not opening. The doctor advised Sofradex to be applied regularly by pushing back the skin. After about 3 months he again had this problem and this time as we had moved to another city, we consulted a child specialist here who again asked us to use Sofradex but informed us that as the opening was too small for urine to flow it was ballooning and the urine discharge was slow. He further suggested that we might have to go for surgery if it does not get sorted with applying the cream. We used to visit the doctor daily for applying the cream and on one occasion he used an instrument (like a scissors) and increased the opening a bit, although it bled for a while the urine discharge has thereafter become much faster/quicker. He has advised us to continue to apply the cream twice every day by pushing the skin behind the head. My son being only 2 years old does not allow this and is crying most of the times, may be because of the pain. My elder son had cold in the past 2 days and we took him to the same doctor who had a look at his penis and said he too was having the same problem. It came as a surprise to us as he never complained of any pain in the penis etc. I am seeking your advice on what is the best way to overcome this problem?

A:Your children appear to have 'phimosis'. I put the diagnosis in quotes because a non-retractable foreskin is physiologic and normal at 2 years of age. You must NOT forcefully pull the skin back and certainly NOT allow any instrumentation to stretch it. These procedures cause much pain and do more harm than good. You should gently pull the skin for hygiene purposes and allow it to separate naturally, which it does till 5-7 years of age. In case there is local infection then your child will need a small operation called circumcision in which the foreskin is removed.