Penile Adhesions After Circumcision

Common, Worrisome, and Easily Treated

Doctor examining a newborn baby
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Parents of newborn baby boys often choose to have their infants circumcised, a procedure in which the loose skin around the tip of the penis, the foreskin, is surgically removed. Typically it's done in the hospital soon after birth or, in the case of Jewish families, in a religious ceremony about eight days after birth.

In either case, as long as a circumcision is performed by a trained professional and the penis is cared for properly while it heals, the procedure is relatively risk-free, although there is one fairly common, non-serious complication: the development of penile adhesions.

Whether you're trying to decide whether to circumcise your baby boy and are weighing the benefits and risks, or you plan to have your child circumcised and so you want to learn as much as you can beforehand, here's what you should know about penile adhesions.

A Sticky Situation

Adhesions form when the skin on the shaft of the penis attaches itself to the glans—the bulb-shaped head of the penis. Sometimes so much skin sticks to the glans it can look as if the penis was never even circumcised. Adhesions can develop if an excess of foreskin is left behind after circumcision. 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 pubic area.  

There are three types of penile adhesions: 

  • Glanular adhesions, in which 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 are thicker, potentially permanent adhesions.
  • Cicatrix. This type of adhesion, 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.

Treating Adhesions

When a baby develops a glanular adhesion, it's likely his 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, 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 treatment. Skin bridges usually can be surgically separated in an outpatient procedure. In extreme cases, the circumcision may have to be redone.

To treat a cicatrix, which is sometimes called a trapped penis, a 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 15 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 (pulling back) of the foreskin—clearly a preference to having to go through a revised circumcision.

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