Penile Adhesions & an "Innie" - Mothering Forums

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#1 of 17 Old 05-20-2010, 10:55 PM - Thread Starter
 
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Hello, I am new here and real glad that there is a spot to post topics such as this. Hopefully somebody may be able to give me some insight into this. My son is 19 months old and I had him circumcised when he was just born. Yes, I know most people in here are against that and are for keeping their sons intact. I totally respect that and wish I had done that now as well. I don't want any arguments, I just want some insight. So, here is the situation.

After the circumcision, he developed adhesions. To make matters worse he also has an "innie" penis. I believe they call them either a concealed or buried penis. Usually overweight children will have that because of a fat pad by their groin. My son on the other hand is very, very thin but he still has this pudgy fat by his groin area. So, because of his penis going inwards, the extra skin started to adhere to the glans. The female pediatrician said nothing was wrong that that was normal looking. I took him to a male pediatrician and he said that indeed the skin had adhered. Well he manually pulled the skin back and caused a great deal of pain and bleeding. I don't want to go through that again. Unfortuneately, the skin began to adhere again and now here we are with him being almost 19 1/2 months and he still has adhesions.

I did call the Urologist office and one of the nurses told me that there is nothing to worry about that in time the skin will just pull away on it's own. My newest pediatrician said the same thing, that in time it will pull away from the glans and that everything will be fine. I can't help but worry though. Plus, his penis just doesn't look normal with it all being inside the fat pad like that. It just looks so small! The nurse at the Urologist office said that a lot of babies and toddlers look like that and that it looks like a turtle and in time he will grow into it. He does have a lot of extra skin though. When the OB did the circumcision she left a lot of skin. I guess they call that a loose circumcision.

Anyways, I was just hoping that some of you may be able to console me on this. I am just worried sick that his penis will never stick out and look normal or that the skin will never pull away from the glans. I don't want him to have another circumcision. I regret having it done in the first place.
Also, the glans doesn't seem that big either. It's probably because the skin is stuck to it. I can only see the "ridge" of the penis very slightly on the top but the rest is stuck around it. I remember when my son was at daycare and the other baby boys seemed to have larger penises with larger "mushroom" like glans. My sons penis just seems so odd because of how it goes inward and how the skin is adhering around it. Both my husband and the pediatrician say that everything is fine though.

Can anybody please give me some insight into how to handle this? Thank you!

P.S. By the way, I pull the skin back during diaper changes and put Vaseline on him twice a day around the glans area. When can I expect the adhesions to begin to break apart from the glans? The pediatrician said give it time because the foreskin on the intact boys doesn't retract until much later. I guess I am just impatient and since he had a circumcision I just want that extra skin to release from the glans.
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#2 of 17 Old 05-20-2010, 11:25 PM
 
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Though many pediatricians do pull adhesions apart, recent studies have shown that when left alone most adhesions resolve themselves around the start of puberty. You are going to have to be patient about the adhesions.

It is too early to say whether the buried penis is a long term issue or something he will out grow. Many boy do outgrow this problem, so it is best to take a wait and see approach.

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#4 of 17 Old 05-21-2010, 01:45 AM - Thread Starter
 
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Hi Eepster and thanks for the response,
Yes, from my experience, once the pediatrician pulled the adhesion apart it only lasted that way for a bit and then it returned again. Since he still has quite a bit of skin left it just wanted to re-attach itself to the glans, all the better reason why I should have just left him intact. Well, I was naive and a first time mom.

I did hear that most adhesions to resolve themselves as the boy grows so I am hoping that will happen in his case. Since I now can see a bit of the "ridge" on the top portion of the penis I am hopeful that the rest will follow in sometime. The good news is that it doesn't seem to be re-attaching on the top anymore. He was 2 months old when the doctor manually pulled the skin back on him. The skin was nearly covering the urethra, it was so far up. Now it is just stuck around the ridge area but seems to be more stuck underneath where the frenulum is although I heard that that is actually a natural adhesion. I don't know I am confused about all of this.

As far as the buried penis goes, when I push alongside on the fat pad the shaft seems to push out more so I hope he will out grow this. I just want my son to look normal LOL!


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Though many pediatricians do pull adhesions apart, recent studies have shown that when left alone most adhesions resolve themselves around the start of puberty. You are going to have to be patient about the adhesions.

It is too early to say whether the buried penis is a long term issue or something he will out grow. Many boy do outgrow this problem, so it is best to take a wait and see approach.
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#5 of 17 Old 05-21-2010, 01:24 PM
 
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I would leave all of that alone. Your son is lucky that he still has some of his foreskin left. A normal intact boy would naturally have most of his skin adhered to the glans. Many boys are not retractable until puberty. By ripping it off constantly, you are possibly causing more damage and scar tissue and loss of sensation. IMO it's best not to make the damage done from the circumcision any worse by continuing to inflict more damage.

