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Nephew has hidden penis due to circ-can SIL just leave it alone?

post #1 of 29
Thread Starter 
My nephew (6 months) was circ'd. SIL wishes now that she didn't do it. Anyway, he has hidden penis due to excess fat in the pubic area. SIL is wondering if she should just leave it alone so that his foreskin can be restored. I said I really didn't know. She knows that he will never be able to be fully restored, she was just wondering what to do about the hidden penis. I said that I would come here and ask you lovely ladies and gents! Thanks in advance.
post #2 of 29
Just leave it alone, hopefully he'll "grow out" of the hidden penis. They already took way too much, so if anyone suggests a re-circ, tell her to run the other way as fast as she can.
post #3 of 29
Quote:
Originally Posted by Bm31 View Post
Just leave it alone, hopefully he'll "grow out" of the hidden penis. They already took way too much, so if anyone suggests a re-circ, tell her to run the other way as fast as she can.
:

poor little guy ...
post #4 of 29
Thread Starter 
Quote:
Originally Posted by Bm31 View Post
Just leave it alone, hopefully he'll "grow out" of the hidden penis. They already took way too much, so if anyone suggests a re-circ, tell her to run the other way as fast as she can.

That's just it. It really doesn't look like they took too much. It looks like they took a little bit because you can't even see the corona ridge of the glans as it is covered by skin. I hope that I am explaining this right. Thanks so much for the response! And there is no way she would re-circ. She was really talked into it in the first place by her midwife and OB that was supervising the midwife.
post #5 of 29
Quote:
Originally Posted by nummies View Post
That's just it. It really doesn't look like they took too much. It looks like they took a little bit because you can't even see the corona ridge of the glans as it is covered by skin. I hope that I am explaining this right. Thanks so much for the response! And there is no way she would re-circ. She was really talked into it in the first place by her midwife and OB that was supervising the midwife.
Maybe it's actually a "loose" circ, or the fat pad pushing it out to make it look like a loose circ. Either way, don't let them meddle with him any further.
post #6 of 29
This article might be helpful to her:
http://www.rogerknapp.com/medical/circ_incomplete.htm

Good luck!
Tara
post #7 of 29
My first ds is circ'ed and he got a loose circ. He was quite chubby and his penis looked buried for at least the first year of his life. His glans was always completely covered, both because of the loose circ and because it just got tucked in due to his fat. He outgrew it by the time he was 2 or so. His circ is still loose but his penis isn't buried at all anymore. I saw some pictures once of the progression of how circ's change over time and it was really helpful. I will try and find it. I am sorry for your nephew and SIL-I know how it feels to regret it.
post #8 of 29

We left our son's alone

Sounds like our second son. I was told that urologists are always tempted to recirc to try to make the penis look more like the way parents (or docs) think it should, so be very wary. We left it alone and it no longer was hidden a few months before he turned 2 years old. He also had an adhesion, that we weren't sure what to do about (with our 1st son's adhesions, the ped ripped them back and it was horrendous) so this time we decided not to even consult a ped and just wait and see. We also let our son "play" with it as much as he wanted to because he wouldn't do anything to himself that would hurt. After a while (months?) there was no longer an adhesion there either.

I feel so bad for your SIL and her son. I know how she feels. About 4 months after our 2nd son was born and circed, I finally discovered what a horrible mistake we had done to our sons.

When I get time, I will PM you with some extensive information from a professional about hidden penis, which may or may not be helpful.
post #9 of 29
Thread Starter 
Quote:
Originally Posted by vaughnmama View Post
Sounds like our second son. I was told that urologists are always tempted to recirc to try to make the penis look more like the way parents (or docs) think it should, so be very wary. We left it alone and it no longer was hidden a few months before he turned 2 years old. He also had an adhesion, that we weren't sure what to do about (with our 1st son's adhesions, the ped ripped them back and it was horrendous) so this time we decided not to even consult a ped and just wait and see. We also let our son "play" with it as much as he wanted to because he wouldn't do anything to himself that would hurt. After a while (months?) there was no longer an adhesion there either.

I feel so bad for your SIL and her son. I know how she feels. About 4 months after our 2nd son was born and circed, I finally discovered what a horrible mistake we had done to our sons.

