Penile adhesions occur when the skin of the penis shaft adheres to the glans, or head of the penis. This common condition is observed most frequently in circumcised boys following the neonatal procedure. While the presence of adhesions can be concerning for parents, they are generally not dangerous and often cause no pain or discomfort. Understanding the causes and management of these adhesions helps parents ensure proper post-circumcision care.
What Exactly Are Penile Adhesions?
Penile adhesions occur when the inner lining of the penile skin attaches itself to the glans after circumcision. During the initial healing process, the glans and shaft skin have raw surfaces, making them prone to sticking together. Adherence can vary in extent, from minor spots along the coronal margin (the rim of the glans) to a wider attachment across the glans surface.
A dense, permanent attachment forming a band of skin from the shaft to the glans is sometimes referred to as a penile skin bridge. Adhesions are a consequence of the post-surgical healing environment, where the raw surfaces of the skin fuse together due to a lack of barrier between the surfaces.
Adherence is often worsened by the accumulation of dead skin cells and natural secretions, known as smegma, trapped beneath the adhering skin. This accumulation is sometimes mistaken for pus, but it is the body’s attempt to exfoliate the stuck surfaces. Adhesions can also develop if a child gains fat in the pubic area, causing the penis to be pushed inward or “buried,” which encourages the skin to stick to the glans.
How Common Are Penile Adhesions?
Penile adhesions are a common finding in circumcised infants. Studies indicate that the prevalence is high, with some reports showing over 70% of infants may have some degree of adherence in the first year. This rate tends to decrease significantly as boys get older and natural mechanisms take over.
The incidence of adhesions in boys aged one to five years drops substantially to around 28%, and for those older than five, the rate falls to single digits. This natural decline is due to factors like increased penile growth and spontaneous erections, which gently stretch and separate the skin surfaces over time. Most cases are minor and resolve without specific medical intervention.
The likelihood of developing adhesions is influenced by the type of circumcision performed and the consistency of the initial post-operative care. Cases that are more severe, covering a larger percentage of the glans, are less common and require more attention. Severe adhesions covering over 50% of the glans are found in a smaller group of patients, typically those under the age of three.
Identifying and Managing Adhesions
Recognizing a penile adhesion often begins with observing the appearance of the penis during diaper changes or bathing. Parents may notice that the shaft skin does not easily separate from the head of the penis, or that the coronal margin is partially obscured. Another sign is the formation of a white, cheesy discharge, or smegma, which collects beneath the adhered area.
In some cases, parents may observe the skin ballooning during urination as urine collects temporarily beneath the adhered skin before exiting. Significant adhesions can lead to a skin bridge, a permanent band of tissue that may cause discomfort, particularly during an erection in older boys. Localized redness or irritation around the area should prompt a discussion with a healthcare provider.
Management depends on the severity of the adhesion, but most are treated non-surgically. For minor adhesions, a doctor may recommend applying a thin layer of petroleum jelly to soften the skin and act as a separating barrier. The petroleum jelly allows spontaneous erections to gently break the fine attachments over time.
More persistent or denser adhesions often respond well to a short course of a topical steroid cream, such as Betamethasone, typically applied twice daily for several weeks. The steroid cream works by thinning and weakening the adhered skin tissue, making it more elastic and pliable. This allows the skin surfaces to separate more easily, either spontaneously or with gentle, gradual manual retraction by the parent, as advised by the pediatrician.
If conservative treatments fail, or if a thick skin bridge has formed, a medical procedure known as adhesiolysis may be necessary. This procedure is usually quick and performed in a doctor’s office or clinic, often with a topical anesthetic. The doctor gently separates the adhered skin surfaces using a blunt instrument, sometimes involving a scalpel for thicker skin bridges.
Daily Care and Prevention Strategies
Preventing penile adhesions begins immediately after the circumcision procedure. A primary strategy involves using a barrier ointment to keep the healing shaft skin and the glans separated. Applying a liberal amount of petroleum jelly or a similar barrier cream directly to the incision site and the glans for the first few weeks after the procedure is highly effective.
This protective layer acts as a physical shield, preventing the skin from fusing during the vulnerable healing phase. Parents should continue this practice with every diaper change until the site is completely healed, which typically takes about seven to ten days. Some physicians suggest applying a moisturizing ointment for a longer period to maintain skin pliability.
For infants and toddlers, gentle manipulation of the penile skin during diaper changes or bath time ensures the skin remains mobile and does not re-adhere. This involves gently pushing the penile skin down toward the base of the penis to confirm the head is fully exposed. Consistency is important, as the warm, moist environment of a diaper can encourage the skin to stick together.
If a child has been treated for an adhesion, the use of a topical ointment and gentle retraction should be continued afterward to prevent recurrence. Parents should clean the penis thoroughly during baths to remove smegma, which can act as a glue. Consistent monitoring and good hygiene are the best strategies to avoid the recurrence of penile adhesions.