Are Penile Adhesions Evidence of a 'Bad Circumcision'?

How to Approach the Different Types and Treatment of Penile Adhesions

Doctor examining a newborn baby
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Q. My infant son is now 17 days old. He was circumcised before leaving the hospital. It has now totally healed but while bathing him we noticed about 75% of the skin immediately next to the glans has healed to the edge of the glans.

My sister-in-law (an RN) said we were supposed to "pull" the skin of the shaft down away from the glans during the healing process. However, our pediatrician said the circumcision was fine and to just leave it alone.

Is this normal? Was this a bad circumcision and should we attempt to pull the skin away from the glans or will it separate on it's own?

-Marshall, Harrisburg, NC

A. What you are describing isn't really normal, but is a common complication after a circumcision.

In a situation like this, penile adhesions form when the skin on the shaft of the penis attaches itself to the glans or head of the penis. In extreme cases, it can look like the child was never even circumcised, leading parents to believe that the child had a 'bad circumcision.'

What is a Penile Adhesion?

Adhesions are especially common in children who have a 'hidden penis,' in which the whole penis seems to disappear inside a large fat pad around their penis. Adhesions occur when foreskin that remains after a circumcision begins to stick to the tip of the penis.

Adhesions can develop due to excess residual foreskin after circumcision or due to the development of more fat in the baby's pubic area.

 If the skin is attached only on the very base of the glans, then your child has a very mild case of penile adhesions and you can likely just leave it alone. It should eventually separate, especially once your child becomes older, and anyway, forcing it apart would be painful. 

Eventually, you may notice a white substance (smegma) coming out and forcing these adhesions apart on their own.

If this happens, you can usually try to gently separate the adhesions and apply vaseline to the irritated area that has separated so that it doesn't become reattached.

Treatment Options

Treatment for penile adhesions depends on the extent and type of adhesion exhibited in your baby. The 3 types of penile adhesions are:

  • Glanular adhesions. In this case you may not be able to see the purple line that separates the glans from the shaft of the penis because the shaft skin has adhered to the glans. When left alone this type of adhesion tends to resolve on its own. 
  • Penile skin bridges. This type of adhesion is a thicker, more permanent attachment that can't be separated unless the treatment involves some form of surgery.
  • Cicatrix. When the penis drops back into the pubic fat pad and the surgical area contracts, the penis is essentially trapped and cant pull apart from the glans. Cicatrix can be treated with a topical steroid cream that your pediatrician will prescribe. If the steroid cream doesn't work, then surgery may also be necessary in this case.

    Your child's doctor will determine what type of penile adhesion is at play and discuss with you the treatment options best suited for your son.

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