My son is nearly eight years old and his penis has only a small hole and the foreskin cannot be pushed up.

A paediatrician at one Bangkok hospital prescribed Hytisone 1% cream (hydrocortisone acetate) twice a day. After about one month the foreskin could be pushed up, but a paediatrician at another hospital said we should stop using the cream.

However, as soon as we stopped, the skin became tight again. Is it safe to keep applying the cream or is it useful only in the short term? Do you think we should wait and see or we should have our son circumcised now?

I know somebody who had the operation done at the age of 27, when he was already sexually active and it was painful.

Can you recommend a good doctor? Should we consult a paediatric urologist?

Worried Parents in Bangkok

Dear Parents,

Your child has a condition known as phimosis - the inability to retract the foreskin over the glans penis. Newborn infants have this condition with only a small opening allowing urination. The foreskin usually becomes retractable somewhere between three and 10 years of age, but it is not uncommon for it to remain unretractable for life. If it causes urinary obstruction, it becomes an emergency.

If the flow of urine is not restricted, treatment is optional and controversial.

Trying to force retraction can cause damage, scarring and more severe contraction.

Steroid creams may release the adhesions between the glans and the foreskin, but should only be used for a short time. You should not continue to use this cream.

Although many would disagree with me, I would advise circumcision, by a paediatric urologist, under general anaesthesia. It is thought to improve hygiene and lower the risk of HIV transmission and it reduces the incidence of penile cancer to near zero. The earlier it is done, the easier on the child.

Discuss the risks and benefits of each option with your doctor, and if you're still uncertain, don't hesitate to get another opinion.

Hello Dr Mike,

Please let me, and other readers also, know how harmful mobile phones can be.

I have been talking on my mobile phone with my friends for between two and four hours every day over the last six months.

In the beginning I didn't feel anything but now I can't talk for more than 20 minutes, because I experience a headache. I hear similar complaints from my friends.

Even when I use a hands-free device like Bluetooth or a headphone, I have the same symptoms after only after one hour or so but I can't stay away from my mobile phone.

Is this a warning of a serious problem or I should talk less?

Ahmed

Dear Ahmed,

Mobile phones emit low-energy electromagnetic waves and have been a topic of concern for decades. So far, with billions of users, we haven't seen any outbreaks of diseases that we can attribute to this use, but no one knows for sure and lots of people are worried, scientists as well as the general public.

The phone companies have a huge financial incentive to minimise the perception of risk, confusing the issue even further.

There have been studies showing that radiation energy from mobile phones can damage human cells in a laboratory setting, but this hasn't been proven to cause disease in real life.

The Independent Experts Group on Mobile Phones (the Stewart Report) concluded that while the phones can damage cells in the lab, they do not cause human illness.

A recent study, published in the journal Epidemiology, concluded that long-term mobile users had an increase in the incidence of acoustic neuroma, a benign brain tumour, on the side which the phone was held.

So what does this all mean? Well, most of us are not going to throw out our mobile phones, especially here in Bangkok, but it does make sense to take some basic precautions. Talk on your mobile less. Use landlines when available, keep mobile conversations short, send text messages when feasible and consider a headset.

It's probably not a good idea to give mobile phones to young children.

By Dr mike miller

The doctor can be contacted at dr_mike_bkk@yahoo.com.