1 Does your child have a pain in the penis only when passing urine?

2 Does your child have a painful scrotum?

3 Does your child have a painless swelling in the scrotum?

4 Do one or both of the following apply to the swelling?

• It is smaller or absent first thing in the morning
• It increases in size when your child cries or coughs

5 Does the skin of the scrotum look red and inflamed?

6 Does one or both of the testes appear to be absent from your child's scrotum?

7 Is your child cold or feeling anxious?

8 Does your child have soreness, irritation, or redness at the tip of the penis?

9 Has the foreskin been pulled back, and are you unable to replace it?

10 Are you concerned that your child's foreskin may be too tight?

11 Is your child over 4 years old, and/or does the foreskin balloon when he urinates?

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go to Urinary problems

13 Emergency! Call an ambulance

Possible cause Torsion of the testis, in which one of the testes is twisted within the scrotum, cutting off the blood supply, is a possibility. This condition can occur after an injury but often develops spontaneously during sleep.

Action Urgent surgery to untwist the testis and restore its blood supply is essential. During surgery, both testes will be anchored within the scrotum to prevent the condition recurring.

14 See your doctor within 24 hours

Possible cause Your child probably has a hernia, in which a loop of intestine bulges through a weak area in the abdominal wall. This condition is commonest in babies.

Action Your doctor will examine your child. If the diagnosis is confirmed, the hernia should be repaired to prevent the possibility of a loop of intestine becoming trapped. The operation is carried out under general anaesthetic.

15 See your doctor within 24 hours

Possible cause and action Your child may have a harmless collection of fluid around the testis, known as a hydrocele. This condition is especially common in newborn babies and usually disappears by the time the child is 6 months old. Your doctor may arrange for your child to have an ultrasound scan to exclude damage to the testis or an underlying disorder. Most hydroceles in children disappear without treatment.

16

Possible causes The skin of the scrotum may be inflamed as the result of an allergic reaction to a detergent used to wash your child's nappies or underwear or because of a fungal infection. Consult your doctor.

Action Your doctor will examine your son and prescribe a corticosteroid cream for an allergy or an antifungal cream for a fungal infection. If an allergy is diagnosed, use a non-biological detergent and rinse clothes thoroughly.

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Possible cause and action Muscles attached to the testes draw them up into the groin for protection when it is cold and during times of stress. If your child relaxes in a warm bath, you should be able to feel the testes again. If you cannot feel both testes, consult your doctor.

18

Possible cause One or both of your child's testes may have failed to descend fully into the scrotum. Consult your doctor.

Action Your doctor will examine your child. If your child's testes have not yet descended, your doctor will re-examine him regularly. In most cases, the testes descend on their own, usually within a year of birth. However, if they have not descended by 1-2 years of age, an operation will be needed to draw the testes into the scrotum to preserve fertility.

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Possible causes Balanitis, in which the foreskin is inflamed due to infection or chemical irritation, is likely.

Action Make sure your son's penis and foreskin are cleaned frequently using only water. If the symptoms are no better within 48 hours, consult your doctor. He or she may prescribe an antibiotic or antifungal cream. In future, avoid scented soaps and using biological detergents for clothes washing. If the condition recurs frequently, your doctor may recommend circumcision.

20 Emergency! Call an ambulance

Possible cause A foreskin that cannot be replaced can damage the blood supply to the head of the penis if not treated urgently.

Action While you are waiting for help, apply an ice pack to reduce the swelling. In hospital, the doctor will try to replace the foreskin, but it may be necessary to make a small cut in the foreskin under local anaesthetic. Prompt circumcision is usually needed to prevent the problem from recurring.

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Possible cause Your child may have phimosis, in which the opening in the foreskin is too small. This can impede urine flow and makes recurrent infection of the head of the penis more likely. Consult your doctor.

Action Do not use force in an attempt to retract the foreskin because this may lead to further narrowing. Your doctor will examine your child to confirm the diagnosis and ensure there is no associated infection. He or she may recommend circumcision.

22

Possible cause and action The foreskin cannot normally be retracted in boys under a year old. As a boy grows older, the foreskin gradually becomes free of the head of the penis and it should then be possible to retract it. Trying to force the foreskin to retract may cause serious damage and may make the problem worse. Consult your doctor if you remain concerned or if your son's foreskin still cannot be retracted by the age of 5. Rarely your doctor may recommend circumcision.

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Consult your doctor if you are unable to make a diagnosis from this chart.