Penile adhesions occur when the skin of the penile shaft abnormally sticks, or adheres, to the glans (head) of the penis, creating a tethered appearance. This condition is most often seen in infants following a circumcision procedure, but it can also affect uncircumcised boys and, less commonly, adult men due to inflammation or hygiene issues. While often benign, adhesions can sometimes cause discomfort, impact hygiene, or lead to complications. Addressing this issue involves a careful, step-wise approach, starting with non-invasive home care and progressing to medical interventions when necessary.
Identifying Penile Adhesions
Penile adhesions present with distinct signs that a parent or individual can observe, though milder forms often cause no pain or obvious symptoms. The most visible sign is a partial or full attachment of the shaft skin to the glans, which restricts the skin’s normal retraction. This adherence may prevent the skin from fully separating from the coronal margin, the ridge at the base of the glans.
In infants, adhesions commonly result from the natural healing process after circumcision if raw skin surfaces are allowed to touch and fuse. In adults or uncircumcised males, adhesions often relate to poor hygiene, localized inflammation, or conditions like lichen sclerosus. A white, waxy discharge called smegma, which is a collection of dead skin cells and oils, may accumulate under the adhesion, but this is not typically a sign of infection.
Adhesions are classified by their severity, ranging from simple glanular adhesions to more permanent penile skin bridges. Simple adhesions are thin and fibrinous, often resolving on their own. A skin bridge is a thicker, scar-like attachment that forms a permanent connection between the shaft skin and the glans.
Non-Invasive Home Management
Home management is the first-line treatment for mild, thin, non-vascularized adhesions. This approach centers on softening the tissue to encourage natural separation and requires patience, as results may take several weeks. The primary goal is to maintain moisture and apply gentle, persistent pressure to the adhered area.
The application of a simple emollient, such as petroleum jelly or white soft paraffin, is foundational conservative care. Applying a small amount directly to the adhesion several times a day helps soften the skin. This allows spontaneous erections or gentle retraction to break the delicate connection. For infants, this is typically incorporated into diaper changes or bath time.
For more stubborn adhesions, a physician may recommend a short course of a low-dose topical steroid cream, such as betamethasone 0.05%. This prescription cream is usually applied twice daily for a period, often up to four to eight weeks. The steroid works by thinning the skin and reducing inflammation, which weakens the bond and makes the adhesion more susceptible to separation.
Gentle stretching exercises, performed during the application of the emollient or steroid cream, are often advised to aid the process. Only apply mild, non-forceful retraction to the skin. Excessive force can cause pain, tearing, and potentially lead to the formation of a thicker skin bridge. Home treatment is most effective for adhesions covering less than 50% of the glans and should be attempted only under healthcare provider guidance.
Professional Medical Interventions
If home management fails to resolve the adhesion after a specified period, or if the adhesion is severe, a medical procedure is necessary. The most common in-office intervention is lysis of adhesions (LOA), which involves manually separating the adherent tissue. This procedure is generally recommended for well-formed skin bridges or adhesions covering more than 50% of the glans.
During an LOA, a local anesthetic cream, such as a eutectic mixture of lidocaine and prilocaine (EMLA), is often applied beforehand to minimize discomfort. Once the numbing agent takes effect, the physician uses a blunt instrument, such as a cotton swab or probe, to carefully separate the skin from the glans. The separation is typically quick, and while it may cause pinpoint bleeding, it does not usually require stitches.
For more mature or vascularized skin bridges, or in cases of extensive scarring, a formal surgical revision may be necessary, often performed under general anesthesia. This involves the careful excision of the scar tissue. A circumcision revision may be performed concurrently to address the underlying cause, especially if excess residual foreskin is contributing to the problem.
Professional intervention is necessary if there is significant pain, signs of infection, or if the adhesion causes functional problems, such as urinary obstruction. After a successful LOA, a detailed aftercare regimen is implemented immediately to prevent the newly separated skin from re-adhering.
Preventing Recurrence
Preventing the recurrence of penile adhesions after successful separation is a crucial step in long-term management. The primary focus is consistently keeping the separated skin surfaces from touching and fusing again during the healing period, which typically lasts several weeks post-treatment.
Following separation, a regimen of regular, gentle skin retraction is required, usually performed once or twice daily. This action ensures the skin remains mobile and prevents it from re-adhering to the glans. Retraction should be done only to the point of mild resistance to avoid new trauma.
The application of a barrier ointment, such as petroleum jelly, remains a foundational part of post-procedure care. Applying a generous amount of ointment after each retraction helps maintain a physical barrier and keeps the skin soft and moisturized. This simple step is highly effective in preventing the raw surfaces from healing back together.
A physician may prescribe a short course of a topical steroid cream to be used after the separation. This helps reduce inflammation and prevents scar tissue from forming that could lead to new adhesions. Consistent follow-up with a healthcare provider is recommended to monitor the healing process and ensure the adhesion does not reform.