When I get time, I will PM you with some extensive information from a professional about hidden penis, which may or may not be helpful.
Thank you again for that info! Big to you. Sounds like you have been through a lot.

Quote:
Originally Posted by gemelos View Post
My first ds is circ'ed and he got a loose circ. He was quite chubby and his penis looked buried for at least the first year of his life. His glans was always completely covered, both because of the loose circ and because it just got tucked in due to his fat. He outgrew it by the time he was 2 or so. His circ is still loose but his penis isn't buried at all anymore. I saw some pictures once of the progression of how circ's change over time and it was really helpful. I will try and find it. I am sorry for your nephew and SIL-I know how it feels to regret it.
This is exactly what it sounds like! Thanks!
post #10 of 29
My son is 19 months and has the same issue. He has a loose circ and it is also hidden in his fatpad. Multiple pediatricians have said that as he slims down it will pop out. But I keep waiting and it hasn't happened yet. It looks like the pictures posted on Roger Knapps website. It doesn't say on his website how old the children were in each picture.

Vaughnmama said she had some extensive info from a professional about hidden penis. I was wondering if she could post this on the board??

I have tried to read all the stuff I can find on the web about hidden penis. Some stuff says to wait and they will outgrow it. Some stuff says they will need surgery to repair it. I plan on going to a pediatric uroligist to see what they have to say. Hopefully he outgrows it soon...
post #11 of 29
He is far too young to address the issue surgically, and that may never even be necessary. Many boys do "grow out of it", and if not, he can decide if he wants/needs surgery when he is much older and has completed puberty. Taking off more foreskin or foreskin restoration does not "cure" buried penis.

Buried penis is not a condition that is related only to circumcision. In the past year I have probably had 5 adult male patients with either partial or complete buried penis and all have been intact. In true cases the cause is the combined effect of ligaments, muscles, and adipose tissue, not the presence of absence of foreskin.
post #12 of 29
Kate3,
Ya I would not think about getting the surgery done at his age. Also I would not have them take off more foreskin. I would rather him have more foreskin than neccesarry than less foreskin.

I guess I was just wondering what percentage of toddlers "grow out" of this and what percentage does the penis stay buried? His penis did not become buried until after a few weeks after the circ. Maybe this is due to how fast infants gain weight?

Thanks.
post #13 of 29
Most will grow out of it. I don't have an exact percent, but this condition in adulthood is not terribly common. I see a lot just because of the nature of my practice.
And yes, the circ and it being "buried" are coincidental, although when foreskin is removed the penis will always look shorter from no overhang of skin.
post #14 of 29
I wouldn't say it's always coincidental. My penis was never buried/trapped until the re-circ at age six. The thing is, I'm not really clear on the terms/differences between buried/trapped/concealed penis. If it's a case of being buried because of an excessive fat pad, they have a better chance of outgrowing it. However, if it's caused by excessive removal of shaft skin (denuding) during the circ the liklihood of outgrowing it is much less; the skin that was meant to be there and expand with the growth of the penis later simply isn't there and it keeps the penis "trapped" under the fat pad in the pubic area. From what I've researched, in those cases the fix is basically reconstructive surgery where they graft some skin back from elsewhere.
post #15 of 29
I think the problem is due to his fat pad, not excess removal of shaft skin. Even when his penis does make an appearance it looks like he isn't circ'd. But I believe this is just due to the "loose" circ. If you push the skin back it looks like a normal circ'd penis. We brought him back to the doctor that did the circ and he even said he tends to lean toward leaving more skin to be on the safe side. Our pediatrician said there is no problem with the circ and as he thins out it should stick out. But we have been hearing this for 18 months now and I am starting to get worried that it won't stick out. If it doesn't get better by 24 months we are going to see a pediatric urologist for a second opinion.
post #16 of 29
Quote:
Originally Posted by db_9 View Post
Kate3,
Ya I would not think about getting the surgery done at his age. Also I would not have them take off more foreskin. I would rather him have more foreskin than neccesarry than less foreskin.
I'm sure this just came out wrong- you know there's no such thing as unnecessary foreskin, right? Every last bit of it has a function.