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#6 of 17 Old 05-21-2010, 07:49 PM - Thread Starter
 
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Balancedmama,

Thank you for your response and from what I am hearing here, it seems that I should just leave it alone and let nature eventually release the adhesions when it's ready. I just had no idea what to expect since I never had children before nor do I have brothers. The hospital never informed my husband or I about keeping the skin away from the glans so it would heal properly without adhering. Once his penis became an innie (he wasn't like that before the circumcision) thats when the skin stuck to the head. I didn't know what was going on. I thought everything was maintenance free after a circumcision. Oh well, now I know and I can't help but be frustrated and impatient.


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I would leave all of that alone. Your son is lucky that he still has some of his foreskin left. A normal intact boy would naturally have most of his skin adhered to the glans. Many boys are not retractable until puberty. By ripping it off constantly, you are possibly causing more damage and scar tissue and loss of sensation. IMO it's best not to make the damage done from the circumcision any worse by continuing to inflict more damage.
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#7 of 17 Old 05-22-2010, 03:43 PM
 
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Originally Posted by Velvet_Satin View Post
Balancedmama,

Thank you for your response and from what I am hearing here, it seems that I should just leave it alone and let nature eventually release the adhesions when it's ready. I just had no idea what to expect since I never had children before nor do I have brothers. The hospital never informed my husband or I about keeping the skin away from the glans so it would heal properly without adhering. Once his penis became an innie (he wasn't like that before the circumcision) thats when the skin stuck to the head. I didn't know what was going on. I thought everything was maintenance free after a circumcision. Oh well, now I know and I can't help but be frustrated and impatient.
If he had not been circumcised, the foreskin would be firmly attached to the head, so it is just trying to heal itself. It would naturally have separated between 3 yrs and puberty, so to prevent further scarring, you need to just leave it alone.

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#8 of 17 Old 05-23-2010, 12:59 PM - Thread Starter
 
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Galatea,
Thank you for your response. If the skin will seperate in time, why then do some doctors tell parents that you must get rid of the adhesions through manual ripping or worse yet surgery? I have read articles where the Urologist (who should know better but apparently doesn't) tells families that their son had an incomplete circumcision and surgery needs to take place to correct the adhesions? If it's natural for the skin to want to heal itself after the circumcision by adhering back to the head, wouldn't the Urologist just tell families to leave it alone?
Why do they have to confuse us?


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If he had not been circumcised, the foreskin would be firmly attached to the head, so it is just trying to heal itself. It would naturally have separated between 3 yrs and puberty, so to prevent further scarring, you need to just leave it alone.
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Quote:
Originally Posted by Velvet_Satin View Post
Galatea,
Thank you for your response. If the skin will seperate in time, why then do some doctors tell parents that you must get rid of the adhesions through manual ripping or worse yet surgery? I have read articles where the Urologist (who should know better but apparently doesn't) tells families that their son had an incomplete circumcision and surgery needs to take place to correct the adhesions? If it's natural for the skin to want to heal itself after the circumcision by adhering back to the head, wouldn't the Urologist just tell families to leave it alone?
Why do they have to confuse us?
Why did the Dr offer to circ your DS in the first place?

They already promote a drastic surgical intervention for a completely harmless/normal/natural state, so why not then also recommend interventions for the problems that are caused by the procedure even if there is a good chance those problems will resolve in time without issue. You will notice that that I say "good chance" and don't say always. There is also a small chance that they won't resolve or that they will become issues (painful erections or post-circumcision phimosis) but of course on the chance that there were issues arising or that they were still present after puberty the issues could be fix at that point. I think that the small chance of real issues with adhesions is a justification for many Drs to "fix" them. Another reason is that it makes the penis appear less like the image they have of a "perfect" circumcision.

My mom used to say "Drs like their treatments." My mom firmly believed that Drs would almost always recommend a treatment if it existed no matter how much worse it was than the problem it was a treatment for. Circumcision shows us Drs will even do painful risky surgical treatments when there are no problems at all.

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#10 of 17 Old 05-23-2010, 04:54 PM
 
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Quote:
Originally Posted by Velvet_Satin View Post
Galatea,
Thank you for your response. If the skin will seperate in time, why then do some doctors tell parents that you must get rid of the adhesions through manual ripping or worse yet surgery? I have read articles where the Urologist (who should know better but apparently doesn't) tells families that their son had an incomplete circumcision and surgery needs to take place to correct the adhesions? If it's natural for the skin to want to heal itself after the circumcision by adhering back to the head, wouldn't the Urologist just tell families to leave it alone?
Why do they have to confuse us?
Most of them are circumcised and don't know about how intact penises work. The only time adhesions are a problem is when they are on the scar line itself. Otherwise they should be left alone.

