A penile adhesion occurs when the skin of the penile shaft adheres to the head of the penis, which is known as the glans. This condition is a common finding in young boys who have been circumcised, though it can also occur in uncircumcised males. While the sight of an adhesion may cause concern, it is generally not a dangerous condition and often resolves without significant intervention.
Visual Identification of Penile Adhesions
Identifying a penile adhesion relies on observing a thin connection of tissue between the skin of the shaft and the glans. The adhesion typically forms near the corona, which is the ridge at the base of the glans. It may appear as a whitish, grayish, or translucent film, almost like a small, delicate web of skin bridging the two surfaces.
In milder cases, the adhesion is often thin and may only partially obscure the coronal margin, a boundary that is normally fully visible after a circumcision. The adhesion restricts the skin’s natural movement over the glans, and attempting to gently pull the shaft skin back will reveal the tethered spot.
A more established form of adhesion is called a penile skin bridge, which represents a thicker, more permanent band of tissue. This bridge is a complete fusion of the shaft skin to the glans or coronal edge, often creating a small tunnel underneath the band of tissue.
Another visual indicator is the presence of smegma, a white or yellowish-white, cheese-like substance that accumulates beneath the adhered skin. Smegma is a natural buildup of dead skin cells and oils that cannot be fully cleansed due to the physical barrier of the adhesion.
Understanding How Adhesions Form
Penile adhesions are primarily a complication of the post-circumcision healing process. Following the procedure, the inner layer of the remaining foreskin or the skin of the shaft is prone to re-adhering to the raw epithelial surface of the glans. This can happen if the two surfaces are not regularly kept separate during the initial weeks of healing.
The mechanism involves the natural healing response where the skin attempts to bridge the gap between the two separate surfaces. If gentle separation is not performed or a protective barrier of ointment is not consistently applied, the skin surfaces can fuse together, often occurring in the first few months after the procedure.
Other anatomical factors can also contribute to the development of adhesions, such as the presence of a prominent pubic fat pad. In some infants, the extra fat in this area can cause the penis to partially retract or become “buried.” This retraction pushes the shaft skin forward, increasing the likelihood that it will contact and adhere to the glans.
Treatment and Resolution Methods
Many simple penile adhesions resolve spontaneously as a child grows, particularly with the occurrence of spontaneous erections that naturally stretch and separate the adhering surfaces. However, for adhesions that persist or become more prominent, medical intervention may be necessary. The first line of treatment often involves the application of a topical steroid cream, such as Betamethasone.
The steroid cream is typically applied twice daily for a period, often lasting up to six weeks. This medication works by thinning and softening the adhered skin, which encourages the adhesion to separate gradually. In conjunction with the cream, gentle retraction of the skin can aid in the eventual release of the attachment.
For cases where topical treatment is ineffective, or for the thicker penile skin bridges, a minor in-office procedure may be required. A physician can manually separate the adhesion after applying a local anesthetic ointment to numb the area. This separation is usually quick and performed with minimal discomfort to the child.
It is important for parents to consult with a pediatrician or pediatric urologist before attempting to forcefully separate any adhesion themselves. Attempting aggressive separation without medical guidance can cause pain, bleeding, and potential scarring, which may lead to the formation of a more severe skin bridge.
Preventive Care and Hygiene
Preventing the formation of penile adhesions centers on a consistent and gentle hygiene routine, especially in the weeks immediately following a circumcision. During the initial healing period, a protective emollient like petroleum jelly should be liberally applied to the glans and the incision site. This barrier prevents the skin of the shaft from making direct contact with the healing glans.
After the initial healing, the daily routine should incorporate gentle retraction of the penile shaft skin away from the glans during diaper changes or bath time. The goal is not to force the skin back but to ensure the skin remains mobile. This action is important for infants in diapers, as the warm, moist environment can facilitate adherence.
The consistent use of petroleum jelly or other doctor-recommended ointment can be maintained as a preventive measure. This lubrication helps keep the skin soft and pliable, allowing natural forces of growth and spontaneous erections to maintain separation. Good hygiene, including regular gentle cleaning, also prevents the buildup of smegma.