I don't have time to look it up now, but I am pretty sure hidden and trapped penis look similar but there are different reasons for the conditions. One iscaused by the fat pad and general structure of the individual's pubic area, and the other caused by a really tight circumcision. And of course the two can occur together. Maybe someone else can find some info on this, or I can check later on. I think I have a link on it.
post #17 of 29
Here is what I've been able to glean from several websites: the general term for a penis that's pulled in and you can't see it is 'hidden', or 'concealed' . If it's due to a large fat pad, and/or binding by the dartos bands, and/or the penile suspensory ligament is not holding the penis in its proper position- this is called 'buried penis'. If it is due to circumcision, the penis is referred to as 'trapped', since the resulting scar tissue is what's holding the penis inside.

So what I understand is that trapped penis is the proper term to describe one that occurs because of circumcision. It can be because the circumcision was 'overzealous', as they say, and now the penis can't extend out. Or it can be a normal circumcision on a chubby child, whose fat pad pushes the remaining foreskin over the glans.

Quote:
The trapped penis is characterized by the shaft of the penis being bound down in scar tissue and thus becoming embedded in the scrotum and prepubic fat, (Fig. 6). This can be seen after trauma or overzealous circumcision. However, it may also occur after an appropriate circumcision when the buried penis is contained within an enlarged fat pad, allowing the penile skin to be pushed forward and heal over the glans. The most common antecedent in the literature is a circumcision which removes an excessive amount of skin from the penile shaft as well as the prepuce. The trapped penis may also be the result of removing too little inner preputial skin. In this instance, the raw edges of the incised foreskin protrude beyond the distal portion of the glans. With nothing to separate them, they may heal together. As healing takes place, the penis is tethered by scar tissue which retracts the penis, frequently leaving little more than the urethra visible. Of the children in our series, 42% came to us with this iatrogenic complication.
http://www.cirp.org/library/complications/bergeson/

Must go put children to bed, but here is another link I used to reach this conclusion: http://www.springerlink.com/content/0r63kcdtwlhvbc8b/

Several sites I looked at mentioned surgery as the solution for trapped penis. If it were my son, I'd research very very carefully and talk with foreskin-friendly doctors (ask Doctors Opposing Circumcision!) Most doctors seem as happy to recommend doing it twice, as they were the first time. But it may be what's necessary; if scar tissue really is holding the penis inside, I don't know that that would resolve on its own. The child needs to be seen by someone who can really determine the cause or causes of the trapped penis, and what should happen in the future.
post #18 of 29
Quote:
Originally Posted by Bm31 View Post
I wouldn't say it's always coincidental. My penis was never buried/trapped until the re-circ at age six. The thing is, I'm not really clear on the terms/differences between buried/trapped/concealed penis. If it's a case of being buried because of an excessive fat pad, they have a better chance of outgrowing it. However, if it's caused by excessive removal of shaft skin (denuding) during the circ the liklihood of outgrowing it is much less; the skin that was meant to be there and expand with the growth of the penis later simply isn't there and it keeps the penis "trapped" under the fat pad in the pubic area. From what I've researched, in those cases the fix is basically reconstructive surgery where they graft some skin back from elsewhere.

Buried penis, concealed penis and trapped penis are terms that are often used interchangeably but there are differences and they are not the same.

Males have differences in their penises. Some will have penises that are held close to the body their entire lives and some will have penises that fall away from their bodies. I have seen the term "some are growers and some are showers" and that describes it well.

Concealed penis is one of these penises that are held close to the body when flaccid. In an infant, the penis can be pulled into the fat pad of the mons pubis and the vast majority of these children will grow out of this condition if not all. No intervention is required.

Buried penis looks very much the same but is a complication of circumcision where the circumcision has gotten into the underlying structure of the skin system and foreshortened it pulling the flaccid penis back into the mons pubis. This condition may self resolve and it may not. If it does self resolve, it usually happens between the ages of 3 and 5 years old.

Trapped penis is where there is phimosis secondary to the circumcision holding the penis inside the remnant skin sleeve.

Some doctors perform a second circumcision to relieve the buried penis condition but this runs great risk of exacerbating the condition by further shortening the skin system. In another forum, a mother reported this condition in her son and by selecting the information she wanted to see, decided to have her son circumcised a second time with the same results as the first circumcision. After searching around, she found another doctor who agreed to perform a third circumcision and it was only then that it became indisputably obvious that all three circumcisions were wrong. She then had to subject her son to skin graft surgery to replace the skin that was removed causing the initial problem. Unfortunately. the upper eyelids are the only site on the body that has skin similar to the penis and the skin had to be harvested from the boy's hip. This will leave the child/man with a very different band of skin around the shaft of his penis. The reason for the original circumcision was cosmetic and the boy ended up with anything but a cosmetically pleasing appearance.

There is little research and good information on hidden/concealed penis. My opinion is that circumcision probably exacerbates concealed penis and in many cases, makes it permanent.


Frank
post #19 of 29
Quote:
Originally Posted by db_9 View Post
I think the problem is due to his fat pad, not excess removal of shaft skin. Even when his penis does make an appearance it looks like he isn't circ'd. But I believe this is just due to the "loose" circ. If you push the skin back it looks like a normal circ'd penis.
This is the common appearance of buried penis syndrome. It actually appears that there is too much skin left when actually, there is too little. This is the reason many boys are circumcised a second time. The doctors think from the appearance that there is too much skin left. In many of these cases, the child still has the same appearance after the second circumcision and in many of these cases, the child has to have a third procedure to replace the skin that was previously removed.


Quote:
We brought him back to the doctor that did the circ and he even said he tends to lean toward leaving more skin to be on the safe side. Our pediatrician said there is no problem with the circ and as he thins out it should stick out. But we have been hearing this for 18 months now and I am starting to get worried that it won't stick out. If it doesn't get better by 24 months we are going to see a pediatric urologist for a second opinion.
24 months is too early to make a "go or no go" decision as the child is likely to still have the fat pad. The typical time that buried penis self resolves is between 3 and 5 years old. The exception is if the child is exceptionally slender and it is apparent that the fat pad is not complicit.


Frank
post #20 of 29
Quote:
Originally Posted by Frankly Speaking View Post
Buried penis, concealed penis and trapped penis are terms that are often used interchangeably but there are differences and they are not the same.

Males have differences in their penises. Some will have penises that are held close to the body their entire lives and some will have penises that fall away from their bodies. I have seen the term "some are growers and some are showers" and that describes it well.

Concealed penis is one of these penises that are held close to the body when flaccid. In an infant, the penis can be pulled into the fat pad of the mons pubis and the vast majority of these children will grow out of this condition if not all. No intervention is required.

Buried penis looks very much the same but is a complication of circumcision where the circumcision has gotten into the underlying structure of the skin system and foreshortened it pulling the flaccid penis back into the mons pubis. This condition may self resolve and it may not. If it does self resolve, it usually happens between the ages of 3 and 5 years old.

Trapped penis is where there is phimosis secondary to the circumcision holding the penis inside the remnant skin sleeve.

Some doctors perform a second circumcision to relieve the buried penis condition but this runs great risk of exacerbating the condition by further shortening the skin system. In another forum, a mother reported this condition in her son and by selecting the information she wanted to see, decided to have her son circumcised a second time with the same results as the first circumcision. After searching around, she found another doctor who agreed to perform a third circumcision and it was only then that it became indisputably obvious that all three circumcisions were wrong. She then had to subject her son to skin graft surgery to replace the skin that was removed causing the initial problem. Unfortunately. the upper eyelids are the only site on the body that has skin similar to the penis and the skin had to be harvested from the boy's hip. This will leave the child/man with a very different band of skin around the shaft of his penis. The reason for the original circumcision was cosmetic and the boy ended up with anything but a cosmetically pleasing appearance.

There is little research and good information on hidden/concealed penis. My opinion is that circumcision probably exacerbates concealed penis and in many cases, makes it permanent.


Frank

Thanks for your explanation, Frank. I'm still not exactly sure how mine would be categorized, but I do KNOW the re-circ had everything to do with it. I was only six when they did it, but I wasn't blind or stupid. I had a nice little penis that hung down normally over my testicles. The only thing "wrong" with it was that I still had most my foreskin, which was the source of the adhesions they thought so important to fix with a re-circ. Afterward, basically I just had an acorn-style glans poking out from my groin which retreated further inward as it "healed" over a matter of months. I was a normal size child and didn't gain a bunch of weight over that time period. It never resolved itself really. So I have to agree, whatever the exact condition is, another circ is only going to be detrimental.
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