Overview of Penile Adhesions in Babies and Young Boys

Father with his newborn child

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Penile adhesions and skin bridges can occur in both circumcised and uncircumcised boys. They occur when the skin surrounding the penis adheres to the head of the penis or the glans.

Types of Penile Adhesions

Adhesions form when the skin on the shaft of the penis attaches itself to the glans (the bulb-shaped head of the penis). Adhesions are especially common in baby boys who appear to have a "hidden penis," in which the entire penis seems to disappear as the baby puts on fat in the pubic area. There are three types of penile adhesions:

  • Glandular adhesions: These adhesions occur when the skin that's attached to the glans covers the coronal margin—the purple line that separates the glans from the shaft of the penis.
  • Penile skin bridges: These adhesions are thicker, potentially permanent, and may need to be corrected surgically.
  • Cicatrix: This type of adhesion, which is basically scar tissue, can develop when the penis drops back into the pubic fat pad and the surgical area contracts, essentially trapping the penis and making it impossible to expose the glans at all.

Symptoms

While penile adhesions are usually visible to the naked eye, they may have no other symptoms and often do not cause any type of pain. Consequently, the penis may look like it's buried in the pubic fat pad. If the adhesions persist, the boy may feel a tugging sensation during erections as he continues to grow.

In uncircumcised boys, sometimes oil and dead skin cells can get trapped under the foreskin and cause a white discharge called smegma. Although this discharge can look like pus, it's not an infection nor is it a sign that anything is wrong. Still, it's a good idea to get it evaluated by your pediatrician if it persists.

Causes

There are a variety of reasons why penile adhesions and skin bridges can occur in children who are circumcised and uncircumcised.

Uncircumcised Penises

When a penis is not circumcised, the foreskin may adhere to the glans, causing an adhesion if the foreskin is not retracted or pulled back periodically once the foreskin has naturally released from the glans. Adhesions may also occur when the skin of the shaft is pushed forward by a large pubic fat pad.

It's normal and expected for the foreskin of an uncircumcised newborn to be attached to the head of the penis—this is not considered an adhesion. Usually, the foreskin isn't able to be retracted until the child is several years old.

Caregivers should never attempt to retract or force back an uncircumcised baby's or young child's foreskin. As the child gets older, the foreskin will naturally begin to separate from the head of the penis, allowing for safe retraction. If it does not, your child's pediatrician may look for signs of a penile adhesion.

If the foreskin tightens again later in life, it may be an issue. The tightening could be the result of skin irritations from chronic adhesions, which requires an evaluation by your child's doctor.

Circumcised Penises

Circumcision is not medically necessary for baby boys, but some parents may choose to have their infant circumcised, a procedure in which the skin around the tip of the penis, known as the foreskin, is surgically removed. If done, the procedure is performed in the hospital soon after birth or, in the case of Jewish families, in a religious ceremony known as brit milah or bris about eight days after birth.

In either case, as long as the circumcision is performed by a trained professional, the procedure is relatively low risk. There is, however, the risk of developing penile adhesions after circumcision.

Adhesions can develop in circumcised boys if an excess of the foreskin is left behind after circumcision. They also can occur when the remaining skin is not retracted or pulled back frequently enough during circumcision care.

Adhesions can also develop as the circumcised baby develops more fat in the pubic area. As this happens, the skin may become irritated and stick to the surrounding tissues. When this occurs, the penis can appear trapped or like it disappears in the skin or fat pad.

Diagnosis

Usually, penile adhesions are benign and cause no pain or discomfort. In fact, you may not even notice them until your child's doctor points them out at a routine doctor's visit.

If you do notice what looks like an adhesion while changing your baby's diaper, you may want to call your doctor's office to schedule an appointment. While penile adhesions are typically not an emergency, you do need to have them evaluated by your child's doctor. This way, you can begin treatment right away and prevent the skin from adhering further.

Treatment

When a baby develops a granular adhesion, it's likely your doctor will recommend simply applying petroleum jelly to keep it soft and otherwise leaving it alone. Eventually, a white substance called smegma, a mix of dead skin cells and secretions from oil glands, will begin to form under the stuck skin, gently helping it to separate from the head of the penis.

This substance, along with spontaneous erections, will eventually take care of the adhesion. Smegma may look a bit like pus, so don't be alarmed when you see it but do call your pediatrician if you aren't sure.

The other two types of penile adhesions require more involved treatments. Skin bridges usually can be surgically separated in an outpatient procedure. In extreme cases in circumcised boys, the circumcision may have to be redone, which is called a circumcision revision.

To treat a cicatrix, which is sometimes called a trapped penis, your child's pediatrician may prescribe a corticosteroid, such as betamethasone. Research shows this can be an effective way to avoid surgery, as was the case for 11 of 14 baby boys in one small study who were treated with betamethasone three times a day for three weeks.

The medication softened the cicatrix enough to easily release it with gentle retraction, or pulling back, of the foreskin. Another option, which can be performed in the office with local anesthesia, is to lightly stretch the skin and follow up with the cream. This retracting action should never be performed at home.

The results of this combination therapy have shown that babies often don't require follow-up treatment, unlike using the cream alone. Clearly, these methods are the preferred choice compared with having to go through a revised circumcision. But in some cases, surgery will still be required.

A Word From Verywell

When dealing with penile adhesions, parents may be worried that their babies will have to undergo additional treatments or surgeries. But in most cases, the complication is not serious and the condition will heal with minor, non-surgical interventions. Consult your doctor to find out all available treatment options.

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  1. Palmer J, et. al. The use of betamethasone to manage the trapped penis following neonatal circumcisionJ Urol. 2005;174(4 Pt 2):1577-8. doi:10.1016/S0022-5347(01)68726-3

  2. Alpert SA, Ching CB, Dajusta DG, McLeod DJ, Fuchs ME, Jayanthi VR. Combination treatment for cicatrix after neonatal circumcision: An office-based solution to a challenging problem. J Pediatr Urol. 2018;14(5):471-475. doi:10.1016/j.jpurol.2018.05.022

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