With all of our sons, my husband and I decided to circumcise. Within a month of our first baby boy’s circumcision, we noted it just didn’t look quite right. Less of the head of the penis appeared visible than we expected, and when the remaining foreskin was pulled back the edges of the head could not be seen. After further research and a pediatrician visit, we found our son had a penile adhesion.
What is a penile adhesion?
A penile adhesion occurs when the remaining foreskin after a circumcision reattaches to the glans or head of the penis. Penile adhesions vary in severity and can be located anywhere around the glans. If you gently pull back the skin of a baby’s penis that has a penile adhesion you can see skin sticking to the edge of the head in locations or may not be able to see the edge of the head at all. Remember that a circumcised penis should resemble a mushroom. If it doesn’t, your baby may have an adhesion.
Can penile adhesions be prevented?
In my first son’s case, he was born with an unusual amount of foreskin, so after his circumcision more than usual remained. I was told simply to place Vaseline on the diaper to prevent sticking and allow it to heal. What I was not told is after healing the remaining foreskin should be gently pulled back during diaper changes and baths until 18 months of age to prevent infant penile adhesion. Not only can this process greatly reduce the risk of penile adhesion, but many parents find it to be cleaner. It’s a misconception that a circumcised penis requires no care. Even a circumcised infant will form smegma, or a white substance in the folds of skin around the penis, under the penis itself, and under the remaining foreskin. Choosing not to circumcise will also not prevent the chance of adhesion. Both circumcised and uncircumcised boys suffer adhesion.
It should be noted even with regular retraction of the remaining foreskin infant penile adhesions can still form. With my second baby boy, I was more versed in how to care for an infant circumcision and my baby still developed minor adhesions, yet my third son had no issues.
How are penile adhesions treated?
Expert opinions on how infant penile adhesion should be treated vary. Some feel that the adhesion should be gently pulled free in an office visit to prevent the need for surgery later. Others feel most penile adhesions resolve themselves by the time the baby turns five. Studies currently support the later of the two opinions finding that of the 71 percent of infants that had penile adhesions shortly after birth, only 28 percent still had adhesions by age 5, 8 percent by age nine, and 2 percent beyond this.
It’s recommended that all infant penile adhesions be evaluated by a pediatrician. While some adhesions will indeed resolve themselves, others will not. A medical professional is the best person to make this determination. With my first son, we opted to have the manual retraction. A numbing agent was placed on his penis, and then an hour later his doctor gently pulled the attached skin free. He had some redness for a day or so, but didn’t even cry. The skin did reattach again. It’s not uncommon for a baby that has had a penile adhesion to experience a reoccurrence of penile adhesions. We had the skin unattached a second time, and kept Vaseline between the remaining foreskin and the head this time until redness faded entirely. The adhesion has not returned.
In our second son, the adhesion was less severe. A pediatrician, in this case, recommended either leaving it alone or slow detachment. This should be done at the tail end of a bath. The bath will help soften the tissue. Place one thumb below the adhesion and another on the glans or head of the penis. Then you simply gently push in opposite directions. After a few baths, many adhesions are resolved. You can ask your pediatrician how to do this, and whether or not it is a good idea in your particular case.
In rare cases, penile adhesions exceed the fifth year of life. In these cases, surgery is usually recommended.