adhesions and skin bridge in circ'd toddler...treat or leave alone?

[caedmyn]

I realize this is the anti-circ forum, but hopefully someone here can give me some suggestions. My 13 month old DS has a loose circumcision. He's had an adhesion for a long time going maybe 40% of the way around (it appeared to be at the top of the circumcised area which appears to be bad from my googling, but I don't understand why). For the past couple of months it has looked like the whole top has an adhesion, though the area where the original adhesion was still looks slightly different. He's also had a diaper rash/infection/something in that area (quite red at times)...doctor said it was a rash but I'm not entirely convinced. It also looks like he's developing a skin bridge.

So I've googled and it appears that there's a difference of opinion as to whether adhesions should be treated by gentle pressure (aimed toward eventually getting him to retract) at diaper changes/baths, or whether they should be left alone to (in most cases?) spontaneously resolve. The doctor said I should use pressure and said if it didn't correct by about age 4 DS would need surgery, which I obviously don't want. I guess I'm not really sure which way to go on this. If anyone has any personal experience with dealing with something like this I would love to hear it. Please, no flames or mentions of why I shouldn't have had him circ'd.

[MommytoB]

Is the remaining foresking covering up only 40% on the ridge as in the edge of the glans meaning that the glans is exposed or is it covering up most of the glans with part of the remaining foreskin loose in other areas ?

is the covering part on the top side, bottom side or the sides ?

Where was the orignal adhesion and did your doctor pull back that adhesion ?

[glongley]

Here is the abstract of a study (and an article about the study) which supports the idea that most adhesions will resolve on their own in time:

http://www.cirp.org/news/ponsky2/
http://www.cirp.org/library/complications/ponsky2/

They conclude that "penile adhesions develop after circumcision and the incidence decreases with patient age. Although there is debate on whether to lyse these adhesions manually, our findings suggest that adhesions resolve without treatment. Based on our results we do not recommend lysing [cutting] penile adhesions, except perhaps those involving the circumcision line." I would thing that adhesions or skin bridges which persist to adulthood and cause pain with erection or intercourse would also be candidates for surgical separation. In a child, it's just more of a wait and see situation, unless there are constant problems with inflammation.

Not sure what the official definition of a "skin bridge" is. My impression is that at skin bridge is a very localized, narrow adhesion. Any adhesion can have an open space underneath it which can leading to trapping of debris and set it up for problems with cleaning and inflammation. In fact, because of this, and the frequency of adhesions, young circumcised boys are more likely to have inflammation than young intact boys. Parents are often not told about adhesions as a possible complication of circumcision. With more loose circs being down nowadays, they are a very common problem.

I hope you will feel welcome here. There are many other moms of circumcised boys who come here to learn and share.

Best wishes, Gillian

[caedmyn]

Originally Posted by MommytoB

Is the remaining foresking covering up only 40% on the ridge as in the edge of the glans meaning that the glans is exposed or is it covering up most of the glans with part of the remaining foreskin loose in other areas ?

is the covering part on the top side, bottom side or the sides ?

Where was the orignal adhesion and did your doctor pull back that adhesion ?

I am not sure I understand all your questions, but I'll try to answer anyway. The glans is the roundish part at the top of the penis, right? I would guess that maybe a third of the glans is exposed normally, maybe less. The remaining foreskin is not what I would call loose at all, it adheres all the way around. I can push it down a little but not very much. The foreskin doesn't completely cover the glans (by that I mean so that the glans isn't visible in in an area) at all.

The original adhesion was right where the glans meets the remaining foreskin. I would say it covered 40% of the circumference of the foreskin at the top. The doctor pushed down on the foreskin but I did not let him break/separate the adhesion.

[caedmyn]

I do not even know how I am supposed to clean it. I have always just wiped the outside, but if stuff can stuck underneath am I supposed to push the remaining foreskin down gently and clean whatever is exposed?

[FernG]

The term "loose" refers to the amount of foreskin left after the circumcision. If your son has a loose circumcision, he has more foreskin left so he's less likely to have problems having enough skin to have an erection as an adult.

By continuously breaking adhesions or pushing down the foreskin, one risks creating scar tissue. This can result in problems with erections/adhesions later. Leaving the adhesions alone can prevent this. After your son reaches puberty, his hormones should increase to help the adhesions break. These adhesions are unnatural because of the circumcision and may not break as easily as natural adhesions. Because it is normal for the glans to be covered by the foreskin before puberty, his body is trying to heal and return to normal. If his adhesions haven't released by late puberty, he can use steroid cream and stretching exercises. Those creams are very effective, but they don't create lasting change until the hormones from puberty have kicked in. It's very popular for doctors to recommend the creams at age 3, but they will be useless. As long as your child can pee, he does not need the creams until sexual maturity.

Clean the penis like a finger - wipe down away from the body. For very messy poops, sit your son in a sink/bowl/tub of water and swish his penis. I do not push wipes up my daughters vulva when she has pop in it. I sit her in water or I may spray down with a peri bottle. The penis is just the same. The foreskin is trying to adhere because it's function during infancy is to keep the penis clean. When in doubt, think about how you would clean a girl. For example, would it make sense to retract a baby girl's clitoral hood or to worry about clitoral hood adhesions? American doctors used to worry about that, but, thankfully, that age has passed.

I hope that helps. Please keep asking questions as you need to!