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

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#1 of 29 Old 01-20-2008, 04:19 PM - Thread Starter
 
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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.

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#2 of 29 Old 01-20-2008, 06:41 PM
 
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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.
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#3 of 29 Old 01-20-2008, 07:59 PM
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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 ...
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#4 of 29 Old 01-20-2008, 08:06 PM - Thread Starter
 
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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.

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#5 of 29 Old 01-20-2008, 09:10 PM
 
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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.
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#6 of 29 Old 01-20-2008, 09:13 PM
 
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This article might be helpful to her:
http://www.rogerknapp.com/medical/circ_incomplete.htm

Good luck!
Tara

Tara Momma to Callum and Gavin
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#7 of 29 Old 01-20-2008, 10:43 PM
 
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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.

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#8 of 29 Old 01-20-2008, 11:28 PM
 
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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.
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#9 of 29 Old 01-21-2008, 09:47 AM - Thread Starter
 
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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.

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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!

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#10 of 29 Old 03-12-2008, 10:09 PM
 
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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...
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#11 of 29 Old 03-12-2008, 10:46 PM
 
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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.
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#12 of 29 Old 03-13-2008, 09:01 AM
 
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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.
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#13 of 29 Old 03-13-2008, 09:09 AM
 
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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.
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#14 of 29 Old 03-13-2008, 09:32 AM
 
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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.
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#15 of 29 Old 03-13-2008, 10:50 AM
 
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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.
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#16 of 29 Old 03-13-2008, 11:34 AM
 
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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.

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#17 of 29 Old 03-13-2008, 09:05 PM
 
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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.

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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.

~*Kristi*~
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#18 of 29 Old 03-14-2008, 10:22 AM
 
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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.


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#19 of 29 Old 03-14-2008, 10:46 AM
 
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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.


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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.


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#20 of 29 Old 03-14-2008, 09:06 PM
 
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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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#21 of 29 Old 03-15-2008, 12:18 PM
 
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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.




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
Frank,
Thanks for the explanation. That was probably the most complete explanation I have found on the web thus far. Our son definatley still has the fat pad right now. If we push on the sides of it his penis pops out without a problem. So I know it is not trapped penis. Is there anyway to tell the difference between concealed penis and buried penis just by looking at it? My son actually looks very similar to the boy on the left in the pictures on this website:

http://www.rogerknapp.com/medical/circ_incomplete.htm

Also I was not planning on any surgery for my son. I was going to see the pediatric urologist when he turns 2 just to get a second opinion. Just to see if he/she believes it will pop out as he thins out.

Thanks for your help.
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#22 of 29 Old 03-16-2008, 09:42 AM
 
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Is there anyway to tell the difference between concealed penis and buried penis just by looking at it?
Not likely. If you saw his penis before the circumcision and can remember what it looked like you can determine if it is concealed or buried. If his penis and glans hung outside the pubic mound, it would be buried penis. If the glans was pulled back into the pubic mound with only the foreskin sticking out, it would be concealed penis. If it was pulled into the pubic mound, it could also be a combination of concealed penis and buried penis. Until he loses the fat at the pubic mound, it can't be determined what the final result will be. That usually starts happening around 3 years old.


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#23 of 29 Old 03-16-2008, 09:56 AM
 
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my son has a buried penis. he also has adhesions now because of it. i should never have had him circ'ed! but the ped told me to keep pulling on it and it'll dettach easily. then the next time i asked, he said to leave it and it'll dettach on its own. he has severe adhesions. it's attached all along the ridge of the head of his penis. i'm not quite sure what to do...other than NOT circing my next son!
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#24 of 29 Old 03-16-2008, 11:16 AM
 
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You really don't need to do anything. These adhesions are similar to labial adhesions girls get. In both cases, the adhesions will disolve on their own with time.

I find it often helps for mothers to understand why this happens. When boys are born, the foreskin is bonded to the glans by normal epithelial adhesions. Those adhesions will disolve with time. Now, when a circumcision is done, those adhesions are torn apart long before the time they would naturally disolve. The child's body views this as an injury and tries to heal the injury by "growing" the adhesions back to put his body back as closely as possible to it's normal state. These adhesions are normal epithelial adhesions, not adhesions of scar tissue and they will disolve when the proper time comes. The exception to this is when the circumcision scar adheres to the glans. This is scar tissue and is very unlikely to release on it's own. This type of adhesion almost always has to be surgically released.


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#25 of 29 Old 03-16-2008, 01:40 PM
 
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Not likely. If you saw his penis before the circumcision and can remember what it looked like you can determine if it is concealed or buried. If his penis and glans hung outside the pubic mound, it would be buried penis. If the glans was pulled back into the pubic mound with only the foreskin sticking out, it would be concealed penis. If it was pulled into the pubic mound, it could also be a combination of concealed penis and buried penis. Until he loses the fat at the pubic mound, it can't be determined what the final result will be. That usually starts happening around 3 years old.


Frank
Thanks again Frank,
I guess I will just have to wait and see what happens. Would a pediatric urologist be able to tell? What concerns me is how am I supposed to potty train my son when his penis is buried/concealed?
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#26 of 29 Old 03-16-2008, 06:28 PM
 
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Thanks again Frank,
I guess I will just have to wait and see what happens. Would a pediatric urologist be able to tell? What concerns me is how am I supposed to potty train my son when his penis is buried/concealed?
I don't understand what this has to do with potty training? He can pee, right?
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#27 of 29 Old 03-16-2008, 07:27 PM
 
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Check into it carefully. I've read hidden penis almost always causes adhesions (something we're going thru now I think w/ one of my older kids)

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#28 of 29 Old 03-17-2008, 09:09 AM
 
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Thanks again Frank,
I guess I will just have to wait and see what happens. Would a pediatric urologist be able to tell? What concerns me is how am I supposed to potty train my son when his penis is buried/concealed?

There is a great chance that a urologist is going to tell you that your son needs to be circumcised a second time.

There shouldn't be much difficulty in potty training. His penis will be in a position that the urine stream may go straight out or even arch upward missing the shield on the training seat but eventually, he will learn to press on the pubic mound with his forefinger and thumb to pop his penis out and grasp it to point it downward.

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Check into it carefully. I've read hidden penis almost always causes adhesions (something we're going thru now I think w/ one of my older kids)
I've seen no research showing this to be the case but logic and reason would suggest a relationship between buried penis and post surgical adhesions.


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#29 of 29 Old 03-17-2008, 09:38 AM
 
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I don't understand what this has to do with potty training? He can pee, right?
Yes he can pee. But it is more of an issue with aiming, if you know what I mean.
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