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taken from the Australian Family Physician

Normal foreskin anatomy
At birth, the inner layer of the prepuce is firmly adherent to the glans and is unable to be retracted at all. These adhesions are formed early in foetal development and serve to protect the developing glans.3 Separation of these adhesions occurs slowly over the next few years and there is great variability in the timing of this event. It has been classically stated that the foreskin should be fully retractable by the age of three years. However, this can occur as early as the first few months in some boys and not until 9 or 10 years in others.4 Almost all the perceived foreskin problems in young boys relate to the existence of subpreputial adhesion.

Common foreskin related complaints
Phimosis
The term phimosis is broadly regarded as describing a foreskin that is unable to retract. However, it is very important to distinguish between true pathologic phimosis from the normal anatomic situation where the infantile adhesions have not yet separated. In the latter situation, the tip of the foreskin is supple and unscarred and is likely to retract normally and fully in time (Figure 1).

True pathologic phimosis occurs when fibrosis, induration and scarring occur in the tip of the foreskin usually secondary to inflammation or trauma (Figure 2). Phimosis may also be due to lichen sclerosus et atrophicus.5 6

Ballooning
Ballooning refers to the swelling of the subpreputial area as urine becomes temporarily trapped under the foreskin during micturition. This probably occurs as a result of the stream being diverted by the adhesions. This phenomenon is not pathologic, usually causes no distress or discomfort to the boy and generally requires no treatment.

Smegma collections
Smegma is a creamy yellow sebaceous material that is secreted by the glans and often accumulates in clumps under the foreskin. These are often mistaken for cysts or pus collections, but require no treatment and will release once the foreskin retracts naturally.

Balanitis
Mild inflammatory changes with redness and some discomfort are often encountered in young boys, particularly while still in nappies, as a result of ammonical dermatitis (Figure 3). True balanitis or posthitis is usually staphylococcal in origin and responds well to simple cleaning and appropriate oral antibiotics.

Management
Normal foreskin
No attempt should be made to retract a foreskin in a child unless significant separation of the subpreputial adhesions has occurred. Failure to observe this basic rule may result in tearing with subsequent fibrosis and consequent true phimosis. However, once the foreskin is able to be retracted, this should be performed every time bathing occurs and the penis cleaned as part of normal male hygiene.

Penile cancer and sexually transmitted diseases have been reported as occurring more commonly in uncircumcised adults.7,8 However, it seems illogical in the extreme to advocate circumcision to prevent these afflictions. Penile hygiene and safe sex education are likely to be far more effective in this pursuit.

Mild redness of the foreskin requires only cleaning., while significant ammonical dermatitis may require some form of barrier cream.

Ballooning and smegma collection require no treatment, unless they are responsible for specific symptoms.

Andy, if you are concerned about the redness, see your pediatrician. However, if he/she tells you to retract it forcefully without current complications present, I would run and never see him again. The foreskin naturally retracts on it's own then normal cleaning is required.