Other than that, I agree with eepster about doctors.

DS1 2004 ~ DS2 2005 ~ DD1 2008 ~ DS3 2010 ~ DD2 born at 31 weeks Oct. 2014
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#11 of 17 Old 05-23-2010, 05:48 PM
 
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Velvet Satin- There are several key differences between post-circumcision adhesions and the natural adhesions babies are born with. Perhaps if I can explain these differences, the seemingly conflicting advice about care and treatment between intact and circumcised children would not be quite so puzzling.

At birth, there is a membrane between the glans and the foreskin that holds the two surface together- yet apart.

If you'd like to google around with it- the "balanopreputial membrane" or "synechia" are key words- but the results you'll get are a bit of a muddle.

Imagine this: You use a slow drying industrial glue to sandwich a slice of bread between two plates. Everything is "stuck" together. Here are two scenarios- you put this stack in the sink and let it soak before the glue dries- the bread would dissolve and the two plates would not be stuck together anymore... but if you then left the two plates sitting on the counter the glue would dry- and now the plates really would be firmly attached to each other! In the other scenario- you allow the glue to dry and then you dissolve the bread... now you can stack the plates with no worry that the two surfaces will re-stick.

As an intact boy matures, his hormones and his age, allow the skin surfaces to become strong and independent, so that when this separating membrane finally dissolves- the touching surfaces are not predisposed to re-stick to each other. When a baby is circumcised- this membrane is destroyed, and two immature skin surfaces are allowed to touch, because of the boy's young age- they tend to stick to each other.

This is why parents of intact boys are instructed to never tear the foreskin away from the glans- but parents of circumcised children are instructed to be careful to push the skin back and apply a barrier ointment at every diaper change until the sticking situation is over. These parents are not dealing with identical situations.

The next factor to consider is that scar tissue can be wacky. (don't google wacky) Wiki has a good article on scars. Scar tissue is very different from normal skin and one thing about it is that it does not know its limits- it only knows to close gaps- so when scar tissue comes in contact with the delicate and raw glans- it does not know that is not a wound to heal- sometimes, rather than simply laying against the surface of the glans- the circumcision scar will grow into the glans- become one with it... this is not simply an adhesion- but is a true skin bridge. This bridge will never come apart with time- but will need to be surgically divided. Adhesions that involve the circumcision scar are an entirely different beast from adhesions only involving skin (which may be encouraged to release just using some ointment)

http://www.jurology.com/article/S002...410-1/abstract
"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."

So now you have two issues to consider, premature separation + the presence of scar tissue.

The last thing I'll mention, earlier someone said something about your son having some foreskin left... I don't know that we know that. The foreskin is just a segment of a continuous sleeve of skin which is not connected to the spongy tissue of the internal penis... it's not simply defined by it's position on the glans- with the shaft of his penis drawn into his fat pat- none of his shaft skin is being used to cover it- it has to go somewhere- the skin you see covering your son's glans- may very well be the exact length needed to cover the distance between his pubis and glans once he does grow up.
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#12 of 17 Old 05-24-2010, 09:31 PM - Thread Starter
 
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PlainandTall,

Thank you SO much for responding! You have been EXTREMELY helpful and VERY knowledgeable! Are you a Urologist by chance?

I have always been confused as to what the Circumcision scar line is. I did some looking into it and looked at my sons penis and can see where the skin is a slightly different color and from that point forward towards the glans thats where the extra skin seems to hang which made me and others think that perhaps some of the foreskin was left for him to grow into. I don't believe he has any skin bridges. The adhesions are around the glans. When he was really little the skin had stuck to almost the entire glans nearly covering the Urethra, and thats when the pediatrician ripped it back. Now it just seems to be stuck around the ridge, although underneath where the Frenulum is it seems to be stuck more-so, up higher on the glans but the pediatrician said that is a normal adhesion.

I really hope that there are no other adhesions or problems that I need to be aware of, I am just so confused and I should have done my homework about all of this before having my son circumcised. I should take some pictures of his penis to show you and get your opinion as to what you think would be going on but I don't know if that would be okay on here. I just want the adhesions to break apart for him and I definitely don't want skin bridges. I hope there aren't any now. I don't believe so but with all that extra skin I don't know whats stuck underneath it all. Plus I just want his penis to stick out like a normal boys would. It looks so abnormal when it retracts into the fat pad like that. By the way, he is a VERY thin boy too, he only has pudginess by the groin area. Another thing is that not only does his penis retract but so do the testicles. They have decended into the scrotum but at times especially when hes cold they will retract again.

Anyways, thank you for your long response and putting so much time into writing to me. It is much appreciated. If you have anymore input I would be more than happy to learn more.



15437376]Velvet Satin- There are several key differences between post-circumcision adhesions and the natural adhesions babies are born with. Perhaps if I can explain these differences, the seemingly conflicting advice about care and treatment between intact and circumcised children would not be quite so puzzling.

At birth, there is a membrane between the glans and the foreskin that holds the two surface together- yet apart.

If you'd like to google around with it- the "balanopreputial membrane" or "synechia" are key words- but the results you'll get are a bit of a muddle.

Imagine this: You use a slow drying industrial glue to sandwich a slice of bread between two plates. Everything is "stuck" together. Here are two scenarios- you put this stack in the sink and let it soak before the glue dries- the bread would dissolve and the two plates would not be stuck together anymore... but if you then left the two plates sitting on the counter the glue would dry- and now the plates really would be firmly attached to each other! In the other scenario- you allow the glue to dry and then you dissolve the bread... now you can stack the plates with no worry that the two surfaces will re-stick.

As an intact boy matures, his hormones and his age, allow the skin surfaces to become strong and independent, so that when this separating membrane finally dissolves- the touching surfaces are not predisposed to re-stick to each other. When a baby is circumcised- this membrane is destroyed, and two immature skin surfaces are allowed to touch, because of the boy's young age- they tend to stick to each other.

This is why parents of intact boys are instructed to never tear the foreskin away from the glans- but parents of circumcised children are instructed to be careful to push the skin back and apply a barrier ointment at every diaper change until the sticking situation is over. These parents are not dealing with identical situations.

The next factor to consider is that scar tissue can be wacky. (don't google wacky) Wiki has a good article on scars. Scar tissue is very different from normal skin and one thing about it is that it does not know its limits- it only knows to close gaps- so when scar tissue comes in contact with the delicate and raw glans- it does not know that is not a wound to heal- sometimes, rather than simply laying against the surface of the glans- the circumcision scar will grow into the glans- become one with it... this is not simply an adhesion- but is a true skin bridge. This bridge will never come apart with time- but will need to be surgically divided. Adhesions that involve the circumcision scar are an entirely different beast from adhesions only involving skin (which may be encouraged to release just using some ointment)

http://www.jurology.com/article/S002...410-1/abstract
"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."

So now you have two issues to consider, premature separation + the presence of scar tissue.

The last thing I'll mention, earlier someone said something about your son having some foreskin left... I don't know that we know that. The foreskin is just a segment of a continuous sleeve of skin which is not connected to the spongy tissue of the internal penis... it's not simply defined by it's position on the glans- with the shaft of his penis drawn into his fat pat- none of his shaft skin is being used to cover it- it has to go somewhere- the skin you see covering your son's glans- may very well be the exact length needed to cover the distance between his pubis and glans once he does grow up.[/QUOTE]
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#13 of 17 Old 05-25-2010, 03:32 AM
 
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My mom used to say "Drs like their treatments." My mom firmly believed that Drs would almost always recommend a treatment if it existed no matter how much worse it was than the problem it was a treatment for. Circumcision shows us Drs will even do painful risky surgical treatments when there are no problems at all.
I think your mother is right- I once had a doctor try to convince to use a treatment that had a potential side effect of DEATH for a problem that in almost all cases goes away on its own. Of course, they didn't mention their drug could kill me, and they certainly didn't mention my problem would likely resolve on its own without treatment. Thankfully I went home and did some research and found this out for myself. I decide against treatment (they sent me a letter "we are aware you have not received the recommended treatment blah blah blah") added some vitamins to help my immune system, and sure enough, a few months later, the problem was gone.
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#14 of 17 Old 05-26-2010, 11:06 PM
 
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P&T - Thank you for taking the time to write your post. I learned something more about the intact penis. I also work with a mother who circed her first and is dealing with adhesions (she left her second son intact). I'm going to recommend she read your post.

Janel ~ wife and mother of 4, L&D RN, midwifery student
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#15 of 17 Old 05-21-2011, 08:23 AM
 
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HI, I sort of have some of the same questions... except that I was told that my son's "innie penis" was normal, and that it would drop out by the time he was four!

Now he is six, and cant aim either sitting or standing! It is creating a lot of problems!  Is there any  way other than surgery that this can be fixed??

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#16 of 17 Old 05-21-2011, 02:12 PM
 
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You should consult a pediatritric urologist who is familiar with the intact penis mommypoppins he/she can better help you decide the best way to fix the problem. I am thinking a simple surgery where they release the tethered penis at the base is the usual way of fixing the problem.

 
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#17 of 17 Old 05-23-2011, 11:08 AM
 
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thanks for the input, are there any other ideas to try and keep him from surgery???

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