My 4 yr old nephew (circ'd) has some adhesions on his penis. He does have some foreskin left, it covers about half the head. The adhesion seems to be right near the sulcus (looking at a diagram), on the glans. Does that make sense?

Anyway, will the adhesion retract on its own or should my nephew be aware to retract it himself? He was NOT retracted as an infant by either of his parents. Sil took him to the doc when he was 1 yr and the doc retracted, which ticked sil off (by that point she'd done some research) and GREATLY upset my nephew. It's just begun retracting on it's own, but it's hurting him. He told his mom he has a boo-boo on his penis, hence the questions.

NO FLAMES about the circ. What's done is done.

J Urol. 2001 Mar;165(3):915.

Penile adhesions after neonatal circumcision.

Ponsky LE, Ross JH, Knipper N, Kay R.

Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

“In these groups we noted an adhesion rate of 71%, 28%, 8% and 2%, respectively. The rate of adhesions more severe than grade 1 was 30%, 10% and 0% in boys 12 months old or younger, 13 to 60 and 61 months old or older, respectively. The oldest patient with grade 3 adhesions was 31 months old. Skin bridges in 6 cases involved the circumcision line in 4.”

"CONCLUSIONS: 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 penile adhesions, except perhaps those involving the circumcision line."

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=10893633&dopt=AbstractPlus

“Penile adhesions occur frequently after circumcision. Some physicians advocate manual lysis of the adhesions. This procedure can be painful and traumatic. Penile adhesions are normal in uncircumcised boys and normally resolve without treatment.”

http://www.kidsgrowth.com/resources/adviceDetail.cfm?id=3420

Gil Fuld, M.D., F.A.A.P.

“Sometimes after a routine newborn circumcision, excess foreskin remains. Since newborn circumcision is not medically necessary, it's certainly better to leave a little extra than to take off too much and damage the child's penis.”

“So, it's a common occurrence in little boys for adhesions to develop under any remaining foreskin, although it's rarely a problem and practically never requires a repeat circumcision.”

http://www.medem.com/medlb/common_error.cfm

Vincent Iannelli, M.D.

“It isn't really normal, but is a common complication after a circumcision. In a situation like this, penile adhesions form when the skin on the shaft of the penis attaches itself to the glans or head of the penis. In extreme cases, it can look like the child was never even circumcised, leading parents to believe that the child had a 'bad circumcision.'”

“If the skin is attached only on the very base of the glans, then your child has a very mild case of penile adhesions and you can likely just leave it alone. It should eventually separate, especially once your child becomes older, and anyway, forcing it apart would be painful.”


http://pediatrics.about.com/od/weeklyquestion/a/05_pnl_adhesion.htm

“The foreskin will almost always detach itself in time as a boy develops. It should not be forcibly retracted. This may lead to scarred adhesions that will not detach without surgery. Penile growth is not usually influenced by adhesion of the foreskin to the glans penis.”

http://www.henryfordhealth.org/19160.cfm


(put together by Jen)

Wonderful! Thanks, Carrie. :) (We share a name, btw!)

This is truely a sad situation. This child had to suffer the pain of circumcision and is still having to suffer the pain years later. This is a common complication of circumcision if you can consider it that. In truth, its the natural reaction of the body of what it sees as an injury.

In an intact child, these adhesions are absolutely normal but in recent years, the medical profession has changed the procedure to this "loose" style to avoid the problems with the older "tight" style circumcision. This leaves part of the foreskin remnant in contact with the glans. The child's body experiences circumcision as an injury and the normal healing process tries to put the injured area back as close to normal as possible and that includes having the foreskin adhered to the glans.

In an intact child, there is sufficient foreskin to accomodate erections without pulling at these adhesions but in a loosely circumcised child, that mobility has been removed and with each erection, the remaining loose skin pulls back and becomes tight pulling at the adhesions. It would be similar to trying to pull the tissue under the fingernails away from the nails.

However, just as the intact child's adhesions will eventually disolve and the foreskin will retract, this child's adhesions will also resolve and the remnant foreskin will also retract. However, I understand that is small comfort when the child is suffering every day with this pain today.

I've often wondered if a child who is suffering like this learns to subconsciously associate pain with a part of his body that is designed to provide immense pleasure and if there is not a price to pay somewhere down the road in his feelings and function about sex